Vol.4 No.1 Serial No.12 January 25th 2004¡¡

¡¾CLC number¡¿ R4;R197.323  ¡¾Documnet code¡¿ A  ¡¾Article ID¡¿1672£­2531(2004)04-0001£­02

¡¡Health Care System Reform in China after SARS:
A View of Evidence-Based Medicine


The crisis of SARS was a smokeless war of human race at the beginning of the new century. According to a sketchy estimate, more than 30 countries or areas have been involved in this disaster which should be held responsible for the world¡¯s economic loss of up to 30 billion US dollars.
   As a result of the sudden outbreak of SARS, 8 439 people have been infected, among whom 812 died. The outbreak put forward a rigid inspection on many countries¡¯public health system, mechanism and emergency response capacity and challenged China¡¯s achievements in health care system in particular, because 90% of SARS cases were found in China.
   When we reflect after the crisis, we find it urgent for us to relocate China¡¯s health care system, in accordance with international regulations, so as to enhance its quality and safety, fairness and costª²effectiveness and to make an evidenceª²based decision.

1 Public system, public service and public product

The ultimate goal of establishing China¡¯s health care system is to ensure and improve the health of the people. More attention, therefore, should be paid and more investment made in establishing the public system, improving public service and developing public products of health service. This goal should be different from that of the regions and hospitals and should be given the highest priority, for it is one of the most important and fundamental projects in China¡¯s social constructions for a wellª²off society.

2 Response mechanism, financial support and structural establishment

The mission of National Health System is to protect people from any emerging or new health hazard, such as diseases, natural disasters, and manª²made calamites. We shall always attach great importance, therefore, to establishing emergency response mechanism and special organizations. While the former is responsible for emergency management with whatever human or material resources available in the absence of the latter, the latter requires an overall and longª²term planning and a mass of human, material and financial resources for making preparations for future problems. A fixed budget for emergency management should be put away annually to guarantee the healthy growth of a notª²strongª²enough emergency response system, which is expected to be capable of managing possible public health affairs and disasters in the future.

3 Information resource, information technology, and information industry

In the 21st century, life science is one of the three mainstream disciplines and health information is one of the biggest and hottest demands. The unreal information about SARS, however, spread faster and wider than SARS and caused unnecessary mental pressure and panic, which was more harmful than the disease itself. This phenomenon alerts us to the fact that ¡°While information could be a virus, knowledge is the best remedy.¡± SARS makes us realize that our health information system and data collection, screening, analysis, integration, storing and releasing system was too weak for government to direct the mass media at the early stage of the SARS epidemic. On the other hand, due to the lack of a communicating system, the mass media failed to conduct adequate communication with the public. As a result, we lost many opportunities in health research and thus lagged behind the advanced countries. We now realize that by continuing to explore the health information resource, information, and technology markets, we can start a promising new industryª²the health information industry.

4 Idea innovation, mechanism innovation, and standard innovation

With the help of our current health management model, which we use to be proud of, the stateª²owned mechanism, and marketing mechanism that are still in exploration, we succeeded in providing the largest health service in the world with relatively few health resources. After the transformation of China¡¯s social economy, however, the weakness of this model in quickly responding to medical emergencies was fully revealed in the SARS crisis. We must update our minds, learn to put China¡¯s problem in the context of the whole world, and to follow internationally acknowledged practice, so as to set up an optimal system that best suits this model.

5 Education, research and practice

SARS helps us realize that the development of China¡¯s medical education must base on the situation of China. This means that we cannot neglect the needs of 800 million farmers in China and that we should shift our focus gradually to the rural areas and communities as a result. To achieve this goal, we should offer medical students and doctors commonª²sense courses on new communicable diseases and related courses on techniques and practical experience as well. We should always keep an eye on the severe communicable diseases, establish the prevention system, and improve the health research system, so as to ensure people¡¯s health and China¡¯s social development. We should also continue educating the public on personal hygiene, public sanitation and environment protection. In short, the objective of China¡¯s health service system in the 21st century is to ensure the people to be physically, mentally and behaviorally healthy to meet any challenge.
   SARS has already passed, but AIDS, hepatitis B, tuberculosis, dysentery and some other old or new diseases are still threatening human¡¯s lives. Thus, we must best utilize the achievements by health researchers of the past to obtain evidence for the benefit of the present. We should learn and make good use of clinical epidemiology and evidenceª²based medicine (EBM) and their methodologies and theories. The best evidences are from Cochrane systematic review (CSR), health technology assessment (HTA), and large sample multiª²centered perspective clinical trials, which enable us to be predictive and exploring as well as reflective. Only if we have been well prepared, can we have confidence to meet emergencies. Thus, we need a group of medical professionals who are well informed of both clinic medicine and evidenceª²based medicine. In 1997, under the direct lead of the steering group of MOH, Chinese Center of Evidenceª²based Medicine (CCEBM) was established, international connections and clinical research database built, Chinese Journal of Evidenceª²based Medicine published, teaching materials compiled, and training courses and evidenceª²based research conducted. All these laid a solid foundation for our health care system and health practitioner training. What is more, this year, the Ministry of Education has approved EBM to be a new discipline and funded the establishment of EBM Virtual Cooperate and Research Center of Evidence Based Medicine; the Chinese Medical Doctor Association was authorized to establish the EBM subª²committee; and EBM is to be the essential course for fiveª²year medical students¡­. All work is going on well as needed and will be tested and developed continually through various practices.
   As early as in 1986, China made its commitment to WHO that it would implement the latter¡¯s global health strategy of ¡°Health service for everyone by 2000¡±, and in the past decades, China¡¯s national leadership has endeavored to establish and develop the health care system and their efforts proved fruitful. Inasmuch as we made resplendent achievements many years from now when China¡¯s economy was much weaker, we are confident that we can make even great achievements in health care system reforms so long as we stick to and act in the spirit of ¡°the three represents¡±.

(Received date£º2003-08-20  Revised date£º2003-12-20)
¡¾Key word¡¿


HUANG Jie-fu

Ministry of Health Beijing 100044

Biography: HUANG Jieª²fu, Prof. of Surgery in hepatology, tutor of Ph.D. Vice Minister of Ministry of Health responsible for medical education and research, and international cooperation, also formerly, president of Sun Yat-Sen University.

ISSN 1672-2531
CN 51-1656/R
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