China needs urgently to implement -- and is capable of implementing -- a system of free basic healthcare that would apply to all citizens. This is one of three basic systems that the government needs to provide for its citizens, the others being free basic care for elderly people and free compulsory education.

     India's per capita income is much lower than China's, yet it provides its people with free medical care and education. In India elderly people, including those in the countryside, enjoy government subsidies. Since India can make this happen, China with its socialist system certainly can do this as well.

     Based on expert estimates, the annual cost of providing nationwide free healthcare would be 150 billion yuan (around US$20 billion). At present, China's annual revenue has reached nearly 4 trillion yuan (US$518 billion). In 2006, revenues were 700 billion yuan higher than the previous year. Yet each year China spends nearly 1 trillion yuan (nearly US$130 billion) on the "three public expenditures" -- which cover officials' dining out, public vehicles and overseas tours. If the government cuts some of these costs, there would surely be enough funds to cover all citizens' basic medical care.

     In October 2006, at a Politburo meeting in Beijing, President Hu Jintao stressed three points concerning healthcare reform: to pursue the public welfare, to strengthen the government's responsibility, and to establish a basic healthcare system for both urban and rural residents. These three points were right on target. They provide essential guidelines for the healthcare reforms set to come out this year, and are key to resolving difficulties and cutting costs for China's 1.3 billion citizens in pursuing medical treatment.

     Pursuing the public welfare and strengthening the government's responsibility mean that public hospitals should provide free or inexpensive high-quality medical services to everyone. They should not put profits first, and leave patients untended if they cannot pay. The government needs to supervise the hospitals and ensure that they are fully funded. Payments for medical care and for medicines should be separated; public hospitals should not depend on drug sales for their survival, which has led to the over-prescription of medicines and the selection of high-priced medicines. Also, repetitive medical checks and medical privileges for the elite should be eliminated.

     Establishing a basic healthcare system for both urban and rural residents means breaking down the boundaries between cities, countryside, and other areas and setting up community hospitals and county clinics, to provide an integrated health care system.

    The following are some specific suggestions of my own:

     First, investment in public hospitals should be increased. Cities need to improve public clinics and outpatient services so patients can visit doctors in their own neighborhood for simple medical complaints. Each county should have at least two public hospitals, and each village or town should have at least one public clinic. The hospitals should be fully funded and their services should include preventive healthcare, especially in rural areas.

     Second, private hospitals should be encouraged, and all hospitals treated equally. Earlier medical reforms failed because the government did not support the development of private hospitals. On one hand, the government wants to throw off the heavy financial burden of medical care, but on the other, it doesn't provide equal opportunities to private hospitals. Hence, it allows public hospitals to earn income through expensive medicines and excessive medical checks. In the future, public hospitals should only offer basic healthcare services and affordable doctor visits for average people. If wealthier people want better services they can pay higher rates for doctors at private hospitals. Even in private hospitals, prices should be affordable for average people, as their prices will come down due to severe competition from an improved public health sector.

     Third, medical professionals should receive reasonable compensation, doctors' salaries should be increased and the practice of receiving commissions, kickbacks and bribes should be severely punished. According to Forbes magazine, among the 25 top high-income occupations in the United States, various types of doctors hold the first eight, and surgeons rank first. There is no such thing as receiving commissions or kickbacks there.

     Fourth, the sale of medicines should be separate from medical care, and pharmacies should be set up near hospitals so that patients can choose whether to obtain drugs from hospitals or buy them from nearby pharmacies. Meanwhile, the multi-level purchasing commission system of medical facilities should be banned. Instead, direct sales between drug companies and hospitals should be established.

     Fifth, government investment should be increased in rural medical clinics, the proportion of fees reimbursed to rural patients for medical services should be increased, and cooperation between rural clinics and public hospitals should be improved to ensure proper care for rural workers and residents suffering from serious diseases.

     Sixth, public expenditure on special wards and sanatoriums for senior officials, their medicines and operations should be cut. People of different locations and backgrounds should have equal access to healthcare resources.

     Seventh, charitable activities should be encouraged and citizens should be allowed to establish charitable foundations and hospitals. Until recently, China has had very few charities. In 2005 the country's first private charity foundation and hospital were established. In the future, there should be hundreds of thousands more, to meet the practical needs of China's large disadvantaged communities.

     Eighth, independent channels should be set up to investigate medical accidents and arbitrate disputes. The media should play a stronger role in reporting on health-related incidents. If government officials fail to respond responsibly to public health emergencies, they must resign their positions.

    Following these guidelines, China can greatly improve its healthcare system, and move on to provide the other aspects of the "three free systems" as well.