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Should Public Health Insurance Cover General Checkups?
A proposal that suggest general health checkups be covered by public health insurance has stirred up debates
 NO. 2 January 12, 2016


At a recent forum in Beijing, Zhan Qimin, President of the Peking University Health Science Center, proposed that the nation's public health insurance programs should cover the costs of general health checkups. This proposal has sparked a heated debate.

Currently, China's public health insurance system, which consists of the urban medical insurance and the new rural cooperative medical scheme, covers both outpatient and inpatient treatments. Under these programs, a proportion of the associated medical expenses can be reimbursed. However, general health checkups are excluded from the schemes. As the combined cost of checkups for an extended family can add up to a large sum, many choose not to undergo such examinations.

Against this backdrop, a large number of people have welcomed Zhan's proposal. They argue that many malignant diseases are preventable and curable at an early stage, and patients can at least live longer if treatment begins early. Besides, compared with the huge medical expenses incurred when treating serious illnesses at an intermediate or late stage, the costs of health checkups are relatively low. Instead of draining the insurance fund pool, medical screening can actually help save resources.

Others, however, have expressed opposition, arguing that funding annual physical checkups will draw a lot of money from the limited health insurance fund pool, which is reserved for seriously ill patients.

Helping build a healthy nation

Hu Jianbing ( In recent years, environmental pollution, food additives and many other factors have led to a rising number of patients with malignant diseases. As the current health insurance fund does not cover health checkups, few people take regular physical examinations. Some companies pay for such procedures for their employees, but the content is usually limited to blood tests, a cardiogram, a chest X-ray and other simple tests which cannot detect the most serious diseases. Consequently, in most cases when a disease is eventually diagnosed, it's already too late.

Ostensibly, if the health insurance fund covers general checkups, it will come under pressure. But with medical screening, many diseases can be diagnosed and cured with comparatively little financial input. For example, according to health authority statistics, diagnosis and treatment of malignant tumors at an early stage extends the life expectancy of 80-90 percent of patients by five years. Under China's current health insurance system, 90 percent of funding is spent on intermediate and late-stage treatment. The high proportion of patients suffering from intermediate and late-stage diseases is pushing up overall medical spending, yet early-stage treatment costs are very low.

Regular and comprehensive physical examinations can help detect diseases early, and this is the fundamental route to cut medical costs. A sharply declining number of people with chronic and malignant diseases will greatly relieve the insurance health fund and also the economic pressure on patients' families.

The health insurance system is expected to ensure the public's health at various stages, instead of only offering financial support when patients are terminally ill. It's urgent to change the current system, which only covers medical treatments, and to incorporate general health checks.

Dai Xianren (Shandong Business Daily): If discovered at an early stage, many malignant diseases can be cured and prevented. This is what general checkups are designed to do. If they are covered by the health insurance fund, we can expect to see a big drop in the number of people suffering from malignant diseases.

To catch diseases in time, people have to take regular physical examinations. If the test fees are borne solely by individuals, these amount to a large sum for each family annually. As a result, most people choose not to have medical checkups, and they therefore miss opportunities to treat and cure diseases at an early stage.

Compared with the huge treatment expenses when patients are seriously ill, physical examination fees are miniscule. Therefore, if the insurance fund covers these fees, this will help reduce much greater medical expenses when diseases have already become too serious to control. When health checkups are available free of charge, people will take regular examinations, which can extend life expectancy by curing diseases at an early stage and thereby benefit both families and society.

Si Hanhan (Xinjiang Daily): Incorporating health checkup fees into the coverage of the health insurance fund will bring several benefits. Traditionally, people in China pay more attention to curing diseases than to their prevention. If medical screening is promoted, many diseases can actually be stopped in their initial stages, when the cost of curbing their development is relatively low. This way, a huge amount of money can be saved, which otherwise would have been spent trying to cure serious diseases that have managed to evade attention due to a lack of medical checkups. The benefit of preventing diseases is obvious, so when the health insurance fund begins to cover health check costs, more people and companies will feel like joining insurance schemes, which will help expand their funding.

As a Chinese proverb says, it's better to prepare for rainy days when it's sunny. People's health is crucial to the nation's sustainable economic and social development. Covering general checkup costs with the health insurance fund will greatly help improve the whole country's health by emphasizing the importance of disease prevention.

Straining health insurance funds

Luo Zhihua (Qingdao Daily): The responsibility of hospitals is to cure diseases, while disease prevention is the work of disease control and public health agencies. The health insurance fund is set up to help patients meet the costs of curing diseases, and special funds are reserved for disease prevention and control and public health causes.

Besides, the health insurance fund can hardly meet patients' needs, a condition that cannot be reversed in the short term. If health checkups are to be covered by the fund, it will be subject to more pressure. Specifically, making health checkups accessible to everyone, whether sick or healthy, at a low price or free of charge will further strain the health insurance fund while expanding public welfare. Worse still, since the physical checkup sector is in something of a mess, the authenticity of checkup results is questionable.

If it's really necessary or desirable for public health insurance to cover routine medical screening fees, then it would be better to provide such financial support to people who would most benefit from medical screening before the program is introduced to everyone.

Li Hongmei (People's Daily): The health insurance fund is set up to ensure every citizen has access to basic medication and to cover their basic drug expenses. General checkups, by contrast, target healthy people, who do not yet fall within the area covered by the fund. China's public health insurance system has extensive coverage. Currently, the medical benefits fund operates under heavy financial pressure, as it has to deal with more and more health insurance items. Take, for example, the new rural cooperative medical scheme, one of the health insurance programs. In most places, the fund has only a little surplus at the end of every year, while in some locations, the fund has almost run out.

Moreover, China is still short of standards to regulate the health screening sector, and some commercial clinics tend to trick clients into taking more tests than they really need to. If the health insurance system is used to pay for such checkups, it will be a huge waste of resources.

Copyedited by Chris Surtees

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