Dr. Yuanli Liu, serving on the faculty of the Department of Global Health and Population at Harvard School of Public Health, is founding director of the Harvard School of Public Health China Initiative since 2005. The China Initiative aims at helping advance health and social development in China by carrying out series of applied research studies targeting China’s major unresolved public health and health system issues, regular policy dialogues to help drawing road maps for China’s social sector reforms and development, and senior health executive education programs to help produce a critical mass of open-minded and well informed health sector leaders. He is also Adjunct Professor of Health Policy and Management at Tsinghua University and director of the Health and Development Institute at Tsinghua School of Public Policy and Management in Beijing. Professor Liu has been teaching and conducting research in the areas of health policy and health system analysis since 1994 at Harvard, and has carried out extensive research and policy consultation work in many African and Asian countries. In particular, he has been closely involved in helping inform China’s policy making process for series of reforms and strategic developments in its health sector since 1993, including a 8-year survey and intervention study (1993-2001) on improving access to healthcare in China’s poor rural areas and the most recent work on Healthy Beijing 2020 – developing China’s first 10-year strategic plan for effectively combating diseases and improving population health. He serves on the Expert Committee of Health Policy and Management and the Expert Committee on Healthy China 2020, both of which are established by the Chinese Ministry of Health to help develop strategies for China to deal with major infectious as well as non-communicable diseases. Dr. Liu also served on the United Nations Millennium Development Taskforce on HIV/AIDS, Malaria, TB, and Access to Basic Medicines. He consulted for many international agencies including the World Bank, Asian Development Bank, UNDP, UNICEF, WHO as well as global corporations.
Dr. Liu received his MD and MPH from Tongji Medical University in 1987, MS in health policy and management from Harvard University in 1988, and PhD in health services research, policy and administration from University of Minnesota in 1995.
刘远立教授简介： 哈佛大学公共卫生学院中国项目部主任，博士生导师，清华大学公共管理学院卫生与发展研究中心主任。刘远立于1987年获得同济医科大学医学硕士学位，1988年获得哈佛大学科学硕士学位，1995年获得明尼苏达大学哲学博士学位。1994年起任职于美国哈佛大学公共卫生学院，从事国际卫生政策与管理的科研和教学工作长达16年，是“卫生体系学”创始人之一，并从2000年至今在哈佛大学担任该学科的博士生导师。2005年被任命为哈佛大学公共卫生学院中国项目部主任，负责领导哈佛大学与中国在医疗卫生领域的学术交流与合作，其中包括：1.与中国卫生部合作举办“中国卫生发展与改革高级国际研修班”（300多名毕业生分别来自中央和各省、市负责卫生与社会发展的厅局长和大型医院院长）， 2. 开展重大卫生政策与管理问题的应用性研究，3.与中央党校合作举办“中国社会发展论坛”。2006年又被清华大学公共管理学院聘为卫生与发展研究中心主任，负责领导中心围绕健康发展和卫生政策领域开展学术研究、政策咨询和教育培训等活动。
刘远立教授的专业研究领域主要着眼于运用经济学等工具探寻发展中国家卫生体系的效率和公平问题之解决办法，在非洲和亚洲10多个国家开展过有关公共卫生（如：艾滋病防治）与卫生体系改革的学术研究。 他参与了中国卫生改革与发展的一系列重大问题的研究和政策咨询，通过多年开展干预性研究、组织干部培训、举办或参与各种高层次论坛等活动，在建立中国农村新型合作医疗制度、城市医疗救助制度，医药价格体系改革、医疗服务领域政府与市场相对作用的界定、医药卫生体系的绩效评价、医疗服务集团化建设、农村卫生服务体系县乡村一体化管理、跨区域的协同医疗服务体系建设、移动医疗与数字医疗体系建设等方面开展了一系列研究和咨询工作，产生了重要影响。作为世界银行的顾问，刘远立教授帮助建立和加强了“中国卫生经济培训与研究网络”。他出版过6本中英文学术专著，在国际和国内学术期刊上发表过100多篇论文。 刘远立教授曾经并继续担任联合国“千年发展目标”顾问委员会委员，世界银行、亚洲开发银行、世界卫生组织、联合国儿童基金会、联合国计划开发署、美国中华医学基金会等国际组织以及世界500强企业的战略顾问。 此外，刘远立教授还是中华人民共和国卫生部卫生政策与管理专家委员会委员、“健康中国2020”战略规划专家组成员、中国医药卫生体制改革研究（“清华方案“）课题组组长、“健康北京2020” 战略规划课题组组长。
Lingling：The Inaugural Harvard America-China Health Summit organized by China Initiative in September 2011 was a great success. As the leader of this historical event, what is your vision on the dialogue between China and the United States?
Professor Liu: Both China and the United States, despite cultural and socioeconomic differences, share a common goal – to create effective, equitable and efficient health systems that increase access, combat disease, and improve people’s health. Recent initiatives in both countries demonstrate these parallel goals: between 2009 and 2010 we saw China announcing its ambitious Health Reform Plan and the United States passing the Patient Protection and Affordable Care Act (PPACA). In the years since implementation of these policies, many questions, challenges and ideas have arisen; we aim to explore these in depth by organizing regular dialogues between health policymakers, experts and healthcare frontline leaders. I believe bringing together health sector leaders from our two great countries and beyond to share experiences and perspectives would help inform future evidence-based policy making. That’s why we are organizing the second Summit, which will be held in Beijing on October 31, 2012.
Lingling：In your report, you highlighted the common features and different characteristics of healthcare reforms in both countries, if each reform can only achieve one greatest accomplishment, what would you expect most?
Professor Liu: While improving health should be the ultimate goal of any health system and thus health system reform efforts, more immediate goals of healthcare reforms around the world can be summarized in three ‘A’s: Availability, Affordability and Appropriateness of healthcare services. Affordability is the key, not only because without it people would suffer impoverishing effects of out-of-pocket medical expenditures, but also because making healthcare more affordable would help increase people’s utilization of the healthcare services they need.
It is worth noting that both U.S. and China included in their reform packages following common measures: strengthening primary care and prevention services, adoption of electronic health records, and provider payment reforms.
—Prof. Yuanli Liu， Harvard
刘教授：提高人民健康水平是任何医疗卫生系统的终极目标和卫生改革努力的方向，全球医疗卫生改革的近期目标可以概括为三个A：医疗保健服务的可用性，可负担性和适当性（Availability, Affordability, Appropriateness）。其中可负担性是重中之重，不仅仅因为穷人会因为自付医疗费用而愈发贫穷，还因为将医疗保健平价化有助于人们更充分利用他们所需要的医疗服务
Lingling：What is the biggest obstacle in each country's health sector reform? What experience or lessons they can share with each other?
Professor Liu: I would say the biggest obstacle is resistance from the powerful interest groups. Any reform is about changing the status quo. Those economic and political groups, whose interests would be adversely affected by the reforms, cannot be expected to stay idle. For example, China’s “public hospital reforms” have not yet made any significant progress because public hospitals are not enthusiastic participants. The reform implementation process in the U.S. has been resisted by at least a third of the states, because the governors of those states are Republican, which is the opposition party running against President Obama. It is worth noting that both U.S. and China included in their reform packages following common measures: strengthening primary care and prevention services, adoption of electronic health records, and provider payment reforms. The U.S. has had rich experiences in the areas of provider payment reforms such as DRGs and bundled payment in the context of developing “Accountable Care Organizations”. China’s unique heritage of traditional Chinese medicine offers alternative ways of helping manage chronic diseases that are confronting both countries.
Lingling：We know that you have had contacts with high-level health officials in both countries. So could you say something about the role of government playing in each country's health reform?
Professor Liu: As the public policy maker and major implementer, government’s role in any health reform is of course essential. But due to different political systems of the two countries, the ways in which the government plays its role are different in China vs U.S. In the United States, a new legislation needs to be passed by the Congress in order for the reform process to be started. China does not need a new law, and the reforms were announced as the State Council “Decisions”. It is also interesting to compare different roles of the central vs local governments. For example, while health insurance for the poor is financed by the Federal and state governments in the United States, Chinese central government plays almost no role in financing healthcare for the poor, which is the local government’s responsibility. I like to point out that despite of the government’s vital role in healthcare reforms, participation of many other stake-holders, especially healthcare providers, are necessary for the reforms to be successful.
Lingling：No health system is perfect. In which aspects you think China surpasses the United States, and vice versa?
Professor Liu: China already managed to provide basic insurance coverage to over 95% of its population, while U.S. still has 15% of the population uninsured. This “nominal coverage” aside, China’s incidence rate of catastrophic medical spending (a measure of individual affordability) is much higher than that of the U.S. Arguably, the U.S. health system is the world’s least efficient system, with 18% of the GDP spent on health and medical waste being estimated to be as high as $750 billion in 2009. In terms of social affordability, China, with its total health spending only taking up 5.1% of its GDP, is in a much better situation than the U.S.
Lingling：Serving as the Director of China Initiative, what was your motivation to initiate this work? What are the major achievements you are mostly proud of?
Professor Liu: I felt fortunate to be the “right person at the right time”. China Initiative at Harvard School of Public Health was established in the aftermath of SARS in 2005, and I have been serving as the founding director ever since. The mission of this initiative is to advance China’s health and social development by carrying out high-impact programs in education, research, and policy. With this multifaceted and integrated approach we aim to create sustainable and cost-effective changes within China’s healthcare system as well as creating lasting relationships between Chinese and international healthcare leaders. I am most proud of our educational programs, mainly because we have trained more than 400 policymakers and senior health executives who are now playing important roles at the national and regional levels to improve health of the 1.3 billion Chinese people. Furthermore, every year during winter break since 2006 I had been conducting a field study course on China’s health system reforms for Harvard students and fellows, whose experiences in China help them play a more effective role in global health.
Lingling： I learned that the Second China-U.S. Health Summit will be held in Beijing at the end of October this year. Would you like to share some information regarding this summit with us?
Professor Liu: Minister CHEN Zhu and Assistant Secretary Sherry Glied, along with more than 700 Policy makers, academic experts, and business leaders from China and elsewhere attended the inaugural Harvard America-China Health Summit in September, 2011 in Boston. After the first Summit, Minister CHEN Zhu suggested that the second Summit be held in China.
The second Summit will take place on October 31, 2012 at the National Convention Center in Beijing (www.hci-bj.org). This summit will be held at a critical juncture of development for both U.S. and China. While the U.S. presidential election is under way and healthcare reforms are again debated and even legally challenged and upheld, China, also with leadership change in the fall, has just begun implementing the 12th 5-Year plan after 3 years of experiences with its Healthcare Reform Plan.
Based on the need assessment, the 2012 Beijing Summit is themed: “Healthcare Reforms: The Roles of Government, Market, and Professionalism”. In addition to senior policy makers from China, such as Minister Chen Zhu and Dr. Sun Zhigang, China’s national coordinator of healthcare reform, and from other countries, this Summit is expected to have about 800 registered participants, including healthcare experts, senior health executives, NGO and health industry leaders. The Beijing Summit is co-hosted by Harvard School of Public Health, Peking Union Medical College, and Tsinghua School of Public Policy and Management. We are grateful for the enthusiastic support of the Chinese Ministry of Health and the U.S. Department of Health and Human Services. We are excited by the impressive set of confirmed speakers and are confident that you will find the presentations and discussions informative and engaging. We sincerely welcome your participation in this Summit to create the most memorable event possible with a long-lasting impact.
Lingling：Do you have any words for CHPAMS (China Health Policy and Management Society)?
Professor Liu: I am a big fan of CHPAMS. I hope you guys can keep up the good work by serving as a bridge and network for sharing relevant and important information and ideas, and for fostering productive relationships among current and future generations of leaders in health policy and management research and practice.
By Lingling Zhang, ScD, Harvard School of Public Health
张玲玲, 博士, 哈佛公共卫生学院