Mechanisms of Accountability for the Realization of the Right to Health in China

Qiu, Shengnan; Macnaughton, Gillian

Supervision: In China, each level of the government is apportioned power and authority over policymaking decisions within its area of dominion. Each health authority is accountable to its corresponding government at the same level; and hospitals are accountable to the corresponding health department at that level. In this way, the government control system aims to ensure that health policies and plans are effectively enforced, especially in times of public health emergencies. Yet, the complex multilevel system often results in several governmental entities with overlapping responsibilities and functions for the same health issues. Beyond the health care authorities, the Ministry of Health also plays a role in monitoring and supervising a number of other actors through regulatory monitoring and enforcement. These actors include public health care providers at the central, regional, and local levels, as well as private health care providers. As an executive body, the Ministry of Health is not simply called on in its own right to meet accountability requirements but also demands accountability from other organs. Policy making and monitoring: For the purpose of policymaking and monitoring, transparency regarding information on budgets, regulations, quality of performance, achievement of targets, and so on is crucial. Paul Hunt, former UN Special Rapporteur on the right to health, recommended that states use a human rights-based approach to health indicators to assess the progressive realization of the right to health, the effectiveness of health policy, and the participation of individuals and groups in the development, implementation, and review of health policy. 64 This approach, however, has generally not been reflected in China's policymaking, implementation, and review process until recently. It is only in the past 10 years that the government has moved toward increasing transparency and public participation in health policymaking. 65 Government agencies at the national and local levels have published draft laws and regulations for public comment, and in some cases have considered the comments. 66 Nonetheless, China's move toward transparency and participation is not yet reflected in its monitoring of implementation of health policy. Notably, in 2014, the UN Committee on Economic, Social and Cultural Rights recognized the absence of reliable statistics in China that would allow an accurate assessment of China's fulfillment of these rights. 67 In his 2016 report, Alston also expressed concern about the lack of transparency in the data collection process, allegations that unfavorable data were not published, and the lack of disaggregated statistics, which are necessary to determine who is being left behind. 68 Complaints mechanisms: In clinical practice, when malpractice occurs, the patient has the choice of seeking a remedy from the administrative mechanism, relevant health authority, or the courts. Similarly, when a health authority fails to fulfill its duties, such as failing to grant quality health care to individuals, the individual may seek a remedy through administrative procedures, the government at the next higher level, or the courts. 69 In practice, seeking administrative accountability is relatively inexpensive compared to resorting to the courts, but it is generally not a fruitful option. 70 Indeed, many claimants are prevented by local authorities from complaining to higher levels of government about inaction or abuse at th