At present, State-owned hospitals are categorized as public institutions, which enjoy government support in terms of finance and personnel administration. They are under the supervision of the Ministry of Health and some other government departments.

Private institutions are regarded as businesses that must make money to support themselves. They are supervised by the industry and commerce departments.

"Such a separate system makes many things confusing," Xu said.

"Introducing private clinics into the public medical insurance system seems good, but who will supervise those clinics to guarantee medical insurance funds are used properly and reasonably?"

Since last March, as a pilot city, the Beijing medical authorities have allowed doctors to work at up to three hospitals.

But so far, few doctors from key State-owned hospitals have chosen such arrangements, according to Zhou Shenglai, vice-president of the Beijing Anzhen Hospital, one of the key State-owned hospitals.

"The doctors are very busy and have no energy or time to work in more than one place," Zhou said.

Xu said that there are still no detailed policies on how to coordinate among various medical institutions on issues related to personnel management, salaries and professional title recognition.

Concerning planned medical service charge increases, Hong said that is necessary and urgent, but the question is, how high?

"The central government asked local governments to formulate their own policies. Given the various economic conditions in different parts of China, the gaps might be very large.

"It will make cross-region medical care very difficult and unfair to some patients," Hong said.

Reform is a must, but it faces many challenges and requires detailed policies, according to Xu and Wang.

Under the 12th Five-Year Development Plan (2011-15) for the medical industry, hospital beds of private medical institutions will make up 20 percent of the national total by 2015.

At the same time, non-profit institutions are expected to provide services for 20 percent of patients.

So far, the hospital beds of private medical institutions only make up 8 percent of the total beds, and they treat less than 10 percent of all patients, said the Chinese Hospital Association.

liujie@chinadaily.com.cn