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Additionally, new resistance in a pathogenic bacterium with no treatment options should be notifiable under International Health Regulations to relevant authorities and control measures must be implemented without delay. This approach will work only if the new systems developing across the world, both regionally and globally, are connected and share a common approach to build synergies and partnerships for robust and effective systems.
Despite evidence pointing to the pre-2014 existence of Ebola dopamine beta hydroxylase disease (EVD) in west Africa, the current outbreak is the largest and longest yet. The urgent need to contain the epidemic focused the global research response on vaccines, therapeutics, and diagnostic tools. Yet the epidemic overstretched and outpaced the capacity of affected countries\' health systems to respond to the health needs of its citizens; the global call for researchers to conduct clinical trials similarly overwhelmed ethical and regulatory capacities. Here we describe a successful research partnership set up during the outbreak between Liberia and the USA.
On Jan 15, 2016, the National Health and Family Planning Commission of China reported its work plan for 2016 at a press conference in Beijing, mentioning that it will expand the public hospital reform to 200 cities in China. The core part of the reform is to ban the price increase of drugs and materials, reduce the cost of medical examinations, and appropriately raise the price of medical services provided by physicians, such as surgery. However, under this circumstance, public hospitals in China are now in the dilemma of whether to choose reasonable hospital operational costs or public welfare. With the increasing demand for health-care services, the operational cost of hospitals will inevitably increase. For public hospitals, drug sales account for about 40% of their revenue, and medical income (eg, from examinations, laboratory tests, and operations) brings in about 49%. With the ban on charging extra for drugs and materials, as well as the reduced cost of examinations, hospitals\' revenue is likely to reduce. Although the income from medical services will increase, this factor is far from enough to offset the operational cost, which will result in a great reduction in many public hospitals\' gross revenue, even leaving some hospitals at a financial loss. According to some health insurance policies, there are limits on how much a patient can spend on their treatment. If the total cost exceeds the limit, then the hospital might not get the balance from the health insurance department. Because of these health insurance issues, hospitals have no choice but to reduce the use of expensive but effective drugs and materials. However, this move could compromise the quality of medical services. The government\'s subsidy accounts for only about 8% of public hospitals\' revenue, putting these institutions under great pressure. Public hospitals have to seek new ways to make a profit instead of only sticking to their public welfare goals. The government has lowered medical costs in response to public demand; however, the subsidy remains the same. To solve the dilemma hospitals are now facing, the government should increase the subsidy to a level that is enough to cover operational costs without damaging the medical staff\'s initiative. Investment in health-care services takes up only about 6% of finance expenditure in China, compared with about 15% in developed countries. Additionally, the adjustment of the prices of medical services is lagging far behind the market prices. The mechanism of adjustment for these prices should be revisited.
Prof Karen Edmond PhD (School of Paediatrics and Child Health, University of Western Australia, Perth, WA, Australia), Sam Newton PhD (Kintampo Health Research Centre, Ghana Health Service, Kintampo, Brong Ahafo Region, Ghana; and Department of Nutrition and Public Health Intervention Research, London School of Hygiene & Tropical Medicine, London, UK), Lisa Hurt PhD (Division of Popular Medicine and Public Health, Cardiff University, Cardiff, UK), Caitlin S Shannon MPH (EngenderHealth, New York, NY, USA), and Prof Betty R Kirkwood FMedSci (Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK).