You are here

Article Text

Article menu

Download PDFPDF

XML
Analysis
Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China
  1. Wenjuan Tao1,
  2. Zhi Zeng1,
  3. Haixia Dang2,
  4. Peiyi Li1,
  5. Linh Chuong3,
  6. Dahai Yue3,
  7. Jin Wen1,
  8. Rui Zhao4,
  9. Weimin Li5,
  10. Gerald Kominski3,6
  1. 1Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, China
  2. 2Research Center of Tradtional Chinese Medicine, China Academy of Chinese Medical Sciences, Beijing, China
  3. 3Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
  4. 4Department of drug policy and evaluation research, China National Health Development Research Center, Beijing, China
  5. 5President's Office, West China Hospital, Sichuan University, Chengdu, China
  6. 6UCLA Center for Health Policy Research, Los Angeles, California, USA
  1. Correspondence to Professor Gerald Kominski; kominski{at}ucla.edu; Professor Weimin Li; weimi003{at}yahoo.com; Professor Jin Wen; huaxiwenjin{at}163.com

Abstract

Universal health coverage (UHC) has been identified as a priority for the global health agenda. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, aiming to provide universal coverage of basic healthcare by the end of 2020. We conducted a secondary data analysis and combined it with a literature review, analysing the overview of UHC in China with regard to financial protection, coverage of health services and the reported coverage of the WHO and the World Bank UHC indicators. The results include the following: out-of-pocket expenditures as a percentage of current health expenditures in China have dropped dramatically from 60.13% in 2000 to 35.91% in 2016; the health insurance coverage of the total population jumped from 22.1% in 2003 to 95.1% in 2013; the average life expectancy increased from 72.0 to 76.4, maternal mortality dropped from 59 to 29 per 100 000 live births, the under-5 mortality rate dropped from 36.8 to 9.3 per 1000 live births, and neonatal mortality dropped from 21.4 to 4.7 per 1000 live births between 2000 and 2017; and so on. Our findings show that while China appears to be well on the path to UHC, there are identifiable gaps in service quality and a requirement for ongoing strengthening of financial protections. Some of the key challenges remain to be faced, such as the fragmented and inequitable health delivery system, and the increasing demand for high-quality and value-based service delivery. Given that China has committed to achieving UHC and ‘Healthy China 2030’, the evidence from this study can be suggestive of furthering on in the UHC journey and taking the policy steps necessary to secure change.

  • health policy
  • health systems evaluation
  • public health
  • health insurance
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2019-002087

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Handling editor Seye Abimbola

    • WT and ZZ contributed equally.

    • Contributors WT and ZZ wrote the first draft of the manuscript, did the literature search and review, collected and analysed the data, produced the tables and figures, and interpreted the results. HD contributed to analysis formulation. PL assisted with data collection. LC was involved in editing each draft. DY, JW and RZ provided comments and suggestions in revisions of the analysis. WL designed the study and set the research direction. GK critically revised the analysis and provided overall guidance. All authors approved the final submitted version.

    • Funding This work was supported by the National Natural Science Foundation of China (grant no 71874115) and China Scholarship Council (CSC no 201806240304).

    • Disclaimer The funders had no role in the study design, data collection, data analysis, data interpretation and in writing the manuscript.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No additional data are available.