Report from China: Health Insurance in China—Evolution, Current Status, and Challenges

Abstract

The authors review the evolution of health insurance in China and analyze how it has been shaped to its current form by political and economic dynamics. They summarize the current status of health insurance in terms of population coverage, benefit design, scope of service, and its interaction with providers; address challenges regarding future health insurance reform; and propose policy recommendations. Although the recent health insurance reform has made major breakthroughs in population coverage, it is still too early to judge whether the political willingness to appease social unrest can be translated into concrete health care protections for the population.

Reducing the medical economic burden of health insurance in China: Achievements and challenges

“…Therefore, the Chinese government established Urban Resident Basic Medical Insurance (URBMI) for those groups in 2007 (3,8). URBMI is also mainly financed by the government, and urban families only contribute a small share of premiums (2).…”

“…From 1990 to 2001, OOP expenditures grew tenfold, and the share of OOP expenditures increased to 59.97% in 2001 (2). However, per capita income grew only fiveor fourfold during the period (3). Such a large medical economic burden resulted in a very large proportion of the population facing catastrophic expenditures and impoverishment due to OOP health expenses (4).…”

Protocol for the China PEACE (Patient-centered Evaluative Assessment of Cardiac Events) retrospective study of coronary catheterisation and percutaneous coronary intervention

“…After the first PCI was performed in China in 1985,5 there followed a period of unregulated dissemination 30 31. In 2000, most patients paid for PCI themselves, and there was widespread variation in access to the technology 6 7. Access was subsequently improved in 2003 with the implementation of the Rural Cooperative Medical Care Scheme that expanded insurance access to the low-income rural population.…”

“…Access was subsequently improved in 2003 with the implementation of the Rural Cooperative Medical Care Scheme that expanded insurance access to the low-income rural population. This government initiative was followed by additional healthcare reforms in the latter half of the decade that further expanded insurance support for rural and urban residents 6 7. In this context, the Ministry of Health established processes for accreditation of interventional centres in 2007 to promote minimal quality standards for PCI 17.…”

“…During the past decade, the volume of percutaneous coronary intervention (PCI) has increased more than 20-fold 4 5. This expansion has occurred in the context of rising rates of health insurance coverage and healthcare costs 6 7. The optimal deployment of advanced care strategies in settings of constrained resources is a common challenge faced by many low-income and middle-income countries 8…”