Towards universal health coverage: achievements and challenges of 10 years of healthcare reform in China

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.

An investigation of the intention and reasons of senior high school students in China to choose medical school

“…Given that UHC has been identified as a priority for the global health agenda, the evidence from this study can be suggestive of furthering on in the UHC journey and taking the policy steps [ 47 ]. Firstly, the factors influence choice of clinical medicine are a combination of medical interests and knowledge about the medical profession.…”

Change in health spending after implementation of a health transformation plan in Iran: an interrupted time series analysis

“…Potential over provision and over utilization during first years after HTP has been raised in similar literatures [ 12 , 16 , 18 ]. From a comparative perspective with china health reform, Tao et al [ 19 ] mentioned achievements and challenges of 10 years of healthcare reform in China. They reported considerable increase in hospital admission and annual resident HR following reform.…”

Trends of prescribing adherence of antiplatelet agents in Hong Kong patients with acute coronary syndrome: a 10-year retrospective observational cohort study

“…National Essential Medicines List was established in China, of which enlisted medications could be reimbursed under medical insurance system to ensure availability and affordability of essential drugs. 27 Clopidogrel had been enlisted in the National Essential Medicines Lists 2012 and there was not restriction on indication of drug, unlike the HA drug formulary in Hong Kong. 28 Implementation of National Essential Medicines List was shown to improve rational use of drugs.…”

“…28 Implementation of National Essential Medicines List was shown to improve rational use of drugs. 27 The unrestricted use of P2Y12 inhibitors from the policy aspect may contribute to better prescription rate of DAPT in China than in Hong Kong.…”