Towards universal health coverage: lessons from 10 years of healthcare reform in China

Tao, Wenjuan; Zeng, Zhi; Dang, Haixia; Lu, Bingqing; Chuong, Linh; Yue, Dahai; Wen, Jin; Zhao, Rui; Liu, Weimin; Kominski, Gerald F.

doi:10.1136/bmjgh-2019-002086

Cited by 115 publications

(105 citation statements)

References 49 publications

(45 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…While the current research has focused on investigating problematic tendencies (i.e., scapegoating motivations) within the two cultural settings, this comparative research also highlights the fact that national leaders and healthcare professionals stand to learn from each other by recognizing divergent cultural strengths. For instance, the Chinese government has continued political support for its healthcare reform from 2009 until now, enabling conditions to achieve national universal health coverage (Tao et al, 2020). The health insurance system has been reformed and different kinds of medical insurance have combined to promote health equity (Meng et al, 2015).…”

Section: Practical Implicationsmentioning

confidence: 99%

Culturally Grounded Scapegoating in Response to Illness and the COVID-19 Pandemic

et al. 2021

View full text Add to dashboard Cite

For years, violence against doctors and healthcare workers has been a growing social issue in China. In a recent series of studies, we provided evidence for a motivated scapegoating account of this violence. Specifically, individuals who feel that the course of their (or their family member's) illness is a threat to their sense of control are more likely to express motivation to aggress against healthcare providers. Drawing on existential theory, we propose that blaming and aggressing against a single individual represents a culturally afforded scapegoating mechanism in China. However, in an era of healthcare crisis (i.e., the global COVID-19 pandemic), it is essential to understand cultural variation in scapegoating in the context of healthcare. We therefore undertook two cross-cultural studies examining how people in the United States and China use different scapegoating responses to re-assert a sense of control during medical uncertainty. One study was conducted prior to the pandemic and allowed us to make an initial validating and exploratory investigation of the constructs of interest. The second study, conducted during the pandemic, was confirmatory and investigated mediation path models. Across the two studies, consistent evidence emerged that, both in response to COVID-related and non-COVID-related illness scenarios, Chinese (relative to U.S.) individuals are more likely to respond by aggressing against an individual doctor, while U.S. (relative to Chinese) individuals are more likely to respond by scapegoating the medical industry/system. Further, Study 2 suggests these culture effects are mediated by differential patterns of primary and secondary control-seeking.

show abstract

Section: Practical Implicationsmentioning

confidence: 99%

Culturally Grounded Scapegoating in Response to Illness and the COVID-19 Pandemic

et al. 2021

View full text Add to dashboard Cite

show abstract

“…To further promote measures to combat rare diseases, in February 2019, the National Health Commission of the People's Republic of China announced the establishment of the "National Network to Collaborate on Diagnosis and Treatment of Rare Diseases" and formally issued the Guidelines for the Diagnosis and Treatment of Rare Diseases (2019), which is the rst national guidelines for the diagnosis and treatment of rare diseases 12,13 . In fact, medical insurance plays an important role in relieving the nancial burden of illness in a large population. Nowadays, basic health insurance in China consists of the Urban Employee Basic Medical Insurance, the New Rural Cooperative Medical Scheme and the Urban Resident Basic Medical Insurance 14 . Since the rst revision of the National Essential Medicines List (NEML), composed of 307 essential medicines, was issued by government in 2009, the latest NEML (2018) has increased the drugs to 685, which contains a large number of drugs for general diseases 15 .…”

Section: Introductionmentioning

confidence: 99%

“…In fact, medical insurance plays an important role in relieving the nancial burden of illness in a large population. Nowadays, basic health insurance in China consists of the Urban Employee Basic Medical Insurance, the New Rural Cooperative Medical Scheme and the Urban Resident Basic Medical Insurance 14 . Since the rst revision of the National Essential Medicines List (NEML), composed of 307 essential medicines, was issued by government in 2009, the latest NEML (2018) has increased the drugs to 685, which contains a large number of drugs for general diseases 15 .…”

Section: Introductionmentioning

confidence: 99%

A Questionnaire-based Study to Comprehensively Assess the Status Quo of Rare Disease Patients and Care-givers in China

Liu

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: There are over 16.8 million rare disease patients in China, representing a large community that should not be neglected. To provide a basis for policy-makers to better understand the status quo of rare disease patients and care-givers in China and to devise some new policies, a comprehensive analysis of the status quo, unmet needs, difficulty caused by the rare disease is essential.Methods: A questionnaire-based study of patients and care-givers (usually family members) was performed. The questionnaire was composed of 116 questions, such as the diagnosis process, treatment access, financial burden, views on patients’ organizations, and a series of standardized tests to assess the quality of their life, including the SF-36, PHQ-9, PHQ-15, GAD-7, and PSQI. To examine the influence of age, disease type, and relationship to patients on the scores in these tests, statistical analysis with a general linear model was conducted.Findings: A total of 1,959 patients and care-givers participated in the survey, representing 104 rare diseases, such as lysosomal storage diseases, hemophilia, and muscular dystrophy diseases. The diagnosis was delayed for 1.4 ± 3.0 years, and patients experienced 1.6 ± 3.8 misdiagnoses between 3.2 ± 2.4 hospitals. The hospitals where diagnoses were made were highly concentrated in 10 large hospitals (43.8%) and 5 big cities (42.1%), indicating a significant inequality of medical resources. The disease often led to difficulty in social life, education, and employment, as well as financial burden that was seldom covered by medical insurance. A battery of standardized tests demonstrated poor health status, depression, somatization, anxiety, and sleeping issues among both patients and care-givers (p<0.05).Statistical analysis of the questionnaire also showed that poor health, anxiety, depression, somatization, and sleeping problems were more prevalent in patients than in care-givers, and more prevalent in more severe diseases (e.g., hemophilia, Dravet) or undiagnosed than in other diseases.Interpretations: This study identified the lack of rare disease awareness and legislative support as the major challenge to rare diseases in China, and makes key recommendations for policy-makers, including legislating orphan drug act, raising rare disease awareness, and protecting rights in education and employment.

show abstract

“…They found that expanding health insurance coverage for all was fundamental in moving towards UHC and recommended leveraging strategic purchasing, improving primary health-care (PHC) and improving the quality of services for further improvements [ 20 ]. Tao et al identified continued political support and increased health financing to be key lessons from China’s health system reforms [ 21 ].…”

Section: Introductionmentioning

confidence: 99%

Advancing universal health coverage in China and Vietnam: lessons for other countries

et al. 2020

View full text Add to dashboard Cite

Background China and Vietnam have made impressive progress towards universal health coverage (UHC) through government-led health insurance reforms. We compared the different pathways used to achieve UHC, to identify the lessons other countries can learn from China and Vietnam. Methods This was a mixed method study which included a literature review, in-depth interviews and secondary data analysis. We conducted a literature search in English and Chinese databases, and reviewed policy documents from internal contacts. We conducted semi-structured interviews with 16 policy makers, government bureaucrats, health insurance scholars in China and Vietnam. Secondary data was collected from National Health Statistics Reports, Health Insurance Statistical Reports and National Health Household Surveys carried out in both countries. We used population insurance coverage, insurance policies, reimbursement rates, number of households experiencing catastrophic heath expenditure (CHE) and incidence of impoverishment due to health expenditure (IHE) to measure the World Health Organization’s three dimensions of UHC: population coverage, service coverage, and financial coverage. Results China has increased population coverage through strong political commitment and extensive government financial subsidies to expand coverage. Vietnam expanded population coverage gradually, by prioritizing the poor and the near-poor in an incremental way. In China, insurance service packages varied across regions and schemes and were greatly determined by financial contributions, resulting in limited service coverage in less developed areas. Vietnam focused on providing a comprehensive and universal service packages for all enrollees thereby approaching UHC in a more equitable manner. CHE rate decreased in Vietnam but increased in China between 2003 and 2008. While Vietnam has decreased the CHE gap between urban and rural populations, China suffers from persistent disparities among population income levels and geographic location. CHE and CHE rates were still high in lower income groups. Conclusion Political commitment, sustainable financial sources and administrative capacity are strong driving factors in achieving UHC through health insurance reform. Health insurance schemes need to consider covering essential health services for all beneficiaries and providing government subsidies for vulnerable populations’ in order to help achieve health for all.

show abstract

Towards universal health coverage: lessons from 10 years of healthcare reform in China

Cited by 115 publications

References 49 publications

Culturally Grounded Scapegoating in Response to Illness and the COVID-19 Pandemic

Culturally Grounded Scapegoating in Response to Illness and the COVID-19 Pandemic

A Questionnaire-based Study to Comprehensively Assess the Status Quo of Rare Disease Patients and Care-givers in China

Advancing universal health coverage in China and Vietnam: lessons for other countries

Contact Info

Product

Resources

About