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Universal coverage and health financing from China perspective

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					                                                                                                           Special theme – Health financing


Universal coverage and health financing from China’s perspective
Shanlian Hu a

Universal coverage of health services                    everyone should have an equal right to       of government spending in total health
is required to ensure social equity and                  health.                                      expenditure is less than 1% of GDP,
justice, particularly for China, which is                     The government focus has shifted        multi-health insurance schemes have
a developing country with an enor-                       from developing the economy to offer-        not been integrated and the basic ben-
mous population.                                         ing public services aimed at improving       efit package varies widely in different
     Since the 1980s, the Chinese                        the living standard of the population.       schemes and provinces. Enrolment is
health system has not been perform-                      Health development must be people-           still based on voluntary participation.
ing well. The income gap between the                     oriented and sustainable. For example,       Government subsidies are not enough
rich and poor has widened and the                        recently the Chinese government              to relieve the economic burden when
“marketization” of medical services has                  significantly increased its financial sup-   people on very low incomes need medi-
led to a decline in equity and access.1                  port to farmers and rural areas. Funds       cal care. Prepaid and capitation pay-
The world health report in 2000 showed                   were transferred from the central gov-       ment systems, as well as the gatekeeper
that equity of financial contributions in                ernment to provincial governments in         system, need re-engineering. Promoting
the Chinese health system was poor,2                     the middle and western parts of China        the equality of public health services
and demonstrated that government                         for the development of the rural and         is necessary. Now that China has put
spending was less than 20% and that                      urban medical insurance system.              health financing on the political agenda,
user fees from consumers were nearly                          A resolution on sustainable health      health reform policies will begin to
60% of total health expenditure.3 In                     financing, universal coverage and social     move towards universal coverage. ■
addition, only 15% of the population                     health insurance was endorsed in the
in the formal sector is covered by social                58th World Health Assembly in May            References
health insurance. The majority of rural                  2005.6,7 In 2005, WHO’s Regional             1.  Yanfeng Ge et al. Evaluation and
and urban residents, children and im-                    Offices for South-East Asia and the              recommendations for Chinese health system
                                                                                                          reform. In: China Development Review 7
migrants are not covered by any health                   Western Pacific also formulated the
                                                                                                          (supp.1). Shanghai: Development Research
insurance system. Catastrophic medical                   2006–2010 Health Financing Strategy.8            Center, State Council; 2005.
expenditure leading to impoverishment                    China has been making great efforts          2. The world health report 2000: health systems:
is common in China. Although more                        on the United Nations’ Millennium                improving performance. Geneva: WHO; 2000.
than 95% of health facilities are public                 Development Goals and the 2005               3. China National Health Accounts Report. Beijing:
hospitals, 90% of operational funds are                  WHO resolution. Since 1978, the                  China National Health Economics Institute; 2007.
                                                                                                      4. Wen J. Reforming and opening is the driven
dependent on fees-for-service. Even in                   number of people classed as “absolute
                                                                                                          force of China’s development. Xinhua Daily
the field of preventive health services,                 poor” has been reduced from 250 mil-             News 2008;28:4.
half the costs are borne by service                      lion to 15 million, i.e. within less than    5. Amendments to the Constitution of the People’s
charges. Therefore, health financing                     30 years.9 The government-sponsored              Republic of China. 2004. Available at: http://
in China is extremely inequitable and                    rural cooperative medical system already         english.peopledaily.com.cn/constitution/
health-care coverage is limited.                         covers 842 million rural residents. From         constitution.html [accessed on 10 October
     In recent years, China’s economy                    2004 to 2007, 80% of the population              2008].
                                                                                                      6. Sustainable health financing, universal coverage
has been booming. Gross domestic                         was covered by three medical insurance           and social health insurance [WHA58.33].
product (GDP) in 2007 was 5% of                          schemes.10 The national target is that,          Geneva: WHO; 2005.
global GDP. 4 Naturally, economic                        by the year of 2010, every citizen in        7. Sustainable health financing, universal coverage
development does not necessarily lead                    rural and urban China will be covered            and social health insurance [WHA58.20].
to investments in health. China’s expe-                  by medical insurance.                            Geneva: WHO; 2005.
rience confirms that political commit-                        Health reform and development is        8. Health financing strategy (2006-2010). New
                                                                                                          Delhi & Manila: WHO Regional Offices for South-
ment is extremely important: changing                    facing a critical time in China and uni-
                                                                                                          East Asia and the Western Pacific; 2005.
the government perception is the                         versal coverage has a long way to go.11      9. Wen J. [Keynote speech]. In: United Nations’
key. The Constitution of the People’s                    The vision is that a basic health system         Millennium Development Goals Summit, New
Republic of China, amended in 2004,                      will be established to provide health            York, 25 September, 2008.
mandated that the government respect                     services for all by the year 2020 and so     10. Hu SL, Tang SL, Liu YL, Zhao YX, Escobar ML, de
and protect human rights (Article 33)                    continuously improve the health status           Ferranti D. Reform of how health care is paid for
and that it develop the required social                  of the Chinese population.                       in China: challenges and opportunities. Health
                                                                                                          System Reform in China 6. Series. pp. 68-75.
insurance, social relief and medi-                            Compared with other transi-                 Available at: www.lancet.com
cal and health services for citizens to                  tional countries, there is still a big gap   11. Yip W, Hsiao WC. The Chinese health system
enjoy this right (Article 45).5 Basic                    in the universal coverage of health              at a crossroads. Health Aff 2008;27:460-8.
health rights are part of human rights;                  services and their financing. The share          PMID:18332503 doi:10.1377/hlthaff.27.2.460



a
  School of Public Health, Fudan University, Shanghai, China.
Correspondence to Shanlian Hu (e-mail: hushanlian2@gmail.com).
doi:10.2471/BLT.08.060046


Bulletin of the World Health Organization | November 2008, 86 (11)                                                                                    819

				
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