CHINA | Summary

OVERVIEW | HISTORY | HEALTH & HEALTH SYSTEM | HEALTH INDICATORS & DEMOGRAPHICS

GDP: 13.343 Trillion USD¹
Health Expenditure (% of GDP): 5.15%²
 

• Population: 1.4 billion
• Housing: 59.7% Urban, 40.3% Rural

The establishment of the health care system in China is typically divided into four phases.⁴ The initial phase followed the establishment of the People's Republic of China in 1949. This led to the creation of a state planned and provided health system, which extended care to rural areas through development of community-based health services, called "barefoot doctors'' as part of the implementation of the Rural Cooperative Medical System (RCMS).⁴

A second key phase in the development of China’s health system began after 1984 with the transition in economic reform from a planned to a market economy.⁴ In this period government financial support for hospitals and community services fell dramatically. As a result, the vast majority of the population were left without insurance - the government did not provide coverage and no private insurance industry existed. By 1999 around 49% of the urban population had access to some form of health insurance (mostly from government and state enterprises), but only 7% of the 900 million rural Chinese had any coverage. The lack of coverage was especially troublesome in rural areas, revealing rural‐urban disparities in access to healthcare services. This period ended with the establishment of the Urban Employee Basic Medical Insurance (UEBMI) in 1998, which required employers to pay for part of the insurance premium for employee.⁴

The third phase of development began in the early 2000s. Radical changes had been sought in a context of rising public discontent over spiralling out-of-pocket expenses and declining trust in the medical profession. Reforms focused on introducing two other partly state funded social insurance schemes to cover different groups⁴: 

 

The fourth and ongoing phase began in 2009, with the Chinese government providing large increases in financing the health care system in the areas of service delivery, essential medicines, public health, insurance, and public hospital reforms. The reformation led to a dramatic improvement in the health status of the population.⁴

 

All four phases include variable levels of government subsidies and employer contributions and out-of-pocket payments. Because of these initiatives the coverage of publicly financed health insurance schemes in China is near-universal - exceeding 95 percent of the population in 2011.⁴ In the 1980s, China allowed commercial insurers to enter the market. Commercial insurers, however, were not overwhelmingly popular since only 5.6% of the population had commercial insurance in 2004.⁵

Ten years into China's multi-billion dollar investment in health-care reform, the country has made progress on some top public health challenges such as including insurance coverage and tackling infectious diseases. China still has a long way to go in encouraging healthy lifestyles and cleaning up pollution to help people avoid cancers and chronic illnesses like heart disease and diabetes. The Chinese Ministry of Health has stated that industrial pollution has made cancer the leading cause of death in China. This is both attributed to air and land pollution. Instituting strict regulation on bans and fines but with the population size it is hard to manage contamination maintenance. Those chronic diseases often relate to lifestyle choices as well. Two of the biggest threats to the health of Chinese people are tobacco and environmental pollution.⁶

 

According to The Commonwealth Fund, China has achieved near-universal coverage through the provision of publicly funded basic medical insurance. Since 2016, the two main programs covering 95% of population are voluntary, residency-based, basic medical insurance; and mandatory employment-based program for urban residents with formal-sector jobs. Those employed in urban areas are required to enroll in an employment-based program, called the Urban Employee Basic Medical Insurance, which is funded primarily via employer and employee payroll. The Cooperative Medical Scheme (CMS) is offered to rural residents and the Urban Resident Basic Medical Insurance is for urban residents without formal jobs, including children, the elderly, and the self-employed. These two are mostly funded by central and local government subsidies with individual premiums. Purchased primarily by higher-income individuals and by employers for their workers, private insurance can be used to cover deductibles, copayments, and other cost-sharing, as well as to provide coverage for expensive services not paid for by public insurance. Although China has universal coverage, it has a very entrepreneurial, unregulated healthcare system which led to some gaps in the system.⁷

The health system is conflicted between stressing quality of care or spreading the scarce medical resources as widely as possible. As evaluated on a per capita basis, China’s health facilities remain unevenly distributed. Only about half of the country’s medical and health personnel work in rural areas, where approximately three-fifths of the population resides. The severest limitation on the availability of health services, however, appears to be an absolute lack of resources, rather than discrimination in access on the basis of the ability of individuals to pay. An extensive system of paramedical care has been fostered as the major medical resource available to most of the rural population, but the care has been of uneven quality.⁸

The benefits and the services covered by the health public health insurances are usually defined by the local government. These insurances typically provide the following: inpatient hospital care (selected provinces and cities), primary and specialist care, prescription drugs, mental health care, physical therapy, emergency care, traditional Chinese medicine.⁷ For individuals who are not able to afford individual premiums for publicly financed health insurance or cannot cover out-of-pocket spending, a medical financial assistance program, funded by local governments and social donations, serves as a safety net in both urban and rural areas.The medical financial assistance program prioritizes catastrophic care expenses, with some coverage of emergency department costs and other expenses. China’s central government has overall responsibility for national health legislation, policy, and administration. It is guided by the principle that every citizen is entitled to receive basic health care services and local governments are responsible for organizing and providing these services.⁷

The Commonwealth Fund states that health expenditures have risen significantly in recent decades because of health insurance reform, an aging population, economic development, and health technology advances. Patients are encouraged to seek care in village clinics, township hospitals, or community hospitals because cost-sharing is lower at these care sites than at secondary or tertiary hospitals. However, residents can choose to see a GP in an upper-level hospital. Signing up with a GP in advance is not required, and referrals are generally not necessary to see outpatient specialists.⁷

• Fertility Rate: 1.7 live births per woman 
• Fertility rates declined drastically in the last 50 years from 6.4 births to 1.7; the one child policy was enacted in 1980, two child policy in 2015, and three child policy in 2021 
• Life Expectancy: 80 Female, 75 Male 
• Infant Mortality Rate: 8.4 deaths per 1,000 live births  
• Child Mortality Rate: 9.8 deaths per 1,000 live births 
• Prevalence of Obesity: 7% 

• 0-14 years: 17.2% 
• 15-24 years: 12.3%
• 25-54 years: 47.8% 
• 55-64 years: 11.4% 
• 65 years and over: 11.3%