CHINA | Summary
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 New Rural Cooperative Medical Scheme was established in 2003 for the rural population
- The Urban Resident Basic Medical Insurance was unveiled in 2007 for urban non-employed citizens (children, students, elderly people without previous employment, and unemployed people)
HEALTH & HEALTH SYSTEM
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
HEALTH INDICATORS & DEMOGRAPHICS
- 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%
1. The World Bank. (2020). China;. Data. https://data.worldbank.org/country/china.
2. The World Bank. (2017). Current health expenditure (% of GDP). Data. https://data.worldbank.org/indicator/SH.XPD.CHEX.GD.ZS.
3. China Demographics. Worldometer. (2020). https://www.worldometers.info/demographics/china-demographics/.
4. Sun, Y., Gregersen, H., & Yuan, W. (2017). Chinese health care system and clinical epidemiology. Clinical Epidemiology, 9, 167–178. https://doi.org/10.2147/clep.s106258
5. Shafrin, J. (2008, August 10). An Olympic Post: The History of the Chinese Healthcare System. Healthcare Economist. https://www.healthcare-economist.com/2008/08/10/an-olympic-post-the-hist....
6. Brink, S. (2019, October 5). New Research: China Is Winning Some Health-Care Battles — And Losing Others. NPR. https://www.npr.org/sections/goatsandsoda/2019/10/05/767274984/new-resea....
7. Tikkanen, R. (2020, June 5). China. The Commonwealth Fund. https://www.commonwealthfund.org/international-health-policy-center/coun....
8. Liu , J. T. C. China. In Encyclopaedia Britannica. https://www.britannica.com/place/China.
9. Geography Now! China. (2016). YouTube. https://www.youtube.com/watch?v=lzAESaVqix0.
10. China Age structure. China Age structure - Demographics. (2019). https://www.indexmundi.com/china/age_structure.html.
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