Abstract
Despite being a developing country with approximately 1.4 billion people, China has managed to extend a basic health care safety net to more than 95 percent of its population over the past decade. What forces converged to make this achievement possible? Guided by the political economy theory on agenda setting developed by John Kingdon (1984), this chapter illustrates that achieving universal health coverage (UHC) in China has required the convergence of the following factors: heightened problem recognition, ideas/ideology for policy formulation, political institution willingness and available fiscal space. We also demonstrate, however, that official universal health insurance coverage in contemporary China has not yet equated to fully comprehensive and effective coverage in practice, as not every citizen has equal access to the same quality of health care. The success of China’s UHC was built on the simultaneous investment in, and development of, preventive and basic health services and the provision of insurance coverage for all. Still, stark health disparities between urban and rural residents remain, along with high health expenditures and inflation of health care costs caused by inefficiency and waste. Nevertheless, China’s policy journey still provides a valuable example to inform other nations as to what is needed to enable major health system reforms.
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Notes
- 1.
See discussion and sources in Yip et al. (2012).
- 2.
See discussion in Zhu et al. (1989).
- 3.
- 4.
In nominal absolute RMB, government revenue actually increased, but inflation and government employee wage increases vastly outpaced revenue growth.
- 5.
Hsiao, William. Personal interview, 8 October 2014.
- 6.
This number is confirmed by independent studies such as Yip et al. (2012).
- 7.
See discussion and resources in Meng et al. (2012).
- 8.
As suggested by Yip et al. (2012). NCMS, though it has increased health service utilization to varying degrees as reported by different studies, does not show a “measurable effect on the reduction of financial risk”. Few studies have been carried out to assess the financial protection effect of URBMI. One study shows that the out-of-pocket payment for hospitalization for URBMI enrolees was about 26 percent lower than uninsured urban residents, suggesting some degree of financial protection with URBMI (Liu and Zhao 2012).
- 9.
The lack of evidence for health outcome improvements may be further explained by the fact that the reforms are rather recent and enough time has not passed to observe their effects. More importantly, the general lack of reliable national data for China that can support a thorough analysis based on rigorous assessment presents another challenge to assessing the health outcomes of system reform. Last but not least, the many moving parts of this complex reform, and significant variations in local governments’ capacities to implement the reform policies, certainly make assessment at the national level challenging.
- 10.
Percentages from World Health Organization Global Health Expenditure Database. Accessed 14 July 2014. http://apps.who.int/nha/database
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Hsiao, W., Li, M., Zhang, S. (2017). China’s Universal Health Care Coverage. In: Yi, I. (eds) Towards Universal Health Care in Emerging Economies. Social Policy in a Development Context. Palgrave Macmillan, London. https://doi.org/10.1057/978-1-137-53377-7_9
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