In 2009, China launched an ambitious US$125 billion programme of health-care reform to ensure universal health coverage. The second paper in The Lancet themed issue on China analyses the implementation of the reform, and offers recommendations for further improvements.
The reform was well overdue, say Winnie Chi-Man Yip at the University of Oxford, UK, and team. "Before announcing health-care reform, the Chinese Government was faced with widespread public discontent stemming from unaffordable access to health care, major financial risks associated with out-of-pocket medical expenses, and growing inequalities in access to health care and health status across regions and populations of different socioeconomic status and between urban and rural areas."
The reform established government's primacy in financing health care, with priority funding funnelled into public health and primary health care, subsidising low-income individuals to enrol in social health insurance programmes, and introducing an essential medicines programme for public primary health-care institutions.
The authors say that, "despite its size and varied socioeconomic local conditions, China has made big strides towards providing its population with affordable and equitable access to basic health care in the past few years. It has overtaken many developing nations and achieved nearly universal insurance coverage in less than a decade and has begun to establish some necessary foundations for primary health care and public health provision."*
Waste and poor quality of health care in public hospitals have to be reduced through further innovative provider payment incentives and new governance structure. "Unless public hospitals are charged with conserving public resources and improving the health of patients with minimum use of resources, they are not likely to give priority to delivering cost-effective, quality services. Self-interest of physicians and hospital directors might come before public interest."
There is more to be done. "China can expand its redistribution of resources by adopting funding formulas that adjust for heterogeneous needs (such as demographics, health, and socioeconomic indicators) at sub-provincial or municipality level. China can show its serious commitment to health by increasing taxes on tobacco. The medical education system has to be reformed to produce well-trained primary health-care providers, but China's needs are vast and it will take a long time to train enough family doctors", say the authors.
"China could consider task-shifting—delegating tasks to workers with less training or narrowly tailored training, such as nurses, community health workers, or village doctors—to fill the workforce gaps", the authors conclude.
Finally, the authors say that pumping money into the healthcare system is necessary but needs to be carefully managed to allow development of absorptive capacity of service providers. Independent, outcome-based monitoring and evaluation are essential for mid-course correction and to make officials and providers accountable.
Dr Winnie Chi-Man Yip, University of Oxford, Department of Public Health, Oxford, UK. T) +44 (0)1865 289 429 E) winnie.yip@dph.ox.ac.uk
Notes to Editors:
*Quote direct from author and cannot be found in text of Review.
Journal
The Lancet