News Release

China's healthcare reforms mean better equity, yet catastrophic health expenses persist

Peer-Reviewed Publication

The Lancet_DELETED

China's plan to ensure universal health coverage has led to massive increases in insurance coverage and impatient reimbursement, yet patients are still faced with extremely high health costs, says the first paper in The Lancet themed issue on China.

A joint analysis by the Center for Health Statistics and Information, Ministry of Health, and the WHO used data from China's National Health Services Surveys in 2003, 2008, and 2011 to assess changes in access to coverage, health-care activities, and financial protection, and to look for improvements, for instance, in equity between rural and urban areas.

The authors say: "Remarkable increases in health insurance coverage and inpatient reimbursement were accompanied by increased use and coverage. The increases in services use are particularly important in rural areas and at hospitals. Major advances have been made in achieving equal access to insurance coverage, inpatient reimbursement, and basic health services, most notably for hospital delivery, and use of outpatient and inpatient care."

However, the study finds that people still face catastrophic health expenses. While inpatient reimbursements have increased substantially, "the increases in health¬insurance coverage have not been accompanied by reductions in catastrophic health expenses among households. Greater attention to risk protection is needed, under the plans to expand the depth and scope of the health insurance schemes, as well as alternative ways of paying for services and health¬care providers."

In an accompanying Comment, Lincoln Chen and Dong Xu say that what is striking in this analysis is the "narrowing of the inequality gap in access and financial protection across China's geographic zones and between the poorest and the wealthiest groups."

Commenting on the data collection, Chen and Xu add: "The fact that a Government ministry selects the indicators, conducts the surveys, and its staff supervise the interviews of respondents could build in all sorts of biases. Datasets should be more open, transparent, and accessible to academics and the general public. Enhanced academic independence would strengthen the credibility of the findings. Given the growing maturation of health reform, China should consider establishing an independent commission consisting of stakeholders and academics for monitoring and evaluation to guide policy adjustments for successful reform."

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Sarah L Barber, WHO, Beijing, China. T) +86 10 6532 7191 ext 81275 E) barbers@wpro.who.int

Dr Lincoln Chen, China Medical Board, Massachusetts, USA. E) lchen@cmbfound.org


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