Overview of China’s health care reform
Wen Chen, Ph.D., Professor
Fudan School of Public Health
March 21, 2016
Basic data

Population (November 2010):
1.37 billion


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Mainland: 1.34 billion
Urban: 0.666 billion (49.68%)
Rural: 0.674 billion (50.32)
Population above 65 years
old(2012): 9.40 %
Population birth rate(2012):
12.10 per 1,000
Maternal mortality(2012): 24.5
per 100,000
2
Health Indicators
3
Source: WHO. World Health Statistics 2015
Health workforce and infrastructure
Psychiatric beds per
10 000
population(2014)
34.1
16.8
Number of nursing
and midwifery
personnel per 10 000
population (2009-2013)
88.0
16.6
Number of physicians
per 10 000 population
(2007-2013)
28.1
14.9
0
United Kingdom
20
40
60
80
100
China
4
Source: WHO. World Health Statistics 2015
Health expenditure
32.4
Per capita THE (100 PPP int. $, 2012)
5.8
Out-of-pocket expenditure as % of private
expenditure on health (2012)
56.4
78.0
General government expenditure on health as % of
total government expenditure (2012)
16.2
12.5
General government expenditure on health as % of
THE (2012)
84.0
56.0
9.3
5.4
Total expenditure on health as % of GDP (2012)
United Kingdom
China
Source: WHO. World Health Statistics 2015
0
10
20
30
40
50
60
70
80
90
5
New Challenges for health system
6
Forces Driving Health Reform

Unaffordable access resulting from rising
healthcare costs
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Inequalities in health care
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
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Continuously increasing more rapidly than GDP
Still high level of economic burden by OOP
Across regions and socioeconomic population
groups
Between urban and rural areas
Higher expectation
7
Out-of-pocket payment (%)
Figure 3 Percentages of out-of-pocket payment (OOP) in total health
expenditures, 1978-2011
65
60
55
Percentage of OOP (%)
50
45
40
35
30
25
20
15
10
5
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
0
Source: Report on China’s Health Account Study, 2012
Year
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Health Care Reform Initiatives

Aim: guaranteed access for every Chinese
resident to basic health care

By 2011: to obviously improve accessibility and
effectively reduce medical expenditure burden

To expand health insurance coverage

To establish the National Essential Medicines system
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To strengthen the primary health services delivery system
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To promote basic public health programs
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To advance the public hospital reform pilot
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Increasing Government Expenditure on Health
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Public health services
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Health insurance coverage and medical aids
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Financial subsidies for urban non-employed and rural farmers
Public health institutions
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Core basic package and local extended package
Infrastructure development
Subsidies for personnel salary
Subsides for specific reform initiatives, including implementing
essential medicines system and public hospital reform
Medical education and research
10
Social health insurance schemes
11
Source: Winnie Yip, et al. Lancet 2012
Universal health insurance coverage
Population Coverage
Reimbursement level of
Hospitalization expenditure
12
Source：Meng Q, et al. Lancet, 2012
Success attributed to …

Resource mobilization
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Incentives establishment and development
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Increasing government expenditure on health used for
infrastructure development and subsidies for vulnerable
population
Increasing personal contributions on healthcare through
developing social and private health insurance schemes
Service purchasing through governments and HI agents
Quality and efficiency concerns on public hospitals and
suppliers
Introduction and promotion of new technology and
health system capacity building
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Challenge to tradeoff between value and expense
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Problems in health financing
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Affordable universal coverage
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Informal workers and migrants
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Voluntary enrolment in RHI and NCMS
Equality in access to health care
and financial protection, e.g. OOP
as percentage of income

Contribution level

Benefits package

Increasing medical expenditure

Fee-for-service method adopted to pay for
medical care
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Failure to integrate between primary care and
tertiary care
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Neglect of public hospitals towards quality and
efficiency of health care
Source: WHO Health Report, 2008
14
Life expectancy at birth (by province, in 2010)
15
Financial risk protection
Proportion of households with
catastrophic health spending
(>40% family income)
Proportion of OOP relative to
household spending
16
Source：Meng Q, et al. Lancet, 2012
Conclusions
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Great progress on achieving universal health
insurance coverage and improving equity in
financing and service utilization
Still existing challenges and problems
Needs further reforms in payment and services
delivery
More information can be found from China Health in Transition at
http://www.wpro.who.int/asia_pacific_observatory/hits/series/chn/en/
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