Intended for healthcare professionals


Nine in 10 Chinese are covered by medical insurance, but access to treatment remains a problem

BMJ 2012; 344 doi: (Published 09 January 2012) Cite this as: BMJ 2012;344:e248
  1. Jane Parry
  1. 1Hong Kong

China’s wide ranging reforms of the health sector have resulted in almost universal coverage by social health insurance schemes and a greater degree of medical security, conclude reports from official state media.

Healthcare financing experts acknowledge China’s progress as a result of a three year reform process, with central government funding of ¥850bn (£87bn; €105bn; $134bn) that started in early 2009, but point out that universal coverage is just one step on the road to equitable access to affordable healthcare.

The Chinese health minister, Chen Zhu, announced last week that 89% of urban residents and 97% of rural residents are now covered by one of the country’s three medical insurance schemes, up from only 55% of urban residents and 21% of rural residents in 2003, reports China’s official Xinhua news agency.

Although this is a laudable improvement, population coverage is just one of three key aspects of universal coverage, said Henk Bekedam, director of the Division of Health Sector Development at the World Health Organization’s Western Pacific regional office in Manila. He said, “You also need to look at the benefit package and the percentage of reimbursement, which is still around 30-50%. A poor person cannot pay 50-70% of the bill, and so even when they are insured they may not go to hospital, and catastrophic medical costs are the single biggest factor that propels people into poverty.”

The decentralised nature of the health system is also an obstacle to ensuring equitable access to healthcare. Jui-fen Rachel Lu, professor and dean of the Department of Healthcare Management at Chang Gung University, Taiwan, said, “It will be difficult to challenge the numbers released by the Chinese government, as alternative sources of information are rare. However, my impression from talking to various healthcare providers and researchers during my visits to China (to Wuhan and Changchun) is that the government seems to make great efforts in increasing coverage rate through expanding the New Rural Cooperative Medical Scheme and urban health insurance programmes.”

She added, “Critical challenges remain, though, in the wide disparity in the benefits provided by various programmes and the quality of care rendered to the insured in China’s multiple payer system.”

Other serious healthcare financing problems have yet to be dealt with. The health ministry also announced last week that by 2015 all public hospitals will be barred from imposing a 15% surcharge on prescription drugs, with fees for services replacing the shortfall. Given that as little as 10% of a hospital’s funding currently comes from the government, such surcharges are one of the major funding mechanisms for hospitals and result in widespread irrational prescribing. The gradual elimination of such surcharges was one of the key planks of the health sector reforms announced in 2009, but no deadline was set at the time, in the face of resistance from hospital managements.


Cite this as: BMJ 2012;344:e248

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