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Analysis China’s Health System Reforms: Review of 10 Years of Progress

Enhancing financial protection under China’s social health insurance to achieve universal health coverage

BMJ 2019; 365 doi: (Published 21 June 2019) Cite this as: BMJ 2019;365:l2378

China's health system reforms: review of 10 years of progress

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  1. Hai Fang, professor1,
  2. Karen Eggleston, senior fellow23 ,
  3. Kara Hanson, professor4,
  4. Ming Wu, professor5
  1. 1China Center for Health Development Studies, Peking University, Beijing, China
  2. 2Shorenstein Asia Pacific Research Center, Freeman Spogli Institute for International Studies, Stanford University, Stanford, California, USA
  3. 3National Bureau of Economic Research, USA
  4. 4Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  5. 5Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
  1. Correspondence to: Hai Fang hfang{at}

Hai Fang and colleagues highlight the need for better financial protection for poor people

Universal health coverage means that all individuals and communities should get the quality health services they need without incurring financial hardship.1 It has three dimensions: population coverage, covering all individuals and communities; service coverage, reflecting the comprehensiveness of the services that are covered; and cost coverage, the extent of protection against the direct costs of care.2

The UN sustainable development goals in 2016 committed countries to achieve universal health coverage by 2030 with a focus on essential health services and financial protection.3 A recent report by the World Health Organization and the World Bank showed that China had a fairly high score for coverage of essential health services on 16 health indicators but a low score for financial protection to reduce the risk of illness induced poverty.4

China started comprehensive health system reforms in 2009, and in another article in this series Meng and colleagues provide a detailed review of these.5 An important goal of China’s health system reforms was to achieve universal health coverage through building a social health insurance system. We examine China’s progress in enhancing financial protection of social health insurance and identify the main gaps that need to be filled to fully achieve universal health coverage.

What was proposed in the 2009 reform?

The 2009 health system reforms proposed a universal health insurance system that consisted of three main social health schemes: urban employee basic medical insurance (UEBMI), urban resident basic medical insurance (URBMI), and rural new cooperative medical scheme (RNCMS), with other supplementary insurance and private insurance (table 1).7 The 2009 reforms aimed to cover all the Chinese population with one of the three basic schemes to give them greater financial protection. In 2016, the urban resident and rural schemes merged …

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