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01-03-2012 | Legal medicine | Article

China’s healthcare reforms improve equity, costs remain ‘catastrophic’


Free abstract

MedWire News: China's healthcare reforms have led to considerable increases in insurance coverage and inpatient reimbursement, but healthcare costs for patients are still extremely high, shows research published in The Lancet.

In 2009 the Chinese State Council announced a systematic plan to achieve universal healthcare coverage by 2020, focusing on five areas between 2009 and 2011: service delivery, essential medicines, public healthcare, insurance, and public hospital reform.

In this study, Sarah Barber (World Health Organization, Beijing, China) and colleagues used data from China's National Health Services Surveys in 2003, 2008, and 2011 to investigate trends in access to coverage, healthcare activities, and financial protection that could be attributable to the government's scheme.

They also looked for trends regarding urban versus rural residency, geographic region, and household income.

The researchers found that between 2003 and 2011, insurance coverage significantly increased from 29.7% to 95.7%, and the average share of inpatient costs reimbursed from insurance increased from 14 to 4 to 46 to 9.

They also note that hospital admissions increased significantly by 2.5 times from 3.6% in 2003 to 8.8% in 2011, and that cesarian section rates increased from 19.2% in 2003 to 36.3% in 2011.

Despite the significant improvements in coverage, the researchers also found that 12.9% of households (2425 of 18,800) had catastrophic health expenses in 2011.

The study shows that the differences in access and financial protection between urban and rural areas reduced greatly between 2003 and 2008, and improved further by 2011. Likewise, the gap between the western and central regions versus the eastern region decreased between 2003 and 2011.

The researchers also found that the gap between the poorest and wealthiest groups also decreased between 2003 and 2011. The only exception to this trend was the figures for the percentage of households with catastrophic health expenses.

Barber and colleagues express that "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 write: "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."

By Chloe McIvor

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