Tracking China's health reform

Abstract

In response to growing public concerns over widening inequalities in health, the Chinese Government offi cially launched another round of the national health system reform plan in early 2009 with a commitment of ¥850 billion (US$125 billion) for the next 3 years. The proposed reform has ambitious targets, including 90% health insurance coverage by the end of 2010 and universal coverage of essential health-care by 2020. But how will these reforms be monitored? Over the past three decades, China’s health information system has evolved to include national household surveys of health-care use and expenditures, real-time surveillance of communicable diseases, and periodic disease-specifi c prevalence surveys. These health metrics were key factors in the current reforms. With use of the national health service surveys in 1993 and 1998, the Development Research Center concluded in 2002–04 that earlier reforms had not been successful. The proportion of health expenditures covered by the government had dropped from 36% to 15%, funding for prevention had relatively declined, health insurance coverage had collapsed to 13% of rural and 40% of urban residents, and 70% of residents from the poorest regions of the country failed to seek inpatient treatment because of cost. In July, 2005, a newspaper article about the study in the China Youth Daily provoked widespread public discussion and debate that was sustained by a litany of media stories of human and fi nancial health-system failings. China’s blood-banking system, as detailed by Xuerong Yu and colleagues. Production of China’s human resources depends on professional medical education. As described by Dong Xu and colleagues, higher education in China has several purposes: global academic excellence, training professionals to service diverse Chinese populations, and re-engineering the professions to grapple with the onslaught of non-communicable diseases. How China harmonises these diverse aims will determine not only the contributions of its next generation of professionals but also very probably the success and sustainability of its ambitious reforms towards universal health coverage. For these and other studies, more and more Chinese health data are increasingly accessible, as illustrated by the wealth of data on child mortality from the internet in Chinese that was analysed by Rudan and colleagues. As reviewed by Yan Guo and colleagues, the recent round of health reforms will be monitored by key indicators, just as the reforms were stimulated in part by results from earlier health surveys. While it is too early to draw conclusions, China has rapidly expanded medical insurance so that the recent national household healthsurvey found a dramatic turnaround: 87% of urban and rural populations reached by 2008. In view of these developments, it seems likely that China will achieve universal insurance coverage well before 2020, albeit providing only limited benefi ts. The Lancet’s two China collections, in 2008 and 2010, illustrate the deepening engagement of Chinese academics in the global health sciences. The recent appointment of a Lancet Asia editor based in Beijing augers well for the journal’s future publications on health in China. Just as China has much to learn from international science, China also has much to share for the mutual benefi t of the entire global health community.