Moving Towards Universal Health Coverage: Challenges for the Present and Future in China

Moving Towards Universal Health Coverage: Challenges for the Present and Future in China

Ching Yuen Luk (Nanyang Technological University, Singapore)
DOI: 10.4018/978-1-5225-2633-9.ch002


This study uses a refined version of historical institutionalism to critically examine the complex interplay of forces that shape the health insurance reform trajectory in China since the mid-1980s and identifies problems that impede the government from achieving universal health coverage (UHC). It shows that China's multi-layered social health insurance system has covered more than 95 percent of its population, but failed to provide insured people with access to a range of essential services and make health care affordable. To achieve UHC, the government has to overcome significant hurdles, which include the inherently discriminatory design of the social health insurance system, disorder in the drug distribution system, deficits in the funding of health insurance, and insufficient medical protection for the old people.
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Rapidly ageing population (Hsu et al., 2015), rising medical costs (Augustovski et al., 2011) and the burden of NCDs (Bristol, 2014, p.1) have driven governments worldwide to find ways to achieve UHC. According to the World Health Organization (WHO), there are three dimensions of UHC: (i) the breadth of coverage; (ii) the depth of coverage; and (iii) the height of coverage (World Health Organization, 2008, pp. 25-6). The breadth of coverage refers to ‘the proportion of the population that enjoys social health protection’ (World Health Organization, 2008, p. 25). The depth of coverage refers to the provision of the range of essential services that can effectively address people’s health needs (World Health Organization, 2008, p. 26) while the height of coverage refers to the portion of healthcare costs covered by pooled funding and pre-payment mechanisms (World Health Organization, 2008, p. 26). In recent years, UHC has become a key global health objective advocated by WHO and the World Bank (Cheng, 2015, p.1) and has been adopted by many countries as a national aspiration (Reich et al., 2016, p. 811). It is believed that UHC can improve the health and well-being of people (World Health Organization, 2013, p. xi), and “is necessary for economic growth and development” (Cheng, 2015, p. 2).

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