Towards universal health coverage: lessons from 10 years of healthcare reform in China

Tao, Wenjuan; Zeng, Zhi; Dang, Haixia; Lu, Bingqing; Chuong, Linh; Yue, Dahai; Wen, Jin; Zhao, Rui; Li, Weimin; Kominski, Gerald F

Universal health coverage (UHC) is driving the global health agenda and is now an ambition for many nations at all stages of development. 1 2 UHC is a means for achieving improved equity, health, financial well-being and economic development, ensuring that everyone has access to quality, affordable health services when needed. 3 Most countries have made UHC a key global health objective through the United Nations' resolution, and move towards UHC following the Sustainable Development Goals (SDG) set in 2015. At the beginning of the 21st century, the push for UHC seems stronger than ever. 4 The new WHO director general, Dr Tedros, emphasised that UHC is the 'top strategic priority' in the road map for WHO's renewal. 5 Accordingly, WHO's General Program of Work for 2019-2023 has set an ambitious goal of benefiting more than 1 billion people from UHC by 2023. 6 WHO states that there is 'no one size to fit all'-there are different ways to attain UHC. An increasing number of low and middle-income countries (LMIC) are actively pursuing policies to achieve UHC and share their implementation experience from different political settings, such as Turkey, 7 Indonesia, 8 Thailand 9 and Bangladesh. 10 According to The World Bank report, the march to UHC in China is unparalleled. 11 Also, Yip et al commented that 'China's reform goals and systemic strategies are exemplary for other nations that pursue UHC.' 12 In early 2009, the Chinese government launched a new round of health system reform with the goal of providing affordable and equitable basic healthcare for all by 2020, which is in line with the basic concept of UHC defined by WHO. 13 This year marks the 10th anniversary of China's most recent healthcare reform. Evidence from China is especially timely for countries pursuing UHC. However, much of the early research focused solely on the first 3-year reform after 2009 in China, summary box â–º Continued political support is the most important enabling condition for achieving universal health coverage (UHC). China has shown clear political willingness to make UHC achievement a more countryled process. â–º Increasing health financing is necessary, and the investment from both government and private sector is considered. â–º A strong primary healthcare system should be regarded as a core component in realising UHC. The Chinese government has made primary healthcare a priority in its 'Healthy China 2030' strategy. â–º Some lessons providing reform experiences for other countries include the pilot reform and systematic reform strategy. without addressing the issue of the reform evolution and progress during the past decade. There is inadequate understanding of how China moves towards UHC step by step. We undertook a literature review, and analysed policies and secondary data from governmental sources. We aim to share the complete experience and strategy about China's healthcare reform, and provide the critical lessons for other nations, especially for LMICs.