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

medical service system Establishing a strong primary care delivery system is an ongoing priority in China. The government has increased BMJ Global Health investment in primary care, with initiatives that include strengthening the infrastructure of primary healthcare (PHC) facilities, expanding human resources for primary care through incentives and supporting projects, establishing a general practitioner system 61 and improving the capacity of PHC personnel through training and education, such as general practice training and continuous medical education programmes. Public hospital reforms focus on removing drug mark-ups as a source of financing, and rationalising medical service pricing (eg, improving the price of medical services that can reflect the value of medical staffs' technical services, and piloting the removal of medical consumable mark-ups). Additionally, the priority task is establishing a tiered healthcare delivery system by developing healthcare alliances to improve intersectoral coordination and integration 62 and providing family practitioners contracted services. 63 The development of private hospitals is encouraged to increase the supply of healthcare resources. Further, telemedicine is promoted to improve the delivery of services to people living in remote and poverty areas. public health service system The 'equalization of basic public health services' policy implemented the national BPHS programme and the crucial public health service (CPHS) programme. It aims to reduce major health risk factors, prevent and control major communicable diseases and chronic diseases and improve response to public health emergencies. 64 This policy seeks to achieve universal availability and promote a more equitable provision of basic health services to all urban and rural citizens. The BPHS set out the minimum services for all citizens, including health management and monitoring. The service package can be expanded by local governments according to local public health issues and financial affordability. CPHS seeks to fight important infectious diseases (eg, prevention and control of tuberculosis, AIDS and bilharziasis) and meet the needs of vulnerable groups (eg, breast and cervical cancer screening for rural women, cataract surgery for low-income patients). 65 With a focus on public health and prevention, the State Council announced a series of 15 recommended actions to achieve 'Healthy China 2030' on 15 July 2019, which include 'intervening in health influencing factors, protecting full-life-cycle health, and preventing and controlling major diseases'. 66 During the past 10 years since the latest round of healthcare reform, China made steady progress in achieving the reform goals and UHC. Table 2 showed the summary of the main reform initiatives and achievements.