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

can be summarised as 'one goal, four beams, and eight columns' (figure 1). 42 43 Under the goal of achieving UHC, China concentrated on establishing the four systems (ie, public health service system, medical service system, health insurance system, and drug supply and security system), based on the eight functional mechanisms that could provide essential supports. Accordingly, three sequential phases of healthcare reform plans were to be carried out to achieve the overall goal by 2020: the 2009-2011 phase, the 2012-2015 phase and the 2016-2020 phase (figure 1). 31 44 BMJ Global Health The 2009-2011 phase The first 3-year reform plan laid a foundation for the 2020 goal. There were five reform priorities: (1) accelerating the establishment of a basic health insurance system; (2) establishing a preliminary national essential drug system; (3) improving the primary care delivery system to provide basic healthcare; (4) making basic public health services (BPHS) available and equal for all; and (5) piloting public hospital reforms. 45 46 Reforms during this first phase focused on strengthening primary care. This phase of reform obtained positive evaluations and was confirmed to be heading in the right direction by WHO and others. 12 47 48 The 2012-2015 phase The second phase of healthcare reform, China's '12th Five-Year Plan', continued in the same general direction. 49 The reforms were promoted and deepened during this period, and clarified three tasks: (1) basic health insurance for all; (2) consolidation and improvement of the essential drug system; and (3) reform of public hospitals.