Overview of China’s health care reform Wen Chen, Ph.D., Professor Fudan School of Public Health March 21, 2016

2 Basic data Population (November 2010): 1.37 billion Mainland: 1.34 billion Urban: billion (49.68%) Rural: billion (50.32) Population above 65 years old(2012): 9.40 % Population birth rate(2012): per 1,000 Maternal mortality(2012): 24.5 per 100,000

3 Health Indicators Source: WHO. World Health Statistics 2015

4 Health workforce and infrastructure Source: WHO. World Health Statistics 2015

5 Health expenditure Source: WHO. World Health Statistics 2015

New Challenges for health system 6

7 Forces Driving Health Reform Unaffordable access resulting from rising healthcare costs Continuously increasing more rapidly than GDP Still high level of economic burden by OOP Inequalities in health care Across regions and socioeconomic population groups Between urban and rural areas Higher expectation

8 Out-of-pocket payment (%) Source: Report on China’s Health Account Study, 2012

9 Health Care Reform Initiatives Aim: guaranteed access for every Chinese resident to basic health care By 2011: to obviously improve accessibility and effectively reduce medical expenditure burden To expand health insurance coverage To establish the National Essential Medicines system To strengthen the primary health services delivery system To promote basic public health programs To advance the public hospital reform pilot

Increasing Government Expenditure on Health Public health services Core basic package and local extended package Health insurance coverage and medical aids Financial subsidies for urban non-employed and rural farmers Public health institutions Infrastructure development Subsidies for personnel salary Subsides for specific reform initiatives, including implementing essential medicines system and public hospital reform Medical education and research 10

Social health insurance schemes 11 Source: Winnie Yip, et al. Lancet 2012

Universal health insurance coverage 12 Source ： Meng Q, et al. Lancet, 2012 Population Coverage Reimbursement level of Hospitalization expenditure

Success attributed to … Resource mobilization Increasing government expenditure on health used for infrastructure development and subsidies for vulnerable population Increasing personal contributions on healthcare through developing social and private health insurance schemes Incentives establishment and development Service purchasing through governments and HI agents Quality and efficiency concerns on public hospitals and suppliers Introduction and promotion of new technology and health system capacity building Challenge to tradeoff between value and expense 13

14 Problems in health financing Affordable universal coverage Informal workers and migrants Voluntary enrolment in RHI and NCMS Equality in access to health care and financial protection, e.g. OOP as percentage of income Contribution level Benefits package Increasing medical expenditure Fee-for-service method adopted to pay for medical care Failure to integrate between primary care and tertiary care Neglect of public hospitals towards quality and efficiency of health care Source: WHO Health Report, 2008

Life expectancy at birth (by province, in 2010) 15

Financial risk protection 16 Proportion of households with catastrophic health spending (>40% family income) Proportion of OOP relative to household spending Source ： Meng Q, et al. Lancet, 2012

17 Conclusions Great progress on achieving universal health insurance coverage and improving equity in financing and service utilization Still existing challenges and problems Needs further reforms in payment and services delivery More information can be found from China Health in Transition at