Throughout most of the 20th century China struggled with their healthcare systems but by the year 2000, China started to make reforms that greatly improved its healthcare. Before the changes started around only 20% had some form of health insurance but by 2011 95% of the population had basic coverage. Currently, China has two healthcare programs. There is the Urban Employee Basic Medical Insurance which was created in 1998. This type of coverage is mandatory for urban residents with formal jobs. It is mostly funded through payroll taxes by the employer and employee. There were 316.8 million covered by employee-based insurance in 2018.
The other type of healthcare coverage is the Urban-Rural Resident Basic Medical Insurance which was formed in 2016 by combining two other programs. This insurance is voluntary and covers rural and urban residents like those who are self-employed, without a formal job, children and the elderly. 897.4 million people in 2018 were covered under this program. Healthcare in China is not mandatory and the vast majority of the people are covered by one of the programs mentioned above. There are private insurances available but are mostly only affordable by the wealthier urban residents.
Healthcare in China is covered and controlled by central and local government agencies. What is covered by insurance is typically determined by the local government. Basic coverage usually includes; traditional Chinese medicine, mental health, emergency care, prescription drugs, inpatient care and primary/specialist care. Maternity care is covered by a separate insurance plan. There is also some preventative care that is covered separately by the government that everyone is entitled to such as immunizations.
Even though most healthcare in China is provided by the government there is still cost sharing and out-of-pocket costs which can be quite high. Public insurance programs only reimburse patients up to a certain point then residents are required to cover all out-of-pockets costs. The reimbursement ceilings are a lot lower for outpatient than for inpatient care. The costs to patients depend on a few different factors such as region, type of hospital and insurance plan. Around 29% of healthcare costs were paid by individuals in 2018 with a high percentage of that being the cost of prescriptions. While it is still much higher than other countries like Japan (12.8), France (9.3) and the U.S (10.6), it is significantly lower than it used to be.
There are a couple different options available for those who cannot afford the premiums for health insurance or out-of-pocket costs. There’s the medical financial assistance program which is funded by local governments, and social donations. The assistance funds are mostly used to pay for copayments, deductibles, premiums and costs that exceed the annual caps. In 2018, around 3.8% of the population received aid for direct health expenses and 5.5% got assistance for health insurance enrollment.
Over the last two decades China has improved its healthcare systems and the health of its citizens every year. Life expectancy has gone up, infectious diseases have gone down and healthcare is much more widely available. Where they once had high birth/death rates they now have low birth/ death rates. One of the areas of focus has been on reducing child mortality and they have managed one of the fastest rates of decline in history. For the past 20 years, the death rate for children under 5 has gone down by 9% a year. China may have the appearance of providing universal healthcare but in reality, it only provides the most basic of coverage and can leave its citizens with crippling out-of-pocket costs.
In China, the quality of care can greatly differ depending on insurance plans and location. Healthcare that patients receive in larger urban centers is much better than that in smaller townships and rural areas. The hospitals and doctors are also better in urban areas. In the more rural parts of the country, there are often just clinics and village doctors with less education than their city counterparts. However, there are programs through medical schools to ensure that rural clinics are staffed with healthcare workers by providing discounts and scholarships. Healthcare is also cheaper at community hospitals and village clinics than with a General Practitioner at an upper level hospital.
There are many differences between healthcare in China and of that in the United States. While both have high out-of-pocket costs China at least has very basic coverage for its citizens. One of the biggest differences is in the quality of care. In China it varies greatly depending on location and hospital type but in the U.S a patient can reasonably expect the same quality no matter the hospital. There is a standard quality of care in the U.S that China doesn’t seem to have. China does have better maternal death rates than the U.S which is among the highest for a developed nation. Despite all the changes that China has made in the last couple of decades it still has a way to go with its healthcare but they are continuing to improve it.