Commentary: China's changing health system: Implications for sexual and reproductive health

Assessment of progress towards sexual and reproductive health (SRH) in China requires the consideration of changes in separate health and family planning systems, as well as consideration of the transition from a command economy to a socialist market economy, led by a highly centralised political system, in the last three decades. Reform of the health system in the 1980s and 1990s encouraged marketisation of health services, while the rural Cooperative Medical Scheme (CMS) functioning during the 1960s and 1970s collapsed. Both health and gender equity were seriously damaged. The majority of the rural population paid for health services out of pocket, which impoverished many. Poor rural women suffered disproportionately because their access to basic reproductive health services was sharply curtailed (Fang, 2004). The Third Plenary Session of the 16th Central Committee of the Chinese Communist Party, held in fall 2003, attempted to ‘rebalance’ an overly economy-centred growth process towards a greater focus on social development (Fewsmith, 2004). This adjustment produced a number of health policies and programmes supporting greater equity. A new rural CMS was initiated in 2003 that has since provided basic medical insurance, covering maternal health care and institution-based delivery for rural populations, and by 2012 it covered 98% of the intended beneficiaries (Ministry of Health, People’s Republic of China, 2013). HIV testing and counselling, antiretroviral treatment, prevention of vertical transmission and care for AIDS orphans have been provided to all citizens free of charge since 2003 (Ministry of Foreign Affairs of the People’s Republic of China, United Nations System in China, 2010). In 2008, the government began to provide financial subsidies for rural women in the central and western areas to deliver in hospitals, and in 2009, this policy was expanded to cover all rural areas, resulting in a rapid increase in the rate of institutional delivery (Ministry of Health, People’s Republic of China, 2012). Also, in 2009, a new policy provided the framework for health sector development in future decades, including free provision of selected public health services for all citizens, covering maternal and child health care, and other SRH services such as screening for cervical and breast cancers (Ministry of Health, People’s Republic of China, 2012).