Challenges to the Chinese Health Insurance System: Users’ and Service Providers’ Perspectives

Editorial To achieve universal health insurance coverage, China has launched three phases of health care system reforms. The first round of reforms was embarked on in the mid-1980s with the introduction of market incentives. The second round began in 1997 with the introduction of the Urban Employee Basic Medical Insurance (UEBMI) scheme which provided health insurance coverage to all urban workers in addition to a long-term/historical scheme for government workers. Both the government and UEBMI schemes were limited to individual enrolment; however, dependents such as a spouse or child were not covered. The third phase of reforms began in 2003 with the launch of the New Rural Cooperative Medical Care System (NRCMS). This system covers rural residents at the household level. In 2007, the Urban Resident Basic Medical Insurance (URBMI) program was introduced that further expanded the insurance coverage to unemployed urban residents. [1] UEBMI, URBMI, and NRCMS are acknowledged as basic medical insurance (BMI) and all schemes require payment of enrolment premiums. Both the BMI and government payment systems employ co-payment rates that vary between plans and jurisdictions. In addition to co-payment, there are deductibles and annual ceilings in the BMI system. As of 2011, the government insurance scheme and the BMI system covered 95% of the Chinese population, up from 15% at the start of the third phase of reforms. The remaining 5% of the population were covered by commercial insurance or must fully self-fund their medical treatment. Remarkable health outcomes have been achieved since the start of the health care reforms. The infant mortality rate has fallen from 34/1000 live births to 11/1000 live births between 1982 and 2013; while life expectancy has simultaneously increased from 68 years and 75 years. However, there are still some concerns. First, total health expenditures, and in turn, the proportion of the gross domestic product (GDP) spent on health has increased markedly since the early 1990s. [6] However, second, health insurance only accounted for approximately one fifth of the total health expenditures due to deductibles, co-payment rates, and ceilings, the remaining was mostly paid by out-of-pocket (OOP). The increasing health expenditure proportion of income has triggered a healthcare inequity issue with more households exposed to the risk of high payments when confronting catastrophic illness. Normally, three main parties are involved in the healthcare system: healthcare users (patients), healthcare providers (such as hospitals), and the government. The government in particular plays an …