Towards universal health coverage: China lessons learned

In view of significant progress made in improving the health status of the population through Universal Coverage of primary health care services in China, the WHO Country Office in China has organized a high level visit of senior government officials from the Mekong countries to share the experience of China in its health reform.

Funded by the UK Department for International Development (DFID) and implemented through the Center for Project Supervision and Management of the National Health and Family Planning Commission, the visit, from 8-12 April 2013, involved a high level meeting in Beijing and a 3 day visit to the province of Henan, one of the provinces that have successfully implemented the pillars of China’s health reform.

A WHO-organized Roundtable Meeting on universal health coverage took place in Beijing on 8 April 2013, with participants from six Mekong countries, and colleagues from DFID and WB

Seventy international and national participants from six Mekong countries including China, Cambodia, Lao People’s Democratic Republic (LPDR), Myanmar, Thailand and Vietnam participated in the study visit. These participants were from health, planning, finance, insurance, parliamentarians and representatives of international organizations.

The participants recognized China’s political commitment to universal health coverage. A comprehensive three-year reform plan (2009-2011) was implemented aiming at covering all urban and rural populations with safe, effective, convenient and low cost health services, and followed by continuous reform effort under the 12th Five-Year Plan (2011-2015) with a massive investment into the health sector.

Dr Michael O’Leary, WHO Representative in China made opening remarks at the Roundtable Meeting for sharing China’s experiences on health care reform and universal health coverage

By the end of 2011, significant achievements were realized, including health insurance coverage of more than 1.28 billion people (more than 95% of the total population); free public health package provided to the majority of families; and improvement of health indicators and equity.

The leading role and responsibility of the government in the provision of basic services for health is carried on responsibly at all levels (central, provincial, municipal and village). One of the notable good practices is the use of operational guidelines that are clearly written at all levels. These guidelines have provided a basic standard course of action for all stakeholders, and indicators by which progress and performance can be measured.

In Henan Province, one of the provinces where Rural Health Development project was implemented with support from DFID and the World Bank, 12 items of free public health services have been provided to all targeted populations by government purchasing, contract management and performance-based pay to ensure quality and efficiency. The New Rural Cooperative Medical Scheme covered more than 97.7% of the rural population. For public hospitals reform, the provincial government introduced clinical pathways and provider payment by disease groups for improving service quality and containing medical costs.

To ensure quality health service delivery, contracts have been uniformly managed with the use of specifications for tasks appraisal standards, and performance indicators. The payment system has also been used as leverage to ensure quality assurance - the use of performance standard and reform in the management, regulation and control of adverse behaviour and practices.

The participants visited the Henan Provincial Health Bureau, Peoples Hospital of Yiyang County, Health Centre of Xianglushan Township, Health Clinic of Suoying Village, and People’s Hospital of Dengfeng City, to meet with senior government and health officials and share experiences.

In the People’s Hospital of Dengfeng, a public secondary hospital, the participants noted that clinical pathways are used for every treatment encounter, and the application of these is monitored in real time via computer monitors. Any deviation to the clinical pathway is recorded.

The patients are well informed for both the course and cost of their treatment via the clinical pathways. The pathways therefore have served as a good mechanism, not only to standardize, monitor and assure the quality of care, but also to reduce information asymmetries between the health service providers and patients.

The Rural Health Reform Project (2009-2013) was jointly funded by China government, the World Bank and UK DFID to implement health care reform. It covered 40 counties in eight provinces (Jiangsu, Heilongjiang, Henan, Shanxi, Chongqing, Qinghai, Shaanxi and Gansu), extending from the eastern to the middle and the western regions of China.

Experts actively participated in the opening session of the Roundtable Meeting in Beijing on 8 April 2013

During this high level visit, Mekong countries also shared their own country experience. Each country has its own way to achieve universal health coverage. For example, In Vietnam health insurance was initiated in 1992 and a health insurance law came into effect on 1 July 2009. Its health insurance covered 62% population in 2010. It intends to include formal and informal sectors into a single national pool of insurance fund. It also made efforts to improve primary health care and applied capitation payment for primary health care.

All Mekong countries have strong policy direction to achieve universal health coverage and health sector reform. The lessons learned during this visit will be helpful in strengthening the health systems in the participants’ own countries.

For more information, please contact

Helen Yu
Communications Officer, WHO in China
Tel: +86 10 65327191
E-mail: yuji@wpro.who.int

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