Current Status and Prospects Towards the Road of Universal Health Coverage (UHC) in China: a Systematic Review
Keywords:
Universal Health Coverage, Current Status and Prospects, Health System, China
Abstract
Background: Over the past decade, China has successfully extended its basic healthcare safety net to more than 95% of the population. The Chinese government aims to provide universal health coverage for all citizens by 2030. However, China still suffers from an inadequate tiered medical care system, lack of information sharing on hospital visits, and medical staff with low salaries and excessive overtime. This paper will further discuss China's current status and prospects in six building blocks of the WHO health system framework. Methods: We used various popular search engines, such as PubMed, Google, Google Scholar, etc., to identify studies on achieving universal health in China. The purpose of the search was to understand the state of the existing health system in China, especially in mobile health (mhealth), mental health, and medical personnel protection. Findings: We found nine articles related to health service delivery, three articles related to the medical workforce, four articles related to health information systems, three articles related to medical products, vaccines, and technologies, five articles related to health financing, and five articles related to health system management. Discussion: The findings based on the six health system building blocks are summarized in conjunction with other literature.
References
[1] (ADDCN) AoDDCoN. State restructuring and issues of local self governance in Nepal; 2008.
[2] World Health Organization. Health financing for universal health coverage. Geneva: World Health Organization; 2016.
[3] World Health Organization. Tracking universal health coverage: first global monitoring report. Geneva: World Health Organization; 2015.
[4] Clark J. Medicalization of global health 4: the universal health coverage campaign and the medicalization of global health. Glob Health Action. 2014; 7:24004.
[5] Stuckler D, Feigl AB, Basu S, McKee M. The political economy of universal health coverage. Background paper for the global symposium on health systems research. Geneva: World Health Organization; 2010.
[6] Bärnighausen T, Sauerborn R. One hundred and eighteen years of the German health insurance system: are there any lessons for middle-and low-income countries? Soc Sci Med. 2002; 54:1559–87.
[7] World Health Organization. Tracking universal health coverage: 2017 global monitoring report. Geneva: World Health Organization; 2017.
[8] Hogan DR, Stevens GA, Hosseinpoor AR, Boerma T. Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services. Lancet Glob Health. 2018; 6:e152–68.
[9] Sustainable Development Goals [Internet]. 2022 [cited 2022 6 Jun]. Available from: https://www.un.org/sustainabledevelopment/ sustainable-development-goals/
[10] Ranabhat CL, Atkinson J, Park MB, Kim CB, Jakovljevic M. The influence of universal health coverage on life expectancy at Birth (LEAB) and healthy life expectancy (HALE): a multi-country cross-sectional study. Front Pharmacol. 2018; 9:960.
[11] Ranabhat CL, Park MB, Kim CB, Kim CS, Jeong HS, Koh SB, et al. Influence of key health related indicators on adult mortality: result from UN member countries. Iran J Public Health. 2018; 47:794–802.
[12] Ranabhat CL, Kim CB, Park MB, Acharaya S. Multiple disparities in adult mortality in relation to social and health care perspective: results from different data sources. Global Health. 2017; 13:57.
[13] UHC2030_Global_Compact_WEB.pdf [Internet]. [cited 2022 Jun 7]. Available from: https://www.uhc2030.org/fileadmin/uploads/ uhc2030/Documents/About_UHC2030/mgt_arrangemts___docs/UHC2030_Official_documents/UHC2030_Global_Compact_WEB.pdf
[14] World Health Organization. The world health report 2013: research for universal health coverage. Geneva: World Health Organization; 2013.
[15] United Nations Population Fund. World population dashboard-China [Internet]. New York: UNFPA; 2022 [cited 2022 6 Jun]. Available from: https://www.unfpa.org/data/world- population/CN
[16] United Nations Development Programme. China: human development indicator [Internet]. New York: UNDP; 2020 [cited 2022 6 Jun]. Available from: https://hdr.undp.org/ en/countries/ profiles/CHN#
[17] Brown RE, Piriz DG, Liu Y, Moore J. Reforming health care in China: historical, economic, and comparative perspectives [Internet]. Ford School of Public Policy; 2012 [cited 2022 6 Jun].
Available from: http://sites.fordschool.umich.edu/china-policy/files/2012/07/PP 716_Final_Policy_Paper_Health-Final.pdf
[18] The World Bank. The World Bank in China [Internet]. Washington DC: The World Bank; 2022 [cited 2022 6 Jun]. Available from: https://www.worldbank.org/en/country/china
[19] Tao W, Zeng Z, Dang H, Lu B, Chuong L, Yue D, et al. Towards universal health coverage: lessons from 10 years of healthcare reform in China. BMJ Glob Health. 2020; 5:e002086.
[20] Hesketh T, Zhu WX. Health in China: from Mao to market reform. BMJ. 1997; 314:1543–5.
[21] Dobson A. Health care in China after Mao. Health Care Financ Rev. 1981; 2:41–53.
[22] Burns LR, Liu GG, editors. China's Healthcare System and Reform. Cambridge: Cambridge University Press; 2017.
[23] Hsiao W, Li M, Zhang S. China’s Universal Health Care Coverage. In: Yi I, editor. Towards Universal Health Care in Emerging Economies: Opportunities and Challenges [Internet].
London: Palgrave Macmillan UK; 2017 [cited 2022 Jun 7]. p. 239–66.
[24] Zhu C. China's latest health reforms: a conversation with Chinese health minister Chen Zhu. Interview by Tsung-Mei Cheng. Health Aff (Millwood). 2008;27(4):1103-10.
[25] 111202_Freeman_ImplementingChinaHealthReform_Web.pdf [Internet]. [cited 2022 Jun 7]. Available from: http://csis-website-prod.s3.amazonaws.com/s3fs-public/legacy_files/ files/publication/ 111202_Freeman_ImplementingChinaHealthReform_Web.pdf.
[26] Tu J. Health Care Transformation in Contemporary China [Internet]. Singapore: Springer Singapore; 2019 [cited 2022 Jun 7]. Available from: http://link.springer.com/10.1007/978- 981-13-0788-1
[27] Li L, Fu H. China's health care system reform: Progress and prospects. Int J Health Plann Manage. 2017;32(3):240-53.
[28] Li C, Tang C, Wang H. Investigating the association of health system characteristics and health care utilization: a multilevel model in China's ageing population. J Glob Health. 2020;10(2): 020802.
[29] Liang D, Mays VM, Hwang WC. Integrated mental health services in China: challenges and planning for the future. Health Policy Plan. 2018;33(1):107-22.
[30] Jiang F. [From survive to thrive: advancing early childhood development in China's maternal and child health system]. Zhonghua Er Ke Za Zhi. 2021;59(3):161-4.
[31] Zeng XJ, Zhou XD, Chen WX. [Development and improvement of Chinese oral public health system]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2020;55(6):361-6.
[32] Chai P, Wan Q, Kinfu Y. Efficiency and productivity of health systems in prevention and control of non-communicable diseases in China, 2008-2015. Eur J Health Econ. 2021;22(2):267-79.
[33] Zhang L, Cheng G, Song S, Yuan B, Zhu W, He L, et al. Efficiency performance of China's health care delivery system. Int J Health Plann Manage. 2017;32(3):254-63.
[34] Ta Y, Zhu Y, Fu H. Trends in access to health services, financial protection and satisfaction between 2010 and 2016: Has China achieved the goals of its health system reform? Soc Sci Med. 2020; 245:112715.
[35] Li C, Chen Z, Khan MM. Bypassing primary care facilities: health-seeking behavior of middle age and older adults in China. BMC Health Serv Res. 2021;21(1):895.
[36] Yao H, Zhan C, Sha X. Current situation and distribution equality of public health resource in China. Arch Public Health. 2020; 78:86.
[37] Shi B, Fu Y, Bai X, Zhang X, Zheng J, Wang Y, et al. Spatial Pattern and Spatial Heterogeneity of Chinese Elite Hospitals: A Country-Level Analysis. Front Public Health. 2021;9:710810.
[38] Hu D, Zhu W, Fu Y, Zhang M, Zhao Y, Hanson K, et al. Development of village doctors in China: financial compensation and health system support. Int J Equity Health. 2017;16(1):9.
[39] Li YQ, Chen H, Guo HY. Examining Inequality in the Public Health Workforce Distribution in the Centers for Disease Control and Prevention (CDCs) System in China, 2008-2017. Biomed Environ Sci. 2020;33(5):374-83.
[40] Yang SZ, Wu D, Wang N, Hesketh T, Sun KS, Li L, et al. Workplace violence and its aftermath in China's health sector: implications from a cross-sectional survey across three tiers of the health system. BMJ Open. 2019;9(9):e031513.
[41] Li X, Krumholz HM, Yip W, Cheng KK, De Maeseneer J, Meng Q, et al. Quality of primary health care in China: challenges and recommendations. Lancet. 2020; 395 (10239):1802-12.
[42] Wang L, Wang Z, Ma Q, Fang G, Yang J. The development and reform of public health in China from 1949 to 2019. Global Health. 2019;15(1):45.
[43] Tian M, Zhang X, Zhang J. mHealth as a health system strengthening tool in China. Int J Nurs Sci. 2020;7(Suppl 1):S19-s22.
[44] Feng X, Feng W, Shen P, Wang Z, Shen J, Wang B. The effect of the integrated delivery system in rural areas of China. Ann Palliat Med. 2021;10(3):3018-27.
[45] Gong D, Jiang Q, Chantler T, Sun FY, Zou J, Cheng J, et al. Health System Barriers and Facilitators to Delivering Additional Vaccines through the National Immunisation Programme in China: A Qualitative Study of Provider and Service-User Perspectives. Vaccines (Basel). 2021;9(5).
[46] Fang H, Yang L, Zhang H, Li C, Wen L, Sun L, et al. Strengthening health system to improve immunization for migrants in China. Int J Equity Health. 2017;16(1):19.
[47] Diao Y, Li M, Huang Z, Sun J, Chee YL, Liu Y. Unlocking Access To Novel Medicines In China-A Review From A Health System Perspective. Risk Manag Healthc Policy. 2019;12:357-67.
[48] Zhao Y, Atun R, Oldenburg B, McPake B, Tang S, Mercer SW, et al. Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data. Lancet Glob Health. 2020; 8(6): e840-e9.
[49] Zhao Y, Zhang P, Oldenburg B, Hall T, Lu S, Haregu TN, et al. The impact of mental and physical multimorbidity on healthcare utilization and health spending in China: A nationwide longitudinal population-based study. Int J Geriatr Psychiatry. 2021;36(4):500-10.
[50] Shu Z, Liu Y, Li M, Li J. The effects of health system reform on medical services utilization and expenditures in China in 2004-2015. Int Health. 2021;13(6):640-7.
[51] Zhao Y, Oldenburg B, Mahal A, Lin Y, Tang S, Liu X. Trends and socio-economic disparities in catastrophic health expenditure and health impoverishment in China: 2010 to 2016. Trop Med Int Health. 2020;25(2):236-47.
[52] Chen S, Kuhn M, Prettner K, Bloom DE, Wang C. Macro-level efficiency of health expenditure: Estimates for 15 major economies. Soc Sci Med. 2021;287:114270.
[53] Zhai T, Goss J, Dmytraczenko T, Zhang Y, Li J, Chai P. China's Health Expenditure Projections To 2035: Future Trajectory And The Estimated Impact Of Reforms. Health Aff (Millwood). 2019;38(5): 835-43.
[54] Xing C, Zhang R. COVID-19 in China: Responses, Challenges and Implications for the Health System. Healthcare (Basel). 2021; 9(1).
[55] Baru RV. Health systems preparedness during COVID-19 pandemic: China and India. Indian J Public Health. 2020; 64 (Supplement): S96-s8.
[56] Zhang P, Gao J. Evaluation of China's public health system response to COVID-19. J Glob Health. 2021;11:05004.
[57] Yuan B, Jian W, Martinez-Alvarez M, McKee M, Balabanova D. Health system reforms in China a half century apart: Continuity but adaptation. Soc Sci Med. 2020;265:113421.
[58] Hort K, Jayasuriya R, Dayal P. The link between UHC reforms and health system governance: lessons from Asia. J Health Organ Manag. 2017;31(3):270-85.
[60] Xu J, Shi Y, Cheng F, Liang W. China's public health system: time for improvement. Lancet Public Health. 2021;6(12):e869-e70.
[61] Tian M, Zhang X, Zhang J. mHealth as a health system strengthening tool in China. Int J Nurs Sci. 2020;7(Suppl 1):S19-s22.
[2] World Health Organization. Health financing for universal health coverage. Geneva: World Health Organization; 2016.
[3] World Health Organization. Tracking universal health coverage: first global monitoring report. Geneva: World Health Organization; 2015.
[4] Clark J. Medicalization of global health 4: the universal health coverage campaign and the medicalization of global health. Glob Health Action. 2014; 7:24004.
[5] Stuckler D, Feigl AB, Basu S, McKee M. The political economy of universal health coverage. Background paper for the global symposium on health systems research. Geneva: World Health Organization; 2010.
[6] Bärnighausen T, Sauerborn R. One hundred and eighteen years of the German health insurance system: are there any lessons for middle-and low-income countries? Soc Sci Med. 2002; 54:1559–87.
[7] World Health Organization. Tracking universal health coverage: 2017 global monitoring report. Geneva: World Health Organization; 2017.
[8] Hogan DR, Stevens GA, Hosseinpoor AR, Boerma T. Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services. Lancet Glob Health. 2018; 6:e152–68.
[9] Sustainable Development Goals [Internet]. 2022 [cited 2022 6 Jun]. Available from: https://www.un.org/sustainabledevelopment/ sustainable-development-goals/
[10] Ranabhat CL, Atkinson J, Park MB, Kim CB, Jakovljevic M. The influence of universal health coverage on life expectancy at Birth (LEAB) and healthy life expectancy (HALE): a multi-country cross-sectional study. Front Pharmacol. 2018; 9:960.
[11] Ranabhat CL, Park MB, Kim CB, Kim CS, Jeong HS, Koh SB, et al. Influence of key health related indicators on adult mortality: result from UN member countries. Iran J Public Health. 2018; 47:794–802.
[12] Ranabhat CL, Kim CB, Park MB, Acharaya S. Multiple disparities in adult mortality in relation to social and health care perspective: results from different data sources. Global Health. 2017; 13:57.
[13] UHC2030_Global_Compact_WEB.pdf [Internet]. [cited 2022 Jun 7]. Available from: https://www.uhc2030.org/fileadmin/uploads/ uhc2030/Documents/About_UHC2030/mgt_arrangemts___docs/UHC2030_Official_documents/UHC2030_Global_Compact_WEB.pdf
[14] World Health Organization. The world health report 2013: research for universal health coverage. Geneva: World Health Organization; 2013.
[15] United Nations Population Fund. World population dashboard-China [Internet]. New York: UNFPA; 2022 [cited 2022 6 Jun]. Available from: https://www.unfpa.org/data/world- population/CN
[16] United Nations Development Programme. China: human development indicator [Internet]. New York: UNDP; 2020 [cited 2022 6 Jun]. Available from: https://hdr.undp.org/ en/countries/ profiles/CHN#
[17] Brown RE, Piriz DG, Liu Y, Moore J. Reforming health care in China: historical, economic, and comparative perspectives [Internet]. Ford School of Public Policy; 2012 [cited 2022 6 Jun].
Available from: http://sites.fordschool.umich.edu/china-policy/files/2012/07/PP 716_Final_Policy_Paper_Health-Final.pdf
[18] The World Bank. The World Bank in China [Internet]. Washington DC: The World Bank; 2022 [cited 2022 6 Jun]. Available from: https://www.worldbank.org/en/country/china
[19] Tao W, Zeng Z, Dang H, Lu B, Chuong L, Yue D, et al. Towards universal health coverage: lessons from 10 years of healthcare reform in China. BMJ Glob Health. 2020; 5:e002086.
[20] Hesketh T, Zhu WX. Health in China: from Mao to market reform. BMJ. 1997; 314:1543–5.
[21] Dobson A. Health care in China after Mao. Health Care Financ Rev. 1981; 2:41–53.
[22] Burns LR, Liu GG, editors. China's Healthcare System and Reform. Cambridge: Cambridge University Press; 2017.
[23] Hsiao W, Li M, Zhang S. China’s Universal Health Care Coverage. In: Yi I, editor. Towards Universal Health Care in Emerging Economies: Opportunities and Challenges [Internet].
London: Palgrave Macmillan UK; 2017 [cited 2022 Jun 7]. p. 239–66.
[24] Zhu C. China's latest health reforms: a conversation with Chinese health minister Chen Zhu. Interview by Tsung-Mei Cheng. Health Aff (Millwood). 2008;27(4):1103-10.
[25] 111202_Freeman_ImplementingChinaHealthReform_Web.pdf [Internet]. [cited 2022 Jun 7]. Available from: http://csis-website-prod.s3.amazonaws.com/s3fs-public/legacy_files/ files/publication/ 111202_Freeman_ImplementingChinaHealthReform_Web.pdf.
[26] Tu J. Health Care Transformation in Contemporary China [Internet]. Singapore: Springer Singapore; 2019 [cited 2022 Jun 7]. Available from: http://link.springer.com/10.1007/978- 981-13-0788-1
[27] Li L, Fu H. China's health care system reform: Progress and prospects. Int J Health Plann Manage. 2017;32(3):240-53.
[28] Li C, Tang C, Wang H. Investigating the association of health system characteristics and health care utilization: a multilevel model in China's ageing population. J Glob Health. 2020;10(2): 020802.
[29] Liang D, Mays VM, Hwang WC. Integrated mental health services in China: challenges and planning for the future. Health Policy Plan. 2018;33(1):107-22.
[30] Jiang F. [From survive to thrive: advancing early childhood development in China's maternal and child health system]. Zhonghua Er Ke Za Zhi. 2021;59(3):161-4.
[31] Zeng XJ, Zhou XD, Chen WX. [Development and improvement of Chinese oral public health system]. Zhonghua Kou Qiang Yi Xue Za Zhi. 2020;55(6):361-6.
[32] Chai P, Wan Q, Kinfu Y. Efficiency and productivity of health systems in prevention and control of non-communicable diseases in China, 2008-2015. Eur J Health Econ. 2021;22(2):267-79.
[33] Zhang L, Cheng G, Song S, Yuan B, Zhu W, He L, et al. Efficiency performance of China's health care delivery system. Int J Health Plann Manage. 2017;32(3):254-63.
[34] Ta Y, Zhu Y, Fu H. Trends in access to health services, financial protection and satisfaction between 2010 and 2016: Has China achieved the goals of its health system reform? Soc Sci Med. 2020; 245:112715.
[35] Li C, Chen Z, Khan MM. Bypassing primary care facilities: health-seeking behavior of middle age and older adults in China. BMC Health Serv Res. 2021;21(1):895.
[36] Yao H, Zhan C, Sha X. Current situation and distribution equality of public health resource in China. Arch Public Health. 2020; 78:86.
[37] Shi B, Fu Y, Bai X, Zhang X, Zheng J, Wang Y, et al. Spatial Pattern and Spatial Heterogeneity of Chinese Elite Hospitals: A Country-Level Analysis. Front Public Health. 2021;9:710810.
[38] Hu D, Zhu W, Fu Y, Zhang M, Zhao Y, Hanson K, et al. Development of village doctors in China: financial compensation and health system support. Int J Equity Health. 2017;16(1):9.
[39] Li YQ, Chen H, Guo HY. Examining Inequality in the Public Health Workforce Distribution in the Centers for Disease Control and Prevention (CDCs) System in China, 2008-2017. Biomed Environ Sci. 2020;33(5):374-83.
[40] Yang SZ, Wu D, Wang N, Hesketh T, Sun KS, Li L, et al. Workplace violence and its aftermath in China's health sector: implications from a cross-sectional survey across three tiers of the health system. BMJ Open. 2019;9(9):e031513.
[41] Li X, Krumholz HM, Yip W, Cheng KK, De Maeseneer J, Meng Q, et al. Quality of primary health care in China: challenges and recommendations. Lancet. 2020; 395 (10239):1802-12.
[42] Wang L, Wang Z, Ma Q, Fang G, Yang J. The development and reform of public health in China from 1949 to 2019. Global Health. 2019;15(1):45.
[43] Tian M, Zhang X, Zhang J. mHealth as a health system strengthening tool in China. Int J Nurs Sci. 2020;7(Suppl 1):S19-s22.
[44] Feng X, Feng W, Shen P, Wang Z, Shen J, Wang B. The effect of the integrated delivery system in rural areas of China. Ann Palliat Med. 2021;10(3):3018-27.
[45] Gong D, Jiang Q, Chantler T, Sun FY, Zou J, Cheng J, et al. Health System Barriers and Facilitators to Delivering Additional Vaccines through the National Immunisation Programme in China: A Qualitative Study of Provider and Service-User Perspectives. Vaccines (Basel). 2021;9(5).
[46] Fang H, Yang L, Zhang H, Li C, Wen L, Sun L, et al. Strengthening health system to improve immunization for migrants in China. Int J Equity Health. 2017;16(1):19.
[47] Diao Y, Li M, Huang Z, Sun J, Chee YL, Liu Y. Unlocking Access To Novel Medicines In China-A Review From A Health System Perspective. Risk Manag Healthc Policy. 2019;12:357-67.
[48] Zhao Y, Atun R, Oldenburg B, McPake B, Tang S, Mercer SW, et al. Physical multimorbidity, health service use, and catastrophic health expenditure by socioeconomic groups in China: an analysis of population-based panel data. Lancet Glob Health. 2020; 8(6): e840-e9.
[49] Zhao Y, Zhang P, Oldenburg B, Hall T, Lu S, Haregu TN, et al. The impact of mental and physical multimorbidity on healthcare utilization and health spending in China: A nationwide longitudinal population-based study. Int J Geriatr Psychiatry. 2021;36(4):500-10.
[50] Shu Z, Liu Y, Li M, Li J. The effects of health system reform on medical services utilization and expenditures in China in 2004-2015. Int Health. 2021;13(6):640-7.
[51] Zhao Y, Oldenburg B, Mahal A, Lin Y, Tang S, Liu X. Trends and socio-economic disparities in catastrophic health expenditure and health impoverishment in China: 2010 to 2016. Trop Med Int Health. 2020;25(2):236-47.
[52] Chen S, Kuhn M, Prettner K, Bloom DE, Wang C. Macro-level efficiency of health expenditure: Estimates for 15 major economies. Soc Sci Med. 2021;287:114270.
[53] Zhai T, Goss J, Dmytraczenko T, Zhang Y, Li J, Chai P. China's Health Expenditure Projections To 2035: Future Trajectory And The Estimated Impact Of Reforms. Health Aff (Millwood). 2019;38(5): 835-43.
[54] Xing C, Zhang R. COVID-19 in China: Responses, Challenges and Implications for the Health System. Healthcare (Basel). 2021; 9(1).
[55] Baru RV. Health systems preparedness during COVID-19 pandemic: China and India. Indian J Public Health. 2020; 64 (Supplement): S96-s8.
[56] Zhang P, Gao J. Evaluation of China's public health system response to COVID-19. J Glob Health. 2021;11:05004.
[57] Yuan B, Jian W, Martinez-Alvarez M, McKee M, Balabanova D. Health system reforms in China a half century apart: Continuity but adaptation. Soc Sci Med. 2020;265:113421.
[58] Hort K, Jayasuriya R, Dayal P. The link between UHC reforms and health system governance: lessons from Asia. J Health Organ Manag. 2017;31(3):270-85.
[60] Xu J, Shi Y, Cheng F, Liang W. China's public health system: time for improvement. Lancet Public Health. 2021;6(12):e869-e70.
[61] Tian M, Zhang X, Zhang J. mHealth as a health system strengthening tool in China. Int J Nurs Sci. 2020;7(Suppl 1):S19-s22.
Published
2022-11-02
Issue
Section
Original Research Article
Copyright (c) 2022 Hanying Huang
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors submitting to USP journals agree to publish their manuscript under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0) where authors agree to allow third parties to share their work (copy, distribute, transmit) and to adapt it, under the condition that the authors are given credit, and that in the event of reuse or distribution, the terms of this license are made clear
Authors retain copyright of their work, with first publication rights (online and print) granted to Universe Scientific Publishing or the owner of the journal in question.
