Chinese Government response to health inequality
Every five years the National People’s Congress outlines the government’s strategy to deal with issues affecting the country. In 2016 they announced the ‘Healthy China 2030’ initiative.
Health China 2030, is the Chinese government’s health care approach to improve the health of the nation and bring positive outcomes globally.
Health is a key part of all government decisions, and policies. It aims to build community facilities and increase the number of GPs per 10,000 people, to improve healthcare accessibility.
Parents are encouraged to set up pre-payment savings accounts for their children to cover future medical issues. There is also free public healthcare under the social insurance plan. (Source: World Health Organisation)
Inequality of medical insurance coverage
There is more than one system of medical insurance in China. Urban Employee Basic Medical Insurance is paid for by employers and employees and is better funded. Those not able access this sign up to the Urban-Rural Resident Basic Medical Insurance. Individuals pay into this but it is subsidised by central and local government.
Medical insurance is set up to pay hospitals or clinics directly to cover a worker's medical costs. But in most cases individuals have to pay for treatment themselves, claiming the costs back later. This can prove a barrier to treatment for poorer people.
Only treatments on a government-approved list are funded. Individuals need to pay for other treatments themselves.
There is a limit on how much medical insurance pays out. Individuals have to pay for any additional treatment themselves.
Urban employee insurance covers a higher percentage of costs than the more basic urban-rural resident's insurance.
This creates an unequal health system, where those in rural areas, and many migrant workers and workers in the gig-economy are not able to sign up to the same level of insurance coverage as urban employees. Although they are likely to be poorer, they are likely to have to pay more for medical treatment.
Regional inequality in healthcare
There is still inequality of levels of quality healthcare across China. A 2022 study found that the distribution of quality hospitals across China resulted in a Gini index of 0.745 (0 represents complete equality, 1.0 complete inequality). Provinces in the north and west of the country had much poorer access to quality hospitals than those in the south and east.
The Chinese Goverment has tried to address regional inequality in healthcare, for example:
- sponsoring training for rural doctors in urban hospitals
- including some residential training in rural health facilities for new medical graduates
Healthcare for women in China
Healthcare for women has improved dramatically in China over the last 50 years.
One of the biggest improvemens has been around maternity care. In 1990, the maternal mortality rate was 88.8 per 100,000 live births. By 2020 this had fallen to 16.9 for 100,000 live births.
Policies that have contributed to this fall include:
- maternity insurance is one of the five main programmes in China's social insurance system - it coves medical costs and provides some income
- maternal healthcare, including care before and after birth is provided across the country, including rural areas
- the government has promoted hospital deliveries, which accounted for 99.9% of all births in 2020
Recently, maternity insurance has been merged with medical insurance so it is funded out of the same pot. As the government pushes to reverse falling birth rates, maternity insurance will require more funding, and this policy aims to make funding of maternity care more secure.
