Towards universal health coverage via social health insurance in China: Systemic fragmentation, reform imperatives, and policy alternatives

Jingwei Alex HE, Shaolong WU

Research output: Contribution to journalArticles

25 Citations (Scopus)

Abstract

China’s remarkable progress in building a comprehensive social health insurance (SHI) system was swift and impressive. Yet the country’s decentralized and incremental approach towards universal coverage has created a fragmented SHI system under which a series of structural deficiencies have emerged with negative impacts. First, contingent on local conditions and financing capacity, benefit packages vary considerably across schemes, leading to systematic inequity. Second, the existence of multiple schemes, complicated by massive migration, has resulted in weak portability of SHI, creating further barriers to access. Third, many individuals are enrolled on multiple schemes, which causes inefficient use of government subsidies. Moral hazard and adverse selection are not effectively managed. The Chinese government announced its blueprint for integrating the urban and rural resident schemes in early 2016, paving the way for the ultimate consolidation of all SHI schemes and equal benefits for all. This article proposes three policy alternatives to inform the consolidation: (1) a single-pool system at the prefectural level with significant government subsidies, (2) a dual-pool system at the prefectural level with risk-equalization mechanisms, and (3) a household approach without merging existing pools. Vertical integration to the provincial level is unlikely to happen in the near future. Two caveats are raised to inform this transition towards universal health coverage. Copyright © 2016 Springer International Publishing.
Original languageEnglish
Pages (from-to)707-716
JournalApplied Health Economics and Health Policy
Volume15
Issue number6
Early online dateJun 2016
DOIs
Publication statusPublished - Dec 2017

Citation

He, A. J., & Wu, A. (2017). Towards universal health coverage via social health insurance in China: Systemic fragmentation, reform imperatives, and policy alternatives. Applied Health Economics and Health Policy, 15(6), 707-716.

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