Читать книгу The Political Economy of the BRICS Countries - Группа авторов - Страница 83

China’s success in UHC has been hailed as extraordinary, and China has been the focus of many studies since it started its reform process in 2009 (Yip et al., 2012; Yu, 2015), when it announced its Health Care System Reform. The Implementation Plan for the Recent Priorities of the Health Care System Reform visualized the provision of affordable medical care for all its citizens by 2020.⁵ The reform envisaged a complete overhaul of China’s healthcare system, and addressed all aspects of the health system. Particular focus was given to the grassroots medical networks, infrastructure, personnel, hospital reforms, and drugs and medicines.

Earlier, China had a well-performing system of rural health care, and the Rural Cooperative Medical Schemes (RCMS) was seen as a success. Social insurance and barefoot doctors made the rural health system a sturdy one (Wan and Wan, 2010). However, the move towards market economy resulted in major reversals and the system witnessed high OOPS, stemming mainly from the government’s omission to address the health system while it transited to a market economy (Yip et al., 2012).

Currently, China operates a three-level medical service system: national level, province level, and county level. It has three main coverage systems: the Urban Employee Basic Medical Insurance (UEBMI), the New Cooperative Medical Scheme (NCMS), and the Urban Resident Basic Medical Insurance (URBMI). These programs are run in a parallel manner, without resource or service pooling. It also has an essential drug program which has resulted in significant reduction in OOPS.

One main feature of the reforms was to double annual public health spending, which was necessary to achieve the goals set out in its vision for health sector reform. Thus, unlike Brazil, China has moved towards reforms by greatly augmenting its current level of spending. It has also managed to strengthen the primary health care system and bring down OOPS in a relatively short time (World Bank, 2016).

However — as in the case of Brazil — China also is facing challenges in terms of rising costs due to shift in disease patterns and others concerns like quality of services and provider incentives. It has been argued that China’s health system is hospital-centric and volume-driven, with quality concerns (World Bank, 2016). However, these concerns have been recognized by the government, and in 2015 a national strategy named “Healthy China” was endorsed which will guide the next phase of reforms (World Bank, 2016). China is an example of a country that has given serious prioritization to health, as displayed by the huge investment made in the health sector and the series of reforms that continues to take place in the country.