China achieves basic healthcare for all eight years ahead of plan
17 September 2012
Following a national healthcare reform programme, China has
extended basic healthcare access to more than 95% of its 1.35 billion
population eight years ahead of schedule.
The aim of the reform — at a total cost of 850 billion Chinese
Yuan (CNY) or about US$133.5 billion — was to achieve universal
healthcare coverage for the entire population by 2020.
Only a decade back, health insurance coverage was mainly for
those working in urban areas under a formal employer-employee
relationship. In 2003 and again in 2007, the government launched two
schemes to extend coverage to rural populations and to non-working
urban residents. First, the healthcare budget was increased by 30%
each year between 2008 and 2011. A large proportion of these
resources were invested in staff training and enhancement of local
The government invested CNY63 billion in rural areas to support
the construction or improvement of over 2,200 county-level
hospitals, some 6,200 central township clinics and 25,000 village
clinics. CNY4.15 billion was also invested in urban areas to support
the construction and improvement of almost 2,400 community
The government also provided technical assistance to 127 training
centres where 36,000 healthcare staff received training as general
practitioners. More than 10,000 medical students were admitted by
various medical colleges for training free of charge. These students
went on to work in township clinics in the less-developed central
and western regions of China.
In addition, basic medicines are now sold at the same price
across the country. This practice prevents hospitals from
overcharging its patients. Pharmaceutical companies were also asked
to start bidding for contracts, which led to a 30% reduction in the
price of basic medicines.
Helping the “Three No” people
The new system is aimed especially at people with no resources,
no ability to work and no one to support them (the so-called “Three
No” people). It also entitles them to equal access to basic
The old system was unaffordable for most rural and non-working
urban residents, as well as for old and disabled people. Local
governments now fully cover the individual health-insurance
contributions of the latter group.
The rapid extension of health insurance in China can also be
attributed to the 2010 Social Insurance Law, to which the ILO
provided technical assistance.
“Due to the extension of health insurance in the most populous
country in the world, the global social security gap has been
significantly reduced”, said Hu.
“The Chinese experience shows that political will and financial
commitments play a key role in extending health insurance schemes to
vulnerable social groups. It can serve as an example for good
practice to other countries in a similar situation”, concluded Hu.
But the ILO expert cautions that “some insured people — despite
receiving government subsidies — are still unable to benefit from
coverage as they still bear an important part of the costs for
medical treatment and have limited access to good-quality health
services. This is particularly true for the rural areas, where there
are only 1.32 health workers per 1,000 people, compared to more than
8 and 20 per 1,000 in Brazil and Switzerland, respectively”.
Another challenge is China’s rapidly ageing population. The share
of the population aged 65 years and older will increase from 8 per
cent today (about 100 million) to about 14 per cent in 2025 (some
200 million). The number of frail and sick elderly people will
increase accordingly and with it, the costs for the health insurance
A new partnership agreement between the ILO and China was signed
in June 2012. Under the agreement, the ILO and China will work more
closely together. This partnership will also extend to the field of
social insurance, thus contributing to the extension of social