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Universal Health Coverage: International Movement and Chinese Practice

“Universal health coverage is not about providing every person with free medical care. This target can never be achieved. It’s more about allocating medical resources in the healthcare field according to people’s needs and allowing countries to do this in varying ways according to their abilities.” Liu Yuanli, one of the founders of the the U.S.-China Health Summit, Dean of the School of Public Health of Peking Union Medical College, and President of Chinese Aging Well Association, summarized China’s situation as above at the 8th U.S.-China Health Summit on October 12th to response the global campaign of Universal Health Coverage.

LIU Yuanli, Dean, School of Public Health, CAMS & PUMC; President, Chinese Aging Well Association

"Universal Health Coverage: International Movement and Chinese Practice"

China Practices the Declaration of Alma-Atain in a Different Way

The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care in 1978 to protect and promote the health of all people in the world. The goal of “Primary Health for All by the Year 2000” was also presented in the conference.

Over the past 40 years, China has practiced the Declaration of Alma-Ata in a different way. China was once a seriously poor country with a huge population, and its economy had been in a far worse state in the world for a long time since the founding of the People’s Republic of China. “Despite of poverty status in the country and a low per capita income, the average life expectancy in China surpassed the world’s average in the early 1970s because we attached great importance to primary healthcare, valued universal coverage and took measures in advance to prevent problems before they happen.” Liu also stressed that the other side of the coin should be seen: compared with miraculous economy growth, the development of health care in China is relatively lagging behind.

In the first two decades since China started to reform and open up, explosive economic growth and medical and health care development had been witnessed. But Liu Yuanli recalled and analyzed that medical and health protection system’s being seriously lagging behind remained a problem at that time. In 1978, people needed to pay 20% of their total healthcare spending, but this number flied to 60% in 2000. Due to high cost of healthcare and medical services, illness-led poverty remained a major problem in the 1980s and 1990s.

Establish World’s Largest Basic Healthcare and

Medical Insurance Scheme within 20 Years

In 2000, the United Nations proposed the Millennium Development Goals (MDGS). This is the first time in human history that all countries set the strategic goals of common and peaceful development together for the next 15 years. China’s practice of universal health coverage contains two stages during the past target-driven 20 years. In the first phase, the focus is on universal coverage of basic healthcare and medical insurance. In the second phase, the work is mainly on universal coverage of basic public health services.

Liu analyzed that if the work could start to be carried out from urban to rural areas at the end of the 1990s, the goal of establishing a world’s largest basic universal healthcare and medical insurance scheme that covers basic medical insurance, critical illness insurance, medical assistance and commercial insurance could be basically achieved by 2013.

Goals of Universal Health Coverage, which is defined by the World Health Organization as ‘all people receiving quality health services’ cannot be achieved overnight. Progress is going to be made from the most vulnerable groups and people with the most urgent needs to all. Meanwhile, more services are to be covered in the scheme, and higher degrees of protection to be achieved. Liu pointed out that Universal health coverage is not about providing every person with free medical care. This target can never be achieved. It’s more about allocating medical resources in the healthcare field according to people’s needs and allowing countries to do this in varying ways according to their abilities and contributions.

Professor Liu Yuanli analyzed China’s healthcare expenditures over the past decades and summed up the achievements made in the universal coverage of basic medical insurance. “Achievements are mainly reflected in the significant decline in the proportion of people’s spending by themselves in total healthcare expenditures which jumped from 60% to around 30% in 2016. So, it can be said that worthy progress has been made in universal medical insurance coverage in the first phase of Universal Health Coverage.”

Three Major Challenges Facing Universal Health Coverage

In front of three major challenges: the spurt outbreak of chronic diseases, aging of the population which makes chronic diseases a bigger challenge, and imbalanced resources allocation, Liu expect great difficulties in achieving Universal Health Coverage.

“We found that incidence rates of stroke increased by 3-6 times in various provinces from 1986 to 2013, and its ratio of rural to urban areas increased from 0.8:1 to 2:1. Currently incidence rates of stroke in rural areas is significantly higher than that in urban areas. Research shows that 80% of environment-related and lifestyle-related stroke risk factors which are controllable and preventable were not controlled or prevented.” Liu found himself helpless in face of such problem.

Super hospitals in China has always attracted news media and patients. Both number and size of hospitals keep increasing. Compared with the number of hospitals in other countries all around the world, China is among the few countries where the number of hospitals is growing.

“More bigger hospitals do not bring changes to overcrowded large hospitals and empty grassroots institutions.” said Liu. He pointed out that enlarging hospitals cannot be expected to deal with the challenges of aging of population, imbalanced resources allocation and healthcare equality.

In the end, Liu Yuanli proposed that to achieve Universal Health Coverage, a critical change needs to be made. That is, focus should be shifted from successive disease treatment to disease prevention which involves the whole society, the entire population and medical services systems as well.

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