China’s government pledged in March that farmers would get more reimbursements on medical bills and eight million more city dwellers would be covered under its universal healthcare insurance scheme. Below are details on how far China’s healthcare reforms, which began in the countryside in 2003 and in cities in 2006, have come.

Overall pledges
China gave reforms an additional boost in 2009 with an injection of $124bn to cover three years (2009-2011). Those reforms cover five areas:

• Universal medical insurance system
• National essential drug system that meets primary needs
• Improved grassroots primary healthcare
• Access for all to public health services
• Management and finance reforms in public hospitals.

Healthcare spending was also set to increase to 5.35 percent of the overall budget in 2011 against 4.57 percent in 2008

Improvements in 2011
Out of its 1.34 billion population, more than 90 percent are covered by basic healthcare insurance. Of these, 835 million are farmers and 440 million urban dwellers.

Under the New Rural Cooperative Medicare Scheme, the government will raise its subsidy to 200 yuan ($30) per person each year from 120 yuan ($18). The individual pays 30 yuan ($4.5).

The insured person will be reimbursed for up to 70 percent of medical bills for basic and essential drugs and services, up from 60 percent in 2010. Children and the elderly in urban areas are covered by this scheme.

The reimbursement cap for farmers will be raised to 50,000 yuan ($7,600) from 30,000
yuan ($4,600).

Higher-income employees in urban areas are covered by a more expensive Medical Insurance System that is paid for by companies and are insured for up to 10 times more. They are reimbursed for 75 percent or higher of their medical bills.

The government is working to extend coverage for the remaining citizens who were still not insured. They include migrant workers, elderly people and children in cities and people working for small companies.

In response to a long-standing complaint from migrant workers, who say they need to return home to get free treatment, the government says it is building more low-cost clinics in cities. The government is also considering expanding a pilot project to provide extra financial assistance to people suffering breast and cervical cancer and uremia. The scheme currently covers people suffering severe diseases, such as children with congenital heart disease and leukemia.

Challenges and solutions
83 percent of all deaths in China are due to chronic and lifestyle-related diseases and are therefore preventable: heart disease and strokes, hypertension, cancer and respiratory diseases.

An estimated 100 million Chinese are obese and 40 million are diabetic. An estimated 177 million have hypertension but only 40 percent are aware of their condition, suggesting many fail to take intervention measures such as exercise, eating healthily and quitting smoking. Only 28 percent of people who need anti-hypertensive drugs are taking them.

The government is trying to improve primary healthcare facilities and train staff at grassroots levels to prevent, screen, diagnose and treat common chronic diseases. They began paying 15 yuan ($2.20) per person in 2010 for basic screening services for some chronic illnesses; there are also campaigns to get people to walk at least 10,000 steps a day, and for children to adopt healthier diets.

Tobacco use is the leading preventable cause of many chronic illnesses. China has
more than 320 million smokers. The Health Ministry is trying to get smokers to quit and
more cities are imposing smoke-free zones.

Overall, while China’s government does seem to be making a concerted effort to help its vast population with adequate national healthcare, there is still a lot that could be done to improve conditions and the health of the nation in general.