China has improved maternal and newborn health but health affordability must be addressed in future

October 19, 2008

China has done well in provision of maternal and health services, but poorly in non-communicable diseases and smoking cessation. China's health drive must also address the high numbers of families who are financially devastated by seeking healthcare. These are among the conclusions of authors of the final paper in the Lancet Series on Health System Reform in China, written by Dr Yuanli Liu, Harvard School of Public Health, Boston, MA, USA, and colleagues.

In this comprehensive study to measure China's health system performance, the authors used two major indicators: coverage of health services (i.e. the extent to which people in need of certain services actually get them), and affordability of health services (i.e. incidence rate of household catastrophic medical spending and forgone medical care due to inability to pay). The study's major findings include:

Coverage of hospital delivery increased from 20% in 1993 to 62% in 2003 for women living in rural areas; however effective coverage of high blood pressure (hypertension) treatment was only 12% for patients living in urban areas and 7% in rural areas in 2004. And while 45% and 50% of men living in urban and rural areas were regular smokers in 2003, only 5-6% of them tried to quit. With respect to the effect of healthcare on family budgets, 14% or urban and 16% of rural households incurred 'catastrophic' medical expenditure in 2003; while a further 15% of urban residents and 22% of rural residents had affordability difficulties when accessing health care.

Although health insurance coverage improved both in urban areas and rurally between 1993 and 2003, The authors say: "On the basis of the proportion of residents reported having forgone medical care or early hospital discharge due to cost concerns in 2003, we can extrapolate that about 438 million Chinese people had affordability difficulties in 2003...Affordability difficulties had worsened in rural areas. Additionally, substantial inter-regional and intra-regional inequalities in health-system coverage and health-care affordability measures exist. People with low income not only receive lower health-system coverage than those with high income, but also have an increased probability of either not seeking health care when ill or undergoing catastrophic medical spending. China's current health-system reform efforts need to be assessed for their direct effect on performance indicators, for which substantial data gaps exist."

They conclude: "We have shown the urgent need for China to construct a more comprehensive nationally and regionally representative dataset (whether a cohort or repeated cross-sections to be able to monitor and assess health-policy changes properly."
-end-
Dr Yuanli Liu, Harvard School of Public Health, Boston, MA, USA T) +1 617-432-4623 (Boston, USA); +86 135-2259-2907 (China) E) yuanliu@hsph.harvard.edu

Full paper: http://press.thelancet.com/china7.pdf

Lancet

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