Wang Chunshui, Ng Vincent H, Lie Reidar K
Department of Research, Beijing Obstetrics and Gynecology Hospital, Capital Medical University Beijing Maternal and Child Healthcare Hospital, No. 251, Yao Jia Yuan Road, Chaoyang District, Beijing, 100026 People's Republic of China.
Department of Math and Sciences, Northern Virginia Community College, 2645 College Dr, Woodbridge, VA 22191 USA.
Asian Bioeth Rev. 2018 Jun 27;10(3):171-187. doi: 10.1007/s41649-018-0052-1. eCollection 2018 Oct.
The WHO Consultative Group on Equity and Universal Health Coverage published a comprehensive report titled "Making Fair Choices on the Path to Universal Health Coverage" detailing strategies that countries should adopt when moving towards providing healthcare coverage to the entire population. The report provides detailed guidelines on how to expand coverage to more people, what services should be covered, and how to prioritize these healthcare resources in achieving universal healthcare coverage (UHC). The main goal of this WHO report is to ensure fair and equitable access for all population groups within a country during the implementation of UHC. In principle, the group's approach is sound and fair, but we argue that each country must take into account its own unique situations in designing a pathway towards UHC. China has achieved near UHC but did so by an approach that would have been deemed completely unacceptable based on this group's recommendations. In this article, we provide a brief review of the Chinese healthcare system and argue that the implementation of the recommendations in the report is not always feasible. We argue that there are alternate pathways towards achieving UHC and there are good reasons for China's departure from the approach outlined by the WHO report. Nevertheless, we acknowledge substantial inequities still exist for various segments of the population and among the diverse areas of China in accessing healthcare services and make suggestions on how to reduce such inequities within the system.
世界卫生组织公平与全民健康覆盖咨询小组发布了一份题为《在全民健康覆盖道路上做出公平选择》的全面报告，详细阐述了各国在朝着为全体人口提供医疗覆盖迈进时应采取的策略。该报告就如何将覆盖范围扩大到更多人、应涵盖哪些服务以及在实现全民医疗覆盖（UHC）过程中如何对这些医疗资源进行优先排序提供了详细指导方针。这份世界卫生组织报告的主要目标是在实施全民健康覆盖期间确保一个国家内所有人群都能公平、公正地获得医疗服务。原则上，该小组的方法是合理且公平的，但我们认为每个国家在设计通往全民健康覆盖的路径时必须考虑自身的独特情况。中国已接近实现全民健康覆盖，但其实现方式基于该小组的建议会被认为是完全不可接受的。在本文中，我们简要回顾了中国的医疗体系，并认为报告中建议的实施并不总是可行的。我们认为存在实现全民健康覆盖的其他途径，且中国背离世界卫生组织报告所概述的方法有充分理由。然而，我们承认在获得医疗服务方面，中国不同人群以及不同地区之间仍存在严重的不公平现象，并就如何减少该体系内的此类不公平现象提出了建议。
