Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing, China.
Lancet Public Health. 2023 Dec;8(12):e1035-e1042. doi: 10.1016/S2468-2667(23)00255-4.
This report analyses the underlying causes of China's achievements and gaps in universal health coverage over the past 2 decades and proposes policy recommendations for advancing universal health coverage by 2030. Although strong political commitment and targeted financial investment have produced positive outcomes in reproductive, maternal, newborn, and child health and infectious diseases, a fragmented and hospital-centric delivery system, rising health-care costs, shallow benefit coverage of health insurance schemes, and little integration of health in all policies have restricted China's ability to effectively prevent and control chronic disease and provide adequate financial risk protection, especially for lower-income households. Here, we used a health system conceptual framework and we propose a set of feasible policy recommendations that draw from international experiences and first-hand knowledge of China's unique institutional landscape. Our six recommendations are: instituting a primary care-focused integrated delivery system that restructures provider incentives and accountability mechanisms to prioritise prevention; leveraging digital tools to support health behaviour change; modernising information campaigns; improving financial protection through insurance reforms; promoting a health in all policy; and developing a domestic monitoring framework with refined tracer indicators that reflects China's disease burden.
本报告分析了中国在过去 20 年实现全民健康覆盖的成就和差距的根本原因，并为推进 2030 年全民健康覆盖提出了政策建议。尽管强有力的政治承诺和有针对性的财政投资在生殖、孕产妇、新生儿和儿童健康以及传染病方面取得了积极成果，但分散的、以医院为中心的服务提供体系、不断上升的医疗费用、医疗保险计划的福利保障覆盖面较浅以及健康政策缺乏整合，限制了中国有效预防和控制慢性病和提供充分的财务风险保护的能力，尤其是对低收入家庭而言。在这里，我们使用了卫生系统概念框架，并提出了一系列可行的政策建议，这些建议借鉴了国际经验和对中国独特制度环境的第一手了解。我们的六项建议是：建立以初级保健为重点的综合服务提供体系，调整提供者激励和问责机制，优先重视预防；利用数字工具支持健康行为改变；开展现代化的宣传活动；通过保险改革提高财务保障水平；推行健康的所有政策；并制定一个具有反映中国疾病负担的精细追踪指标的国内监测框架。
