School of Public Health, Fudan University, Shanghai, China.
Key Laboratory of Health Technology Assessment (Fudan University), Ministry of Health, Shanghai, China.
J Glob Health. 2024 Jun 28;14:04122. doi: 10.7189/jogh.14.04122.
Achieving universal health coverage (UHC) is a crucial target shared by the Sustainable Development Goals (SDGs). As UHC levels are influenced by factors such as the regional economy and resource allocation, subnational evidence in China is urgently needed. This study aimed to monitor provincial progress from 2016 to 2021, thereby informing the development of region-specific strategies.
Based on the UHC monitoring framework proposed by the World Health Organization, a UHC index was constructed comprising the service coverage dimension (16 indicators) and financial protection dimension (four indicators). In this observational study, routinely collected health data from 25 provinces (autonomous regions and municipalities) in mainland China were obtained from statistical yearbooks, relevant literature, and nationally representative surveys. The indices were calculated using geometric means. Socioeconomic inequalities among provinces were quantified using the slope index of inequality (SII) and relative index of inequality (RII).
From 2016 to 2021, China made laudable progress towards achieving UHC, with the index rising from 56.94 in 2016 to 63.03 in 2021. Most provinces demonstrated better performance in service coverage. Western provinces generally presented faster rates of progress, which were attributed to more substantial increases in financial protection. Despite significant disparities, with the UHC index ranging from 77.94 in Shanghai to 54.61 in Fujian in 2021, the overall equity of UHC has improved across the 25 provinces. SII decreased from 17.78 (95% confidence interval (CI) = 11.64, 23.93) to 12.25 (95% CI = 5.86, 18.63) and RII from 1.38 (95% CI = 1.29, 1.46) to 1.22 (95% CI = 1.16, 1.29). However, the non-communicable disease (NCD) domain experienced a drop in both index score and equity, underscoring the need for prioritised attention.
In the context of SDGs and the 'Healthy China 2030' initiative, China has made commendable progress towards UHC, and inter-provincial equity has improved. However, substantial differences persisted. The equitable realisation of UHC necessitates prioritising the enhancement of service capacity and financial protection in less developed regions, particularly by addressing shortages in the general practitioner workforce and mitigating catastrophic payments. Developed regions should focus on preventing NCDs through effective interventions targeting key risk factors. This study provides insights for other countries to adopt comprehensive monitoring frameworks, identify subnational disparities, and introduce targeted policy initiatives.
实现全民健康覆盖（UHC）是可持续发展目标（SDGs）共同的关键目标。由于 UHC 水平受到区域经济和资源分配等因素的影响，因此中国迫切需要国家以下各级别的证据。本研究旨在监测 2016 年至 2021 年期间各省的进展情况，从而为制定特定地区的战略提供信息。
本研究基于世界卫生组织提出的 UHC 监测框架，构建了一个 UHC 指数，该指数包括服务覆盖维度（16 项指标）和财务保护维度（四项指标）。在这项观察性研究中，我们从中国内地 25 个省（自治区、直辖市）的统计年鉴、相关文献和全国代表性调查中获取了常规收集的卫生数据。使用几何平均值计算指数。使用不平等斜率指数（SII）和相对不平等指数（RII）来衡量各省之间的社会经济不平等程度。
从 2016 年到 2021 年，中国在实现 UHC 方面取得了可喜的进展，指数从 2016 年的 56.94 上升到 2021 年的 63.03。大多数省份在服务覆盖方面表现更好。西部地区的进展速度普遍较快，这归因于财务保护方面的大幅增加。尽管存在显著差异，2021 年上海的 UHC 指数为 77.94，而福建为 54.61，但 25 个省份的 UHC 总体公平性有所提高。SII 从 17.78（95%置信区间（CI）=11.64，23.93）降至 12.25（95%CI=5.86，18.63），RII 从 1.38（95%CI=1.29，1.46）降至 1.22（95%CI=1.16，1.29）。然而，NCD 领域的指数得分和公平性都出现下降，这凸显了需要优先关注的问题。
在 SDGs 和“健康中国 2030”倡议的背景下，中国在实现 UHC 方面取得了值得称赞的进展，省际公平性有所提高。然而，仍然存在显著差异。实现 UHC 的公平性需要优先考虑增强欠发达地区的服务能力和财务保护，特别是要解决全科医生队伍短缺和缓解灾难性支付问题。发达地区应通过针对关键风险因素的有效干预措施，重点预防非传染性疾病。本研究为其他国家提供了采用全面监测框架、识别国家以下各级别的差异以及引入有针对性的政策举措的见解。
