China's health system performance

Lancet. 2008 Nov 29;372(9653):1914-1923. doi: 10.1016/S0140-6736(08)61362-8. Epub 2008 Oct 17.


We created a comprehensive set of health-system performance measurements for China nationally and regionally, with health-system coverage and catastrophic medical spending as major indicators. With respect to performance of health-care delivery, China has done well in provision of maternal and child health services, but poorly in addressing non-communicable diseases. For example, coverage of hospital delivery increased from 20% in 1993 to 62% in 2003 for women living in rural areas. However, effective coverage of hypertension treatment was only 12% for patients living in urban areas and 7% for those in rural areas in 2004. With respect to performance of health-care financing, 14% of urban and 16% of rural households incurred catastrophic medical expenditure in 2003. Furthermore, 15% of urban and 22% of rural residents had affordability difficulties when accessing health care. Although health-system coverage improved for both urban and rural areas from 1993 to 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 effect on performance indicators, for which substantial data gaps exist.

MeSH terms

  • Child Health Services / economics
  • Child Health Services / trends
  • Child, Preschool
  • China
  • Delivery of Health Care / economics
  • Delivery of Health Care / statistics & numerical data*
  • Delivery of Health Care / trends
  • Female
  • Health Care Reform / organization & administration*
  • Health Care Reform / trends
  • Health Services Accessibility / economics*
  • Health Services Accessibility / statistics & numerical data
  • Health Services Needs and Demand*
  • Humans
  • Male
  • Maternal Health Services / economics
  • Maternal Health Services / trends
  • Rural Health Services / economics
  • Rural Health Services / statistics & numerical data*
  • Rural Health Services / trends
  • Urban Health Services / economics
  • Urban Health Services / statistics & numerical data*
  • Urban Health Services / trends