Universal health insurance coverage for 1.3 billion people: What accounts for China's success?

Health Policy. 2015 Sep;119(9):1145-52. doi: 10.1016/j.healthpol.2015.07.008. Epub 2015 Jul 28.


China successfully achieved universal health insurance coverage in 2011, representing the largest expansion of insurance coverage in human history. While the achievement is widely recognized, it is still largely unexplored why China was able to attain it within a short period. This study aims to fill the gap. Through a systematic political and socio-economic analysis, it identifies seven major drivers for China's success, including (1) the SARS outbreak as a wake-up call, (2) strong public support for government intervention in health care, (3) renewed political commitment from top leaders, (4) heavy government subsidies, (5) fiscal capacity backed by China's economic power, (6) financial and political responsibilities delegated to local governments and (7) programmatic implementation strategy. Three of the factors seem to be unique to China (i.e., the SARS outbreak, the delegation, and the programmatic strategy.) while the other factors are commonly found in other countries' insurance expansion experiences. This study also discusses challenges and recommendations for China's health financing, such as reducing financial risk as an immediate task, equalizing benefit across insurance programs as a long-term goal, improving quality by tying provider payment to performance, and controlling costs through coordinated reform initiatives. Finally, it draws lessons for other developing countries.

Keywords: China; Health care reform; Health insurance; Universal coverage.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • China
  • Cost Control / organization & administration
  • Disease Outbreaks
  • Financing, Government / organization & administration
  • Financing, Government / statistics & numerical data
  • Health Care Reform / organization & administration
  • Humans
  • Insurance, Health / organization & administration*
  • Insurance, Health / statistics & numerical data
  • Politics
  • Program Evaluation
  • Reimbursement, Incentive / organization & administration
  • Severe Acute Respiratory Syndrome / epidemiology
  • Severe acute respiratory syndrome-related coronavirus
  • Universal Health Insurance / organization & administration*
  • Universal Health Insurance / statistics & numerical data