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Cited by 58Healthcare Systems and ReformsHealthcare Systems and PracticesHealthcare Policy and Management

Universal health coverage in China part 2: addressing challenges and recommendations

Open access
Yip, Winnie, Fu, Hongqiao, Jian, Weiyan, Liu, Jue, Pan, Jay, Xu, Duo, Yang, Hanmo, Zhai, Tiemin·2023·The Lancet Public Health
DOI 10.1016/s2468-2667(23)00255-4
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Abstract

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.

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  • China's high-volume, hospital-centred health care system, often marked by fragmented care pathways and limited integration with community services, poses challenges for ensuring continuity of care for family caregivers.

    “China's high-volume, hospital-centred health care system—often marked by fragmented care pathways and limited integration with community services—poses challenges for ensuring continuity of care for family caregivers.”

    From The burdens, coping strategies, and unmet needs of family caregivers of Chinese patients with lymphoma receiving commercial CAR-T-cell therapy: A qualitative study (2026) · cites this paper as [72]

    The Underlying causes section describes China's health delivery system as hospital-centric and fragmented, and says hospital physicians are often unwilling to coordinate with primary-care providers. The Establishing a population-based integrated delivery system section also describes hospital-led integration efforts that still prioritise treatment. These passages support the system-level description, but they do not address continuity of care specifically for family caregivers or establish that caregivers face the claimed challenges. (LLM, conf=0.85)

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1 of the 90 references couldn’t be matched to a known paper.

Research works printed but not linked: 6

  1. Young ME. Maternal health in Chinachallenges of the next decade. Health Policy 1990; 14: 87-125.
  2. Center for Health Statistics and Information, National Health Commission. The sixth analysis report of National Health Services Survey in China. Beijing: People Health Press, 2018 (in Chinese).
  3. Lieberthal KG, Lampton DM. Introduction: the 'fragmented authoritarianism' model and its limitations. In: Lieberthal KG, Lampton DM, eds. Bureaucracy, politics, and decision making in postMao China. Berkeley, CA: University of California Press, 1992: 6-12.
  4. Wang X, Sun X, Birch S, et al. Peoplecentred integrated care in urban China. Bull World Health Organ 2018; 96: 843.
  5. He J, Ouyang N, Guo X, et al. Effectiveness of a nonphysician community healthcare providerled intensive blood pressure intervention versus usual care on cardiovascular disease (CRHCP): an openlabel, blindedendpoint, clusterrandomised trial. Lancet 2023; 401: 928-38.
  6. Yip W, PowellJackson T, Chen W, et al. Capitation combined with payforperformance improves antibiotic prescribing practices in rural China. Health Aff 2014; 33: 502-10.

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Authors
Yip, W., Fu, H., Jian, W., Liu, J., Pan, J., Xu, D., Yang, H., & Zhai, T.
Affiliations
  • Harvard University (US)
  • Peking University (CN)
  • Sichuan University (CN)
  • Institute of Population and Labor Economics (CN)
  • China National Health Development Research Center (CN)
Corresponding author
Fu, Hongqiao
ORCID
Venue
The Lancet Public Health
Publisher
Elsevier BV
Published
2023-12
Volume
8
Issue
12
Pages
e1035-e1042
ISSN
2468-2667 (ISSN-L)
DOI
10.1016/s2468-2667(23)00255-4
OpenAlex
W4388927224
Cited by
58
References
90
Citations by year
2026: 21 · 2025: 18 · 2024: 19
FWCI
2.83
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Public Health (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
National Natural Science Foundation of China
Topics
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
  • Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Practices
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
universal health coverage, Chinese healthcare system, health care reform, primary care, integrated health system, provider incentives, health behavior change, digital health, health insurance reform, financial protection, chronic disease prevention, Health in All Policies, health care costs
MeSH terms
Child, China, Humans, Income, Infant, Newborn, Motivation, Health Care Reform, Universal Health Insurance

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