Table 1.

Overview of China's health-care reform

	Description	Progress so far	Plans forward and challenges
Expand health insurance coverage	The government subsidises each rural and urban resident not covered by the UEBMI programme to enrol in the NCMS or the URBMI, respectively	By now, NCMS, URBMI, UEBMI together cover more than 96% of the population Service coverage has gradually been expanded from its initial focus on hospital admission to include outpatient services. Chronic diseases and major disorders that incur high expenditures have also been prioritised for reduced copayment	Further increase in premium subsidies for the NCMS and URBMI schemes to ¥360 RMB per capita by 2015 (up from ¥80 in 2009) Higher NCMS and URBMI reimbursement rates to cover at least 75% and 50% of expenditures for hospital admissions and outpatient services, respectively, and additional insurance for selected groups of diseases with high expenditures Integrate NCMS, URBMI, and UEBMI into one risk pool for each locale Challenges: financial sustainability of the schemes if health expenditure growth is not managed
Equalise public health services for all	The government funds primary health-care providers to deliver a defined package of basic public health services, including health promotion and prevention; immunisation and vaccinations; infectious disease control; secondary prevention for hypertension and diabetes; management of psychotic patients; health examinations for pregnant women, children, and elderly people and compilation of electronic health records for every resident. These services are provided free for users	Reported statistics suggest that most of the government-set targets have been met	Funding would further increase to ¥40 per head by 2015 (up from ¥15 in 2009) to increase service coverage of the defined package of public health services Challenges: the quality of services are unknown
Strengthen primary health care	Building and strengthening of infrastructure for primary health care with a focus on rural areas Improvement of workforce: waiving tuition fees for medical students willing to work at rural primary health-care facilities for 3 years after graduation; recruitment to meet a target of one licensed physician per township health centre; selection of physicians from county hospitals to receive on the job training in tertiary hospitals; and encouragement of experienced physicians to rotate to county hospitals to train staff	2200 county hospitals, more than 330 000 community health centres, township health centres or village posts rebuilt or upgraded	Continue with infrastructure building, general practitioner training, stabilisation of the workforce through training and improved compensation, establishment of a referral system Challenges: Patients still bypass primary health-care facilities and most visits are concentrated at hospitals. Primary health care not performing gatekeeping functions No data have been reported for the quality or equitable distribution of services
Establish essential medicines programmes	Establish national essential drug list: should selection of drugs be based on disease burden needs, safety and clinical efficacy, affordability, past use patterns, and availability of supply Establish province-based centralised procurement system Remove mark-up for drugs at primary health-care facilities	All public primary health-care facilities have used the zero drug mark-up policy Zero drug mark-up policies extended to county hospitals The national essential medicines list and province-based centralised-procurement system has been used in all provinces for public primary health-care facilities. Most provinces have formulated supplementary lists	Improve bidding mechanism Expand items on essential drug lists, encourage generic substitutions, expand drugs for chronic disease and child health conditions, remove drugs with low frequency of use Reduce prices of drugs on essential drug lists Challenges: Local supplements of essential drug list do not seem to be based on cost-effectiveness; rather they are determined by interest groups Kickbacks still exist and therefore providers have not delinked drug revenue from income. No evidence that appropriate drug prescription has improved
Pilot public hospital reform	Do pilots in 17 cities along the following four areas: separation between ownership and regulation; separation of government administration from hospital management; separation between for-profit and not-for-profit; and separation between drug sales and hospital revenues	Little progress	Increase market share for private hospitals to 20%

UEBMI=Urban Employee Basic Medical Insurance. NCMS=New Cooperative Medical Scheme. URBMI=Urban Resident Basic Medical Insurance.