Journal Article

Advancing universal health coverage in China and Vietnam: lessons for other countries

Tang, Shenglan, Tran, Tra, Pender, Michelle, Mao, Wenhui, Tang, Yuchen, Khanh, Phuong Nguyen

2020

Overview

Background China and Vietnam have made impressive progress towards universal health coverage (UHC) through government-led health insurance reforms. We compared the different pathways used to achieve UHC, to identify the lessons other countries can learn from China and Vietnam. Methods This was a mixed method study which included a literature review, in-depth interviews and secondary data analysis. We conducted a literature search in English and Chinese databases, and reviewed policy documents from internal contacts. We conducted semi-structured interviews with 16 policy makers, government bureaucrats, health insurance scholars in China and Vietnam. Secondary data was collected from National Health Statistics Reports, Health Insurance Statistical Reports and National Health Household Surveys carried out in both countries. We used population insurance coverage, insurance policies, reimbursement rates, number of households experiencing catastrophic heath expenditure (CHE) and incidence of impoverishment due to health expenditure (IHE) to measure the World Health Organization’s three dimensions of UHC: population coverage, service coverage, and financial coverage. Results China has increased population coverage through strong political commitment and extensive government financial subsidies to expand coverage. Vietnam expanded population coverage gradually, by prioritizing the poor and the near-poor in an incremental way. In China, insurance service packages varied across regions and schemes and were greatly determined by financial contributions, resulting in limited service coverage in less developed areas. Vietnam focused on providing a comprehensive and universal service packages for all enrollees thereby approaching UHC in a more equitable manner. CHE rate decreased in Vietnam but increased in China between 2003 and 2008. While Vietnam has decreased the CHE gap between urban and rural populations, China suffers from persistent disparities among population income levels and geographic location. CHE and CHE rates were still high in lower income groups. Conclusion Political commitment, sustainable financial sources and administrative capacity are strong driving factors in achieving UHC through health insurance reform. Health insurance schemes need to consider covering essential health services for all beneficiaries and providing government subsidies for vulnerable populations’ in order to help achieve health for all.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: At risk populations / Beneficiaries / Biostatistics / China / Commitment / Comparative analysis / Data analysis / Data collection / Economic development / Economic growth / Environmental Health / Epidemiology / Expenditures / GDP / Geographical locations / Government / Gross Domestic Product / Health care disparities / Health care expenditures / Health care industry / Health care policy / Health insurance / Health policies / Health services / Households / Humans / Income / Insurance / Insurance coverage / Insurance policies / Interviews / Laws, regulations and rules / Life expectancy / Literary criticism / Literature reviews / Low income groups / Medicine / Medicine & Public Health / Mixed methods research / National health insurance / Packages / Policy making / Politics / Population / Population policy / Populations / Poverty / Prioritizing / Provinces / Public finance / Public Health / Public health administration / Reforms / Research Article / Rural communities / Rural populations / Rural urban differences / Statistical analysis / Statistics / Subsidies / systems and management in low and middle-income countries / Universal Health Insurance - organization & administration / Urban population / Urban populations / Vaccine / Vietnam / Vulnerability