A Dream Yet to Come True: Disparity of Healthcare Access in China

Irene J. Su, RN, MSN


Topics in Advanced Practice Nursing eJournal. 2007;7(3) 

In This Article

Introduction to Healthcare in China

In nearly 3 decades since the start of economic reform, China has changed from a closed-door society to a market economy, consistently boasting a double-digit rate of its annual gross domestic product (GDP) growth. The nation, as a whole, has become richer, with GDP rising from Ren Min Bi (RMB) 362.4 billion yuan (approximately 47.88 billion United States Dollars [USD]) in 1978 to RMB 13.7 trillion yuan (approximately 1.81 trillion USD).[1] China has achieved economic success, but its healthcare system is seriously deficient.

Prior to the reform, the Chinese healthcare system was mostly funded and operated by the government and was similar to socialized medicine systems in industrialized nations such as England and Canada. This universal healthcare system was free or of very little cost to the general population. The Chinese universal healthcare system was a century-old dream come true, with decreased mortality rate and increased life span. As Bogg and colleagues[2] pointed out, "There was little doubt that China of the 1960s and 1970s had achieved a high level of public health, thanks to successful preventive programs and an emphasis on primary healthcare and universal accessibility."

Liberalization and privatization brought about by the reform resulted in a drastic reduction in government funding to healthcare delivery in China. A 2005 World Health Organization (WHO) report indicated that while the cost of healthcare in 2002 was 40 times what it was in 1978, government funding decreased from 32% to 15% during that time period.[3] In 2002, individuals were responsible for two thirds of healthcare expenditure. By that time, the majority of the population had lost healthcare coverage due to the dismantling of the universal healthcare system.

The result of a recent national survey showed that[4]:

  • A total of 44.8% of the urban residents lacked insurance coverage;

  • A total of 79.1% of the rural population had to pay the cost of healthcare entirely out of pocket; and

  • Three quarters of the Chinese population had no access to any government funding when they were in need of medical treatment

Consequently, a considerable number of individuals refused to see a doctor until they became seriously ill. One survey conducted in 2006 showed that the number of these individuals accounted for 49% of the total population.[5] A single case of serious illness might deprive them of their lifetime savings, or they could be heavily indebted as they struggled to pay for the rapidly rising cost of healthcare.


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