A Review of Rural Healthcare System Weaknesses in China: Moving toward Universal Coverage by Applying the Benchmarks of Fairness
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This thesis is the first review of China’s rural health care system in the context of the latest healthcare reform settings, which applies the Benchmarks of Fairness. The Benchmarks of Fairness is a tool designed to evaluate issues related to health equity by indicating the factors that need to be improved in order to achieve fair health services. Accompanying by the rapid economic growth since 1980s, the health status of the whole population has been improved greatly, while some negative effects also appeared, particularly the rising medical spending, and the health inequalities between rural and urban areas. Chinese government has made many efforts to shorten the gap. The government reasserted its role in the health sector in 2009, and provided a huge investment into its healthcare system reform which attempts to achieve the universal health coverage by 2020. Currently, the fragmented national health insurance schemes in China have achieved an increasingly broad yet fairly superficial coverage, with various health benefits package. The 97.48% rural population was covered by the New Rural Cooperative Medical Scheme (NRCMS) in 2011. However, the out-of-pocket payment is still a big burden for rural patients, especially for the poor. There are still many problems which need to be resolved. This thesis provides an overview of weaknesses in the rural healthcare system of China despite aspirations for universal coverage. I first present a brief description of the background, the key concepts and definitions. Then I review the present situation of healthcare in rural China, by introducing NRCMS, showing the condition from both supply and demand side, presenting the health service implementation and utilization. There are several reasons that limitations in the rural healthcare system persist, which I will analyze in this thesis, including market failure and the absence of the government, inequalities in social determinants of health, and unfairness in health care. I discuss the fairness issue with specific reference to Daniels et al.’s (2000) Benchmarks of Fairness. Literature review is used as the main methodology, and some statistical reports are also used as needed. Though it is underfunded and the reimbursement rate is low, NRCMS is successful in some extent. Nevertheless, in order to shorten the rural-urban gap, more improvements are needed and some challenges are still existing, especially the cross-sector cooperation and the dual rural-urban social institute.
Master in International Social Welfare and Health Policy