Tracking progress towards universal health coverage for essential health services in China, 2008–2018

Abstract

IntroductionWe comprehensively evaluate whether the Chinese Government’s goal of ensuring Universal Health Coverage for essential health services has been achieved.MethodsWe used data from the 2008, 2013 and 2018 National Health Services Survey to report on the coverage of a range of Sustainable Development Goals (SDG) indicator 3.8.1. We created per capita household income deciles for urban and rural samples separately. We report time trends in coverage and the slope index (SII) and relative index (RII).ResultsDespite much lower levels of income and education, rural populations made as much progress as their urban counterparts for most interventions. Coverage of maternal and child health interventions increased substantially in urban and rural areas, with decreasing rich-poor inequalities except for antenatal care. In rural China, one-fifth women could not access 5 or more antenatal visits. Coverage of 8 or more visits were 34% and 68%, respectively in decile D1 (the poorest) and decile D10 (the richest) (SII 35% (95% CI 22% to 48%)). More than 90% households had access to clean water, but basic sanitation was poor for rural households and the urban poorest, presenting bottom inequality. Effective coverage for non-communicable diseases was low. Medication for hypertension and diabetes were relatively high (>70%). But adequate management, counting in preventive interventions, were much lower and decreased overtime, although inequalities were small in size. Screening of cervical and breast cancer was low in both urban and rural areas, seeing no progress overtime. Cervical cancer screening was only 29% (urban) and 24% (rural) in 2018, presenting persisted top inequalities (SII 25% urban, 14% rural).ConclusionChina has made commendable progress in protecting the poorest for basic care. However, the ‘leaving no one behind’ agenda needs a strategy targeting the entire population rather than only the poorest. Blunt investing in primary healthcare facilities seems neither effective nor efficient.

Universal Health Coverage – Exploring the What, How, and Why Using Realistic Review

“…Universal health coverage focuses on equity, aiming to reach the left behind individuals (136,137). The UHC approach expands essential healthcare services to the poorest (138,139), through which health equity can be achieved (140)(141)(142)(143). Universal health coverage is also linked with other sustainable development goals, exemplified by the call for UHC action to address gender inequities (144).…”

Reduced-visit antenatal care model combined with telemedicine for low-risk pregnant women: protocol for a randomised controlled trial

“…These visits or contacts can facilitate timely assessment of maternal and fetal well-being and provision of interventions needed. However, there are issues of too many visits and cumbersome procedures of ANC in many maternity hospitals of China, especially in urban areas 6 7…”

“…However, there are issues of too many visits and cumbersome procedures of ANC in many maternity hospitals of China, especially in urban areas. 6 7 …”

Provincial inequality of China’s progress towards universal health coverage: An empirical analysis in 2016–21

“…Among them, several studies have used the concentration index and logistic regression models to quantify inequalities based on gender, income, and urban-rural areas, with few exploring regional variations within the country. The slope and relative indices of inequality, another widely used method for health equity research, have been adopted in some studies focusing on subnational differences in service coverage but are rarely used in comprehensive assessments of overall UHC levels [ 11 – 13 ].…”

“…Despite its importance, studies evaluating the conditions in each province are relatively scarce. Except for two studies, all work has been focused solely on one dimension of UHC, or each dimension has been analysed in isolation [ 11 , 26 , 27 ]. The remaining two studies simultaneously examined service coverage and financial protection.…”