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13、Printed in ChinaFront cover:Elderly working out on the public equipment in the park of the Temple of Heaven,Beijing,2017.ShutterstockiiiXChinas experience in pursuing universal health coverage Contents XGlossary v XAbbreviations vi XAcknowledgements vii XExecutive summary viii XIntroduction x X1.Chi

14、nas efforts to improve the multi-tier medical security system 11.1Framework of Chinas medical security system 11.2Legal and policy framework for a universal medical security system 31.3Chinas path towards universal coverage of basic medical security 4 X2.Design of Chinas basic medical security syste

15、m 62.1Population coverage 62.2Benefit design 72.3Financing mechanisms 82.4Service provision 92.5Strategic procurement 92.6Responsibilities of relevant departments 10 X3.Outcome of universal coverage of basic medical security in China 113.1Population coverage 113.2Benefit improvement 123.3Service pro

16、vision 133.4Strategic procurement 153.5Improvement in peoples health 16 X4.Challenges,experiences and prospects for Chinas medical insurance 174.1Major challenges facing the development of universal medical insurance coverage 174.2Experience in achieving universal medical insurance coverage 194.3Pol

17、icy recommendations for achieving universal medical insurance coverage 21 XAnnex 1:Laws and policies on Chinas basic medical security system 23 XAnnex 2:Overview of medical and healthcare institutions in China in 2022 and 2023 26 XAnnex 3:Overview of health workforce in China,20052023 27 XBibliograp

18、hy 28XChinas experience in pursuing universal health coverageivList of figuresFigure 1.Framework of financing,services and benefits of the basic medical 2 security system(as of 2024)Figure 2.Schematic diagram of the development of the basic medical insurance system 4Figure 3.Overview of basic medica

19、l insurance coverage in China 12Figure 4.Overview of medical and health resources 14vXChinas experience in pursuing universal health coverage GlossaryPopulation covered by basic medical insurance schemes refers to the total number of persons enrolled in basic medical insurance for employees and basi

20、c medical insurance for rural and non-working urban residents at the end of the reporting period.Population covered by basic medical insurance for employees(EBMI)refers to the total number of active workers and retirees enrolled in basic medical insurance for employees in accordance with national re

21、gulations at the end of the reporting period.The scheme is implemented based on the combination of risk and financial pooling and individual accounts or on complete risk and financial pooling.Population covered by basic medical insurance for rural and non-working urban residents(RBMI)refers to the t

22、otal number of persons enrolled in basic medical insurance for rural and non-working urban residents at the end of the reporting period,including adults,students and children.Basic medical insurance participation rate refers to the ratio of the population enrolled in basic medical insurance schemes

23、to the population eligible to be enrolled,that is,effective population/eligible population 100 per cent.Enterprises,public institutions and government agencies refer to different types of organizations registered in the Peoples Republic of China in line with the laws.In-service/retirement ratio is t

24、he ratio of active workers participating in basic medical insurance for employees to retirees enrolled in the scheme.Flexibly employed workers(flexible workers)include self-employed individuals without employees,freelancers,and those who have not terminated their social insurance relationship after

25、unemployment,among others.Workers in new forms of employment(NFE workers)refer to individuals employed through digital platforms,primarily including online delivery workers,ride-hailing drivers,internet marketers and others.Fund payment ratio for medical expenses in insurance-covered services(as lis

26、ted in the basic medical insurance catalogue)is calculated as the total payment by each fund divided by the total medical expenses covered by insurance,multiplied by 100 per cent.Maternity allowance refers to the benefit paid for participants in the maternity insurance scheme in line with regulation

27、s during the reporting period,including benefits(wage replacement)for insured female workers on maternity leave and for family planning surgery leave.Diagnosis-Related Group(DRG)is a system where hospitalized patients are categorized into several groups based on their disease,diagnosis,age,gender,et

28、c.Each group is further divided into levels according to the severity of the disease and the presence of complications or comorbidities.Corresponding payment standards are established for each level,and hospitals are reimbursed according to these standards.Diagnosis-Intervention Packet(DIP)is a comp

29、lete management system established with the support of big data,classifying patient data through the common characteristics of“disease diagnosis+treatment modality”.DIP seeks to form a standardized position for each disease-treatment modality combination of the full-sample case data in a certain reg

30、ion,objectively reflecting the severity of the disease,the complexity of the treatment,resource consumption and clinical behaviours.DIP can be applied in medical insurance payments,fund supervision and other fields.E-certificate for medical insurance/medical insurance code is an electronic medium fo

31、r identification of all insured persons based on the basic information database of medical insurance,issued by the national medical insurance information platform.Supported by authentication technology,insured persons can use the e-certificate to access various online medical insurance services,such

32、 as medical insurance business handling,individual account enquiry,medical consultation,and medicine purchasing and payment.XChinas experience in pursuing universal health coveragevi AbbreviationsCPCCommunist Party of China DRGDiagnosis-Related GroupDIPDiagnosis-Intervention PacketEBMIBasic medical

33、insurance for employeesEUEuropean UnionGDPGross domestic productILOInternational Labour OrganizationISSAInternational Social Security AssociationMOHRSSMinistry of Human Resources and Social SecurityNBSNational Bureau of StatisticsNDRCNational Development and Reform CommissionNFENew forms of employme

34、ntNHCNational Health CommissionNHSANational Healthcare Security AdministrationNPCNational Peoples CongressNRCMSNew rural cooperative medical scheme RBMIBasic medical insurance for rural and non-working urban residentsRCMSRural cooperative medical schemeSCIOState Council Information OfficeUHCUniversa

35、l health coverageURBMIBasic medical insurance for non-working urban residents WHOWorld Health OrganizationviiXChinas experience in pursuing universal health coverage AcknowledgementsThis technical note was developed by Ms.Gui CAO(Chinese Academy of Labour and Social Security),with guidance from Mr.L

36、iqiang ZHANG(National Institute of Healthcare Security,Capital Medical University).It has benefitted from the technical inputs of Mr.Ruben VICENTE ANDRES(Social Protection Project Manager)and Ms.Jie ZHOU(National Project Coordinator)of the ILO Country Office for China and Mongolia(CO-BEIJING),as wel

37、l as Ms.Marielle Phe GOURSAT,social health protection expert at the ILO Decent Work Technical Support Team for East and South-East Asia and the Pacific(DWT-Bangkok).The authors extend their gratitude to the National Healthcare Security Administration of China for their careful review and valuable co

38、mments during the drafting process.This publication was developed with the support of the International Labour Office(ILO),as part of the EU-China project“Improving Chinas Institutional Capacity towards Universal Social Protection(Phase 2),”funded by the European Union.Its contents are the sole resp

39、onsibility of the authors and do not necessarily reflect the views of the European Union or the ILO.XChinas experience in pursuing universal health coverageviii Executive summary This technical report was commissioned by the ILO in the context of the EU-funded project“Improving Chinas institutional

40、capacity towards universal social protection(Phase 2)”.Medical security is a crucial component of social security,and China has made significant strides in extending universal health coverage in recent years.Systematically summarizing Chinas experiences will provide valuable references for other cou

41、ntries exploring the possibility of universal health coverage and contribute to the advancement of global health protection.The report is structured into four sections:an overview of the development of Chinas multi-tier medical security system,the design of Chinas basic medical insurance system,the

42、results of expanding universal health coverage,and the challenges,key experiences,and recommendations for advancing Chinas universal medical insurance.China is committed to establishing and improving a multi-tier medical security system.Through the enactment of a series of laws and regulations,the c

43、overage of basic medical security in China has expanded from urban employees to rural residents,and then to urban residents.This expansion has increased coverage from small to large populations and enhanced the level of protection from low to high.Ultimately,China has established a three-tiered basi

44、c medical security system comprising basic medical insurance,critical illness insurance,and medical assistance to mitigate the burden on the public.Additionally,commercial health insurance,charitable assistance and mutual medical aid along with basic medical security,constitute a multi-tier medical

45、security system.The basic medical insurance system in China includes employee medical insurance and resident medical insurance.In terms of coverage,employee medical insurance covers all employees of organizations,self-employed individuals without employees,part-time workers not covered by their empl

46、oyers,and other flexibly employed persons.Resident medical insurance covers all urban and rural residents except for those who should be covered by employee medical insurance or those who are entitled to other forms of protection according to regulations.By the end of 2023,Chinas basic medical insur

47、ance covered 1.33 billion people,accounting for 94.6 per cent of the total population.In terms of benefit design,both employee and resident medical insurance schemes include thresholds(deductibles),caps(ceiling amount for eligible expenses),and fund payment ratios.The fund payment ratios for hospita

48、lization expenses within the catalogue are approximately 80 per cent for employees and 70 per cent for residents.For outpatient expenses,the fund payment ratio for the employee scheme is not less than 50 per cent,with a commonly set cap.The benefit level for the resident scheme is generally lower th

49、an that of the employee scheme.In terms of financing,employee medical insurance is funded by contributions from both employers and employees.The employer contributes 6 per cent of the monthly salary,while the employee contributes 2 per cent.No further contributions are required after retirement.In 2

50、023,the per capita financing for employee medical insurance was 6,182 yuan.Resident medical insurance is financed through flat-rate individual contributions and government subsidies.In 2023,the per capita financing for resident medical insurance was 1,098 yuan.In terms of service provision,there wer

51、e 1.07 million healthcare institutions in 2023,including 38,400 hospitals,1.02 million primary healthcare institutions,and 12,100 specialized public healthcare institutions.The number of beds in healthcare institutions per 1,000 population was 7.23,the number of licensed(assistant)physicians per 1,0

52、00 population was 3.40,and the number of registered nurses per 1,000 population was 4.00.In 2023,there were 520,000 designated medical institutions and 485,000 designated retail pharmacies nationwide for medical insurance.ixXChinas experience in pursuing universal health coverageIn terms of strategi

53、c purchasing,the total revenue of the National Basic Medical Insurance Fund in 2023 was 3.35 trillion yuan,with 2.29 trillion yuan from the employee medical insurance fund and 1.06 trillion yuan from the resident medical insurance fund.The 2024 edition of the National Medical Insurance Medicines Cat

54、alogue includes a total of 3,159 Western and traditional Chinese medicines.In 2023,Chinas per capita life expectancy reached 78.6 years.The national maternal mortality rate fell to 15.1 per 100,000,and the infant mortality rate dropped to 4.5 per 1,000 live births.These major health indicators have

55、generally placed China at the forefront of middle-and high-income countries,achieving a remarkable health leap rarely seen in human history.Despite the significant achievements of Chinas universal health coverage,the system still faces challenges such as achieving full coverage,ensuring adequacy and

56、 fairness of benefits,addressing inadequacies in the financing mechanism,dealing with low-level fund pooling,and managing the rapid growth of medical costs,which increase pressure on the medical insurance fund.Reflecting on the past,Chinas basic medical insurance has covered over 1.33 billion people

57、,achieving nearly universal coverage.This success was primarily due to the Chinese governments strong political will to enhance citizens well-being,its growing economic strength and robust financial support,broad public backing,adaptation of international experiences to local conditions,and the rapi

58、d development of medical insurance informatization.Moving forward,it is essential to accurately identify the uninsured,improve benefit adequacy,establish a fair and uniform benefit guarantee mechanism,and develop a stable and sustainable financing mechanism.XChinas experience in pursuing universal h

59、ealth coveragex IntroductionThe Universal Declaration of Human Rights,adopted by the United Nations General Assembly in 1948,stipulates that everyone has the right to social security,laying a foundation for the establishment of todays international legal framework for social security.Fundamentally,u

60、niversal health coverage(UHC)is an important goal proposed on the basis of human rights and actual human needs.The International Labour Organization(ILO)adopted the Social Security(Minimum Standards)Convention,1952(No.102),which established the minimum requirements for social security systems,includ

61、ing coverage of medical care.The subsequent Medical Care and Sickness Benefits Convention,1969(No.130)and Recommendation(No.134),as well as the Maternity Protection Convention,2000(No.183)and Recommendation(No.191),set higher standards for medical,sickness,and maternity protection.The Social Protect

62、ion Floors Recommendation,2012(No.202),supplemented Convention No.102 and the subsequent higher standards by proposing two dimensions for bridging coverage gaps and achieving universal coverage:extending coverage horizontally to uncovered populations and vertically to higher levels of protection and

63、 more comprehensive benefits.International labour standards have established a series of guiding principles in the field of social health protection,including universal protection,collective financing,adequacy and predictability of benefits,and the primary responsibility of the State.As early as 194

64、4,the ILOs Medical Care Recommendation(No.69)called for the provision of medical services to all people through social insurance,social assistance,and public health services.In 2005,the 58th World Health Assembly formally introduced the concept of UHC,meaning that all people should have access to th

65、e full range of quality health services that they need,when and where they need them,without financial hardship(WHO,2024).Following the conclusion of the Millennium Development Goals,the United Nations established the 2030 Sustainable Development Goals(SDGs)in 2015,where UHC was set forth to promote

66、 the health and well-being of people of all ages(SDG Target 3.8),encompassing population coverage,service coverage,and financial protection.Although the Chinese government has not yet ratified Convention No.102,it has consistently pursued the spirit and principles of the Convention by prioritizing t

67、he protection of peoples health in its development strategy,achieving positive progress in the pursuit of UHC.With six years remaining until the completion of the SDGs,summarizing Chinas experiences in advancing universal health coverage can contribute with valuable insights and strength to the ongo

68、ing development of global health initiatives.1Chinas efforts to improve the multi-tier medical security system1.1 Framework of Chinas medical security systemA social health protection system is essential to UHC a globally shared goal for people of all ages.According to the Social Insurance Law of th

69、e Peoples Republic of China,the Interim Measures for Social Assistance and other national laws and regulations,as well as decisions and plans of the Communist Party of China(CPC)Central Committee and the State Council,China has established a three-tiered basic medical security system comprising basi

70、c medical insurance,critical illness insurance,and medical assistance to mitigate the burden on the public(see figure 1).Basic medical insurance consists of basic medical insurance for employees(EBMI)and basic medical insurance for rural and non-working urban residents(RBMI).In order to meet the div

71、ersified health needs of its population,China has additionally set up commercial health insurances,charitable assistance,mutual medical aid,which,together with the basic medical security system,constitute a multi-tier medical security system.From urban employees to rural and urban residents,Chinas b

72、asic medical security system has seen an expansion of coverage providing higher level of protection and enhanced administrative services(SCIO,2024).By the end of 2023,over 1.33 billion people were covered by Chinas basic medical security(NHSA,2024a),accounting for 94.6 per cent of the countrys total

73、 population(NBS,2024).China has established the worlds largest basic medical security system.Women practicing the traditional fan dance in the park,Luannan County,Hebei Province,2021.Shutterstock12XChinas experience in pursuing universal health coverage X Figure 1.Framework of financing,services and

74、 benefits of the basic medical security system(as of 2024)Tax authorityEducation departmentPublic security departmentHuman resources and social security departmentCivil affairs departmentHealth departmentEmployer:6 per cent(pooled)Individual:2 per cent(individual accounts)Individual 400 yuan(2024)Go

75、vernment 670 yuan(2024)FinancingBenefitsBasic medical insurancePooled fundsIndividual accounts or pooled funds for outpatient expensesSupplementary medical insurance provides further coverage for eligible high-cost medical expensesMedical assistance is provided for expenses in catalogue that remain

76、difficult for individuals and their families to bear,even after coverage by basic and supplementary medical insurances,in accordance with the regulations.Basic medical insuranceEmployee Basic Medical InsuranceBasic medical insurance for urban and rural residentsMedical assistanceMedical assistanceBa

77、sic Medical Security SystemEmployee subsidies for catastrophic medical expenses(including employee critical illness insurance in some provinces)Critical illness insurance for urban and rural residents Medical subsidies for civil servantsCritical illness insuranceInpatient servicesServicesBasic medic

78、al insurance cataloguesMedicines Facilities and medical consumablesMedical services Finance departmentCivil affairs departmentHealthcare security departmentCivil affairs departmentHealthcare security departmentHealth departmentHealthcare security departmentFinance departmentHealth departmentCivil af

79、fairs departmentPublic security departmentDetermination of medical assistance recipientsLocal financeMedical assistanceGeneral outpatient clinicOutpatient chronic&special diseases3XChinas experience in pursuing universal health coverage1.2 Legal and policy framework for a universal medical security

80、systemChina has promulgated a series of laws and regulations to support the development of a universal medical security system(see annex 1).On the institutional side,the 2010 Social Insurance Law of the Peoples Republic of China(henceforth referred to as the Social Insurance Law)provides fundamental

81、 legal guarantees for the improvement and development of the basic medical insurance system and clarifies the basic framework and principles of the social insurance system,a step towards the goal of establishing UHC.The Law of the Peoples Republic of China on Basic Medical and Health Care and the Pr

82、omotion of Health enacted in 2020 stipulates the rights and obligations of citizens to participate in basic medical insurance in accordance with the law.In 2021,the National Healthcare Security Administration(NHSA)released the Medical Security Law(draft for public comment).This programmatic and comp

83、rehensive law on medical security underscores that Chinas medical security system is beginning to be formally anchored in legislation.In the field of medical and healthcare,the Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medi

84、cal and Healthcare System,issued in 2009,made specific regulations and arrangements for the goal,principles,overall structure and key tasks of the reform of the medical and healthcare system.It proposed to“establish a basic medical security system covering urban and rural residents”,which provided a

85、 favourable external environment and an opportunity for rapid development,enabling China to achieve UHC at a fast pace.In May 2018,following a new round of national institutional reform,the National Healthcare Security Administration was established,marking the beginning of a new phase of comprehens

86、ive deepening of healthcare reform.The Chinese government has introduced a series of major reform measures,including top-level design,regulations for the use and supervision of basic medical insurance funds,reform of individual accounts for employee medical insurance,promotion of city-level pooling,

87、centralized procurement of medicines and medical supplies,expansion of payment trials based on Diagnosis-Related Groups(DRG)and Diagnosis-Intervention Packet(DIP),and the establishment of a medical insurance benefits list system(Zheng,2021).These measures have led to the maturation and high-quality

88、development of the basic medical security system.In March 2020,the CPC Central Committee and the State Council jointly issued the Guidelines on Deepening the Reform of the Medical Security System(henceforth referred to as the Guidelines).This makes clear the goal of developing a sustainable multi-ti

89、er social security system that covers the entire population in both urban and rural areas,with clearly defined rights and responsibilities and appropriate support levels.The Guidelines also highlighted the development by 2030 of a medical security system centred on basic medical insurance and underp

90、inned by medical assistance,with supplementary medical insurance,commercial health insurance,charitable donations,and mutual medical aid under co-development.The issuance of the Guidelines marks the beginning of a new development phase in Chinas medical security system reform,aiming to fully establi

91、sh a high-quality,sustainable medical security system with Chinese characteristics(Zheng,2022).In 2021,the General Office of the State Council issued the 14th Five-Year Plan for Universal Medical Security to further refine the implementation of the Guidelines in the next five years.In July 2024,the

92、CPC Central Committee issued the Decision of Fully Deepening Reforms and Promoting Chinese Modernization.This Decision proposes improvements to the social security system,including refining the mechanisms for financing and benefits adjustment of basic old-age insurance and medical insurance.It also

93、aims to enhance social security schemes for flexibly employed workers(flexible workers),migrant workers,and workers in new forms of employment(NFE),expand the coverage of unemployment,work-related injury,and maternity insurances,and remove household registration restrictions on enrolment in social i

94、nsurance schemes at the workplace.Additionally,it seeks to improve policies concerning the transfer and renewal of social XChinas experience in pursuing universal health coverage4insurance entitlements and to fully leverage the supplementary protection role of commercial insurances.The Decision also

95、 calls for advancing provincial-level pooling of basic medical insurance,deepening the reform of medical insurance fund payment methods,refining critical illness insurance and medical assistance schemes,and strengthening the supervision of medical insurance funds.1.3 Chinas path towards universal co

96、verage of basic medical security In the early years of the founding of the Peoples Republic of China,the State established,on the basis of a planned economy,labour medical insurance for enterprise employees and publicly funded medical insurance for staff of government agencies and public institution

97、s.Following socialist market economic reforms,China embarked on the transition from free labour and publicly funded medical insurance schemes to a social medical insurance system(Lu,2022).In December 1998,the State Council released a Decision to establish basic medical insurance for urban employees,

98、emphasizing the principle of local management,meaning that it would be administered within each pooling area.In 2002,enterprise employees and staff of government agencies and public institutions were covered by basic medical insurance(Li,2022;Sun,2018).The rural cooperative medical scheme(RCMS)was i

99、ntroduced in 1957 in the context of the rural collective economy,but it was largely dismantled with the reform of the rural household contract responsibility system.In 2003,the General Office of the State Council released a Decision proposing to pilot a voluntary new rural cooperative medical scheme

100、(NRCMS)focusing on medical insurance for critical illness.As stipulated,the new pilot programme was organized,guided and supported by the government,targeted to rural residents on a voluntary basis and financed by individuals,the collective and the government.The Decision also proposed the goal of“e

101、stablishing an NRCMS that basically covers all rural residents throughout the country by 2010”.Having included urban employees and rural residents in the coverage of basic medical insurance,in 2007,the State Council issued Guidelines on the establishment of a pilot basic medical insurance for non-wo

102、rking urban residents(URBMI),which was financed by insured households and government subsidies.With the establishment of these schemes,China extended basic medical insurance coverage from urban employees to rural and urban residents(see figure 2).X Figure 2.Schematic diagram of the development of th

103、e basic medical insurance systemBasic medical insurance scheme for employeesNew rural cooperative medical schemeBasic medical insurance scheme for urban residentsBasic medical insurance scheme for urban and rural residents199820032007201220162020YearIntegration5XChinas experience in pursuing univers

104、al health coverageAs the system evolved,the per capita financing levels of the URBMI and NRCMS gradually converged,thus in 2012,localities in the country began to explore how to integrate the two schemes to promote a more equitable structure.In January 2016,the State Council issued the Opinions on i

105、ntegrating the Basic Medical Insurance Schemes for Urban and Rural Residents,integrating the scope of coverage,financing policies,benefits lists(catalogues),the management of designated institutions and medical insurance funds of the two existing schemes.Two schemes EBMI and RBMI within the framewor

106、k of the basic medical insurance system facilitated funding of the system and improved the level of benefits for the insured population.In November 2016,the Chinese Government was granted the“ISSA Award for Outstanding Achievement in Social Security”by the International Social Security Association(I

107、SSA),signifying that Chinas achievements in reform and development of universal medical insurance were recognized worldwide.In 2019,the General Office of the State Council issued the Opinions stipulating that maternity insurance should be implemented in conjunction with the EBMI,and that the funding

108、 of the two schemes should be merged into one account and managed in a unified manner.To improve financial protection,the State has established,in addition to basic medical insurance,critical illness insurance for rural and non-working urban residents(hereafter referred to as critical illness insura

109、nce),subsidies for catastrophic medical expenses for insured employees(including critical illness insurance for employees implemented in some provinces),and medical subsidies for civil servants.In 2010,to enhance medical security for rural residents and reduce the burden of critical illnesses on far

110、mers,the former Ministry of Health issued the Opinions on pilot work to improve medical security for rural children.The pilot programme prioritized critical illnesses that threaten childrens health,incur high costs,and have good prognoses with treatment,such as acute leukaemia and congenital heart d

111、isease.In 2012,National Development and Reform Commission(NDRC)and five ministries jointly issued the Guidelines on the development of critical illness insurance for rural and urban residents,clarifying that critical illness insurance for urban and rural residents is an institutional arrangement tha

112、t provides additional coverage for high medical expenses incurred by patients with critical illness,on top of basic medical insurance.Based on the pilot programme,in 2015,the General Office of the State Council issued the Opinions on fully implementing critical illness insurance for urban and rural

113、residents.This document requested the full implementation of critical illness insurance,providing additional coverage for high medical expenses incurred by urban and rural residents due to critical illnesses,ensuring that people do not fall into financial hardship because of illness.In terms of medi

114、cal assistance,in 2003,the Ministry of Civil Affairs and other ministries jointly issued the Opinions on the implementation of medical Assistance in rural areas,which stipulated the establishment of a medical assistance system for rural residents.In 2005,a pilot medical assistance scheme was started

115、 in urban areas.In 2008,a unified medical assistance system for urban and rural residents was fully implemented.The State Council issued the Opinions on further improving medical assistance system and fully implementing medical assistance for critical illness in 2015 and the Opinions on further impr

116、oving medical insurance and assistance for critical illness in 2021.It was proposed that medical assistance should fairly cover urban and rural residents and employees who face heavy medical expenses,with categorized assistance based on the type of recipients.Pichit Phromkade/ILO 2Design of Chinas b

117、asic medical security system2.1 Population coverageIn 2021,the NHSA issued the Opinions on establishing a medical insurance benefits list system(henceforth referred to as the benefits list),clarifying the eligible persons for each scheme in the basic medical insurance system,and the policies of subs

118、idies for enrolment.All employees,self-employed individuals without employees,part-time workers not covered through their employers,and other forms of flexible workers are entitled to participate in the EBMI.Enrolment is mandatory for employees and voluntary for other workers.Employees participating

119、 in EBMI simultaneously participate in maternity insurance,which covers employers and their employees.The RBMI is a voluntary enrolment insurance scheme covering all urban and rural residents except those who are eligible for enrolment in the EBMI or for other types of coverage in accordance with th

120、e regulations.Citizens have the right and obligation to participate in basic medical insurance according to the law.Individual contributions need to be paid annually in a lump sum during the centralized enrolment period at the place of household registration or residence.Part-time workers and other

121、flexible workers can choose to participate in either EBMI or RMBI.In August 2024,the General Office of the State Council issued the Guidelines on improving the long-term mechanism for basic medical insurance enrolment(Henceforth referred to as the long-term mechanism for enrolment),easing household

122、registration restrictions on enrolment.Specifically,megacities are required to remove the household registration restrictions on enrolment in the EBMI for flexible workers,migrant workers,and NFE workers.Primary and secondary school students and pre-school-aged children are entitled to participate i

123、n the RBMI in the place where they live.The Guidelines A nurse at Jiangxi Peoples Hospital replacing dialysate for uremia patients,Jiangxi,2012.Shutterstock67XChinas experience in pursuing universal health coveragealso stipulate that newborns can be enrolled in the RBMI with a birth medical certific

124、ate instead of waiting for household registration.Online application for medical insurance codes allows for immediate insurance coverage upon birth.In terms of critical illness insurance,EBMI participants(including retirees)are requested to simultaneously participate in catastrophic medical expense

125、subsidies/critical illness insurance.RBMI participants are automatically covered by critical illness insurance.When insured individuals seek medical treatment,especially during hospitalization,if their personal expenses exceed a certain amount,generally not higher than 50 per cent of the average dis

126、posable income of residents in the pooled region from the previous year,critical illness insurance is automatically activated(SCIO,2024;NHSA,2021).Medical assistance covers impoverished individuals,low-income households,and those who have fallen back into poverty due to illness.2.2 Benefit designMed

127、ical service expenses incurred by participants receiving basic medical services at designated medical institutions should be mainly covered by the basic medical insurance fund and co-payments by individuals(National Peoples Congress,2020).The fund is used to cover general outpatient medical care,out

128、patient treatment for chronic and special diseases,and inpatient care concerning,respectively,medicines,service facilities,and diagnosis and treatment items that are covered by basic medical insurance(see figure 1).Both EBMI and RBMI set thresholds(deductibles),caps(ceiling amount for eligible expen

129、ses),and fund payment ratios.The individual account of the EBMI can be used to pay for outpatient expenses at designated medical institutions,medicines purchased at pharmacies,and expenses below the deductible line,while pooled funds of the EBMI and the RBMI are mainly used to cover inpatient and ou

130、tpatient medical expenses within the range of the deductible line and the ceiling amount.Maternity benefits,including maternity allowance and maternity-related medical care,are primarily provided through maternity insurance.EBMI participants receive a maternity allowance(paid maternity leave)and rei

131、mbursement for maternity-related medical expenses.RBMI participants do not receive a maternity allowance but can get reimbursement for their maternity-related medical expenses through RBMI.Critical illness insurance under RBMI is an additional layer of protection within the basic medical insurance f

132、ramework,providing further coverage for high medical expenses incurred by RBMI participants.Catastrophic medical expense subsidies for employees(including critical illness insurance in some provinces)provide further coverage for high medical expenses incurred by insured employees(SCIO,2024;NHSA,2021

133、).The duration of basic medical insurance benefits is consistent with the enrolment period.In principle,the maximum payment limit for the EBMI plus subsidies for catastrophic medical expenses for employees,and for the RBMI plus critical illness insurance,is about six times the average annual wage of

134、 local employees and the per capita disposable income of local residents respectively(NHSA,2021).To enhance the mutual aid efficiency of the fund,in 2021,the General Office of the State Council issued the Guidelines on establishing and improving the mutual aid system for covering outpatient medical

135、expenses under the basic medical insurance for employees(henceforth referred to as Outpatient Mutual Aid).It clearly stipulates that employers contributions are fully included in the pooling fund,and the amount transferred from the pooling fund to retirees individual accounts is standardized,and the

136、 family mutual aid function of employees individual accounts is strengthened.By 2024,all provinces have achieved mutual aid across pooling regions within the province for employees individual accounts.The scope of mutual aid has been expanded to include spouses,parents,children,siblings,grandparents

137、,and maternal grandparents of the insured employees.Insured persons can add their close relatives online to achieve mutual aid.The Outpatient Mutual Aid clarifies that on the basis of ensuring outpatient chronic and special disease medical XChinas experience in pursuing universal health coverage8sec

138、urity,the general outpatient expenses for common and frequently occurring diseases will gradually be included in the scope of the pooling fund payment,improving the outpatient benefits for insured persons.To meet the publics needs for cross-region medical settlement,since 2018,the NHSA has expanded

139、inter-provincial settlement services from inpatient expenses to include general outpatient expenses and outpatient treatment expenses for chronic and special diseases.Medical settlement services have also gradually extended from within pooled regions to cross-region settlements within the province a

140、nd inter-provincial settlements.2.3 Financing mechanismsThe EBMI is financed by contributions from employers and employees,with around 6 per cent of the payroll paid by the employer and 2 per cent of the individual wage paid by the employee on a monthly basis(see table 1).The scheme is established o

141、n the basis of a combined model,meaning that individual contributions go into individual accounts and employers contributions,into pooled funds.The contribution base increases with the income level of employees.For participation in maternity insurance,employers pay the contributions,with no individu

142、al contributions required.In 2023,the per capita financing for employee medical insurance was 6,182 yuan.As for the duration of the contribution period,EBMI participants who reach retirement age and meet the required contribution years no longer need to pay contributions and will continue to be prot

143、ected by basic medical insurance.The required contribution period varies across provinces.For example,it is 30 years for men and 25 years for women in Shandong and Guangdong,while in Zhejiang,20 years are required.X Table 1.Financing mechanisms for the EBMI and RBMICore elementEBMIRBMISources of fun

144、dingContributions from employers and employees.Government subsidies and individual contributions.Funding standardEmployer:around 6 per cent of the payroll.Employees:2 per cent of their wages.Flat-rate contributions,which are adjusted annually.Level of pooled fundsGenerally,at the municipal level,and

145、 in some areas at the provincial level.Generally,at the municipal level,and in some areas,at the provincial level.Source:Opinions of the NHSA and the Ministry of Finance on the establishment of medical insurance benefits list system,Social Insurance Law of the Peoples Republic of China,and so forth.

146、The RBMI isfunded through a combination of individual contributions and government subsidies,with government subsidies being the primary source of funding(see figure 1).Government subsidies,provided at both central and local levels:the central Government subsidizes localities in accordance with the

147、regulations,providing subsidies to the western and central regions of 80 per cent and 60 per cent of the per capita government subsidy standard,respectively,and to provinces and cities in the eastern region,according to a percentage of the per capita government subsidy standard(NHSA,2024b).Minimum s

148、tandards for government subsidies and individual contributions are adjusted annually by the State.In 2023,the national government subsidy for the RBMI fund totalled 661.3 billion yuan,or 62.5 per cent of the schemes fund revenue in that year(Ministry of Finance,2024).In 2023,the per capita financing

149、 for resident medical insurance was 1,098 yuan.Individuals are required to make annual lump-sum contributions during the centralized enrolment period in the place of household registration or where they reside.To stay covered by RBMI,participants must keep making contributions.A waiting period is se

150、t for those who suspend their contributions and who are not enrolled 9XChinas experience in pursuing universal health coveragein the scheme on time.For medical assistance recipients,such as impoverished individuals and low-income households,their individual contributions for RBMI enrolment are subsi

151、dized according to regulations.With regard to risk and financial pooling,in the same region,pooling funds for the EBMI and RBMI have been established separately.At present,both EBMI and RBMI have achieved municipal pooling and are pursuing and promoting provincial-level pooling.To date,17 provinces(

152、autonomous regions and direct-administered municipalities)in the country have promoted provincial-level pooling of basic medical insurance.Of these,seven provinces-Beijing,Tianjin,Shanghai,Chongqing,Hainan,Qing Hai and Tibet(EBMI)-are adopting a financial system that unifies the fund revenue and exp

153、enditure,and 11 provinces-Shanxi(RBMI),Jiangxi,Sichuan,Tibet(RBMI),Ningxia,Fujian(EBMI),Shandong(EBMI),Liaoning,Anhui,Shaanxi and Xinjiang(EBMI)are adopting the provincial-level adjustment funds.The funds for critical illness insurance for urban and rural residents are commonly allocated from RBMI f

154、unds.Revenues of the medical assistance funds primarily come from central,provincial,and local financial allocations,special lottery public welfare funds,and social donations.Most regions set the medical assistance pooling fund at the county level.Each year,finance departments at all levels formulat

155、e a budget for medical assistance.Based on these budgets,the Ministry of Finance and the NHSA allocate central funds for urban and rural medical assistance.Provincial finance departments,along with their healthcare insurance administrations,distribute these central subsidies to municipal or county f

156、inance departments,which then allocate the funds to their social insurance accounts.Enrolment subsidies are directly allocated to the social insurance fund accounts in pooling regions,based on medical assistance lists from relevant authorities.Medical assistance fully subsidizes those in special har

157、dship and provides flat-rate subsidies for those in difficulty,including subsistence allowance recipients and those who have fallen back into poverty.Provincial governments set the standards for these flat-rate subsidies based on local conditions(NHSA,2021).For medical expense assistance,recipients

158、only make the pre-defined co-payment when receiving medical care at hospitals.The designated medical institutions cover the other medical costs and declare them to the local medical insurance administration.After the claim is examined and approved,the administration requests payment from the finance

159、 department,which then allocates the funds to the medical institution.2.4 Service provision Basic medical and healthcare services comprise basic public health services and basic medical services.Basic public health services are provided by the State free of charge(NHC,2024).Governments at the county

160、 level and above provide basic public health services through the establishment ofspecialized public health institutions,primary-level healthcare institutions and hospitals,or through the purchase of servicesfrom other medical and healthcare institutions(NPC,2020).Basic medical services are mainly p

161、rovided bygovernment-runmedical and healthcareinstitutions.The State encourages medical and healthcareinstitutionsrun by the private sectorto provide basic medical services(NPC,2020).2.5 Strategic procurement In 2021,the State Council issued the Opinions on promoting the normalization and institutio

162、nalization of centralized medicine procurement,and the NHSA,along with seven other departments,released the Guiding opinions on the centralized procurement and use of high-value medical consumables.These initiatives marked the start of nationwide,institutionalized bulk procurement of high-value medi

163、cal supplies and medicines.By December 2024,10 batches of medicines and 5 batches of high-value medical supplies had been procured.Provinces conducted these procurements independently or through alliances,promoting national joint XChinas experience in pursuing universal health coverage10procurement.

164、Efforts were made to include village clinics in basic medical insurance settlements and to introduce bulk-purchased medicines into grassroots medical institutions,private hospitals,and retail pharmacies.This aimed to reduce the cost burden of classic medicines with expired patents and create space f

165、or new medicines in the insurance system(NHSA,2024e).Since its establishment,the NHSA has adjusted the national medical insurance medicine list seven times,adding 835 medicines,including 530 through negotiation and 38 through bidding,enhancing medicine accessibility and upgrading the pharmaceutical

166、industry(NHSA,2024e).2.6 Responsibilities of relevant departments In May 2018,the NHSA was established,consolidating medical insurance-related responsibilities previously managed by various ministries and commissions.This included the management of EBMI,RBMI,and maternity insurance by the Ministry o

167、f Human Resources and Social Security(MOHRSS),as well as the long-term care insurance pilot programme.It also integrated the new rural cooperative medical scheme from the former Ministry of Health,medical assistance from the Ministry of Civil Affairs,and the management of medication prices and medic

168、al and health services from the NDRC.This centralization has enabled China to achieve unified management of national medical insurance implementation(Zheng,2020;Wang,2018).The main responsibilities of the NHSA are specifically to:formulate and implement basic medical insurance policies,plans and sta

169、ndards;supervise and manage relevant medical insurance funds;implement reform of the medical insurance payment method;organize the formulation,supervision and implementation of medical insurance benefits lists(“catalogues”)and payment standards,fees,price policies,bidding and procurement;handle the

170、administration of medical insurance and development of information systems;encourage participation,interpret policy,and undertake policy advocacy.Some of these functions are carried out by the relevant authorities(see figure 1).X The departments of finance are responsible for the review of the numbe

171、r of insured persons and the allocation of government subsidies,the supervision of income and expenditure,and the management of basic medical insurance funds.They also undertake the review and preparation of the draft budget and final account of basic medical insurance funds,the timely grant of gove

172、rnment subsidies at all levels,and the implementation of the social security strategic reserve fund.XThe departments of public security,human resources and social security,and education play an important role in the RBMI enrolment of newborns,enrolment at the place of residence,and the matching of i

173、nformation on unemployment insurance recipients and insured university students.XThe departments of civil affairs and others assume responsibility for identifying medical assistance recipients.XThe medical insurance administrations mobilize and guide social resources to support medical assistance in

174、 accordance with the law.X The health commissions are responsible for optimizing the allocation of medical resources,strengthening the supervision of medical institutions,and together with the medical insurance administrations,promoting reasonable and moderate growth of medical expenses in line with

175、 the level of economic and social development and medical insurance financing,and public affordability.XAccording to the Reform programme for the national and local tax collection and administration,tax authorities have taken charge of the collection of all social insurance contributions since 2019.

176、At the same time,they have strengthened data matching with medical insurance administrations and assisted in increasing enrolment in medical insurance.X Public security departments enhance cooperation with health commissions and medical insurance administrations,jointly cracking down on illegal and

177、criminal acts concerning medical insurance funds.3 Outcome of universal coverage of basic medical security in China3.1 Population coverage In 1998,the number of people covered by Chinas basic medical insurance was only 18.79 million,or a participation rate of 1.51 per cent.The number surged to 949 m

178、illion in 2007,or 71.83 per cent,with the establishment of the NRCMS and the URBMI,indicating that the two schemes played a significant role in extending coverage of basic medical insurance.In 2009,the NRCMS saw full coverage of rural residents and the URBMI was implemented nationwide,with coverage

179、of both schemes remaining stable at over 95 per cent from 2011 onwards.In 2013,the Report on the Work of the Government declared that“a basic medical insurance system that covers the whole population is taking shape,with over 1.33 billion people being covered by different medical insurance schemes”.

180、In 2022,the nationwide unified medical insurance information platform was fully established,eliminating duplicate enrolments.In 2023,the number of people covered by maternity insurance and long-term care insurance nationwide reached 249 million and 183 million,respectively(NHSA,2024a).Overall,since

181、the establishment of the NHSA in 2018,the total annual enrolments for basic medical insurance have stabilized at around 1.35 billion people,with an enrolment rate of approximately 95 per cent(SCIO,2024).Thus,China has achieved near-universal coverage of basic medical insurance.A nurse in intensive c

182、are unit,Luannan County,Hebei Province,2015.Shutterstock11XChinas experience in pursuing universal health coverage12 X Figure 3.Overview of basic medical insurance coverage in China4.09 2.72 3.10 3.01 2.80 2.72 2.70 2.66 2.79 2.92 2.99 2.97 2.99 3.02 3.00 2.95 2.90 2.84 2.78 2.77 2.78 2.78 2.82 2.80

183、 2.76 2.71 1.51 1.64 2.99 5.71 7.32 8.44 15.70 24.23 43.16 71.83 85.33 92.50 94.61 96.76 98.69 100.40 96.88 96.57 95.67 96.03 96.40 96.49 95.34 94.62 051015202530354045505560657075808590951001050200400600800100012001400199819992000200120022003200420052006200720082009201020112012201320142015201620172

184、01820192020202120222023Total number of insured population(millions)EBMI(millions)RBMI(millions)NRCMS(millions)Worker-to-retiree ratioParticipation rate(%)Source:China Statistical Yearbook 2024;China Medical Security Statistical Yearbook 2024.Note:Data for 2016 and 2017 were incomplete due to the mer

185、ger of the NRCMS and URBMI in 2016.3.2 Benefit improvement According to the China Statistical Yearbook(2024),the share of individual cash expenditure on health as a percentage of total health expenditure was 28.78 per cent in 2016,down from 55.87 per cent in 2003 and it has since plateaued,totalling

186、 27.33 per cent in 2023.3.2.1 EBMI benefitFor inpatient services under EBMI,in principle,the annual deductible should not exceed 10 per cent of the average annual salary in the pooling region.The deductible for critical illness insurance should not exceed 50 per cent of the previous years average pe

187、r capita disposable income of the residents in the region.Basic medical insurance covers around 75 per cent of eligible expenses above the deductible and below the ceiling amount.Critical illness insurance covers at least 60 per cent.Deductibles,ceiling amounts and fund payment ratios vary across me

188、dical institution levels.In 2023,the fund payment ratio for EBMI inpatient expenses was 84.6 per cent,with 83.5 per cent,87.4 per cent,and 89.4 per cent for tertiary,secondary,and primary institutions,respectively(NHSA,2024a).In principle,the maximum payment limit for the EBMI plus subsidies for cat

189、astrophic medical expenses for employees,is about six times the average annual wage of local employees(NHSA,2021).For general outpatient services,the annual deductible ranges from 0 to 1,800 yuan,with a median of 200 yuan.Deductibles are either fixed or based on hospital levels.For example,in Beijin

190、g,the deductible for active employees is 1,800 yuan and 1,300 yuan for retirees.In Hainan,the deductible is 10 yuan for primary,50 yuan 13XChinas experience in pursuing universal health coveragefor secondary,and 100 yuan for tertiary medical institutions.Most provinces have a fund payment ratio of a

191、t least 50 per cent for outpatient expenses within the catalogue.Regarding the maximum payment limit,Beijing and Shanghai do not have a cap,while most provinces do.For instance,in Hainan,the cap is 1,500 yuan for active employees and 2,000 yuan for retirees;in Ningxia,it is 4,000 yuan for active emp

192、loyees and 4,500 yuan for retirees(Zhu,2024).3.2.2 RBMI benefitFor inpatient services under RBMI,the deductible is usually a percentage of disposable income(e.g.,3 per cent in Shandong,5 per cent in Zhejiang,10 per cent in Jilin)or a percentage of average inpatient costs(e.g.,10 per cent in Hubei),o

193、r fixed amounts based on hospital level and frequency(e.g.,300 yuan/year for primary,600 yuan/year for secondary,800 yuan/year for tertiary institutions in Hainan).The deductible for critical illness insurance should not exceed 50 per cent of the previous years average per capita disposable income.A

194、ssistance thresholds are generally removed for low-income and special hardship individuals.Basic medical insurance covers around 70 per cent of eligible expenses above the deductible and below the ceiling,with variations across hospital levels.In 2023,the fund payment ratio for RBMI inpatient expens

195、es was 68.1 per cent,with 63.2 per cent,72.4 per cent,and 80.8 per cent for tertiary,secondary,and primary institutions,respectively(NHSA,2024a).Medical assistance covers at least 70 per cent for low-income and special hardship individuals.The fund payment ratio and actual reimbursement rate for RBM

196、I inpatient expenses are both lower than those under EBMI.In principle,the maximum payment limit for the RBMI plus critical illness insurance,is about six times the average per capita disposable income of local residents.For general outpatient services,there is usually no deductible or a low deducti

197、ble,with a low annual cap.In Beijing,the deductible is 100 yuan for primary institutions with a 55 per cent fund payment ratio,and 550 yuan for secondary and above institutions with a 50 per cent fund payment ratio.The annual outpatient cap is 5,000 yuan.In Yunnan,the fund payment ratio for general

198、outpatient expenses is at least 50 per cent for primary institutions and 25 per cent for secondary and above institutions,with an annual cap of at least 400 yuan.For chronic and special diseases,outpatient medications for conditions like hypertension and diabetes are covered by insurance.Since the c

199、omprehensive establishment of the critical illness insurance for urban and rural residents in 2015,RBMI participants can receive reimbursements for eligible high medical expenses through the critical illness insurance after the basic medical insurance reimbursement.In 2023,the reimbursement rate was

200、 increased by more than 15 percentage points on top of the reimbursement covered by the RBMI fund.In 2023,national expenditure on medical assistance was 74.6 billion yuan,and 80.2 million people were enrolled in basic medical insurance with the help of subsidies from the medical assistance fund.Outp

201、atient and inpatient subsidies were handed out 153.4 million times,with an average amount of 1,241 yuan and 132 yuan per time,respectively,nationwide.The central Government allocated 29.7 billion yuan for medical assistance subsidies.Data show that in 2023,various medical insurance assistance polici

202、es cumulatively benefited the low-income rural population with 186 million instances,alleviating their medical burden in the amount of 188.35 billion yuan(NHSA 2024a).3.3 Service provisionChina saw a large increase in the number of medical and health institutions,hospital beds,licensed(assistant)phy

203、sicians,registered nurses and other medical resources between 2000 and 2023.The number of medical and health institutions rose from 1.03 million in 2000 to 1.07 million in 2023,which included 38,355 hospitals,1,016,238 primary-level medical and health institutions and 12,121 specialized public healt

204、h institutions(see annex 2).In terms of medical facilities,there were 3,855 tertiary hospitals(of which 1,795 were further evaluated XChinas experience in pursuing universal health coverage14as Level A),11,946 secondary hospitals,13,252 primary hospitals and 9,302 unclassified hospitals.In 2023,the

205、number of beds in medical and health facilities per 1,000 inhabitants,and the number of licensed(assistant)physicians and registered nurses per 1,000 inhabitants were 7.23,3.40 and 4.00,respectively,an increase from 2.38,1.02 and 1.08 in 2000.Chinas medical and health services system has continued t

206、o improve,dramatically enhancing the availability and accessibility of medical services to the population.The number of designated medical institutions and retail pharmacies for basic medical insurance sharply increased between 2018 and 2023,from 193,000 and 341,000,respectively,to 520,000 and 485,0

207、00.This has enhanced accessibility to medical services and made it more convenient for the public to seek medical treatment and purchase medicines.X Figure 4.Overview of medical and health resources2.38 2.56 2.62 2.70 2.83 3.05 3.32 3.58 3.84 4.24 4.55 4.85 5.11 5.37 5.72 6.03 6.30 6.46 6.70 6.92 7.

208、23 1.68 1.60 1.60 1.60 1.60 1.70 1.70 1.80 1.80 1.90 2.00 2.10 2.20 2.30 2.40 2.60 2.80 2.90 3.00 3.20 3.40 1.02 1.00 1.00 1.10 1.20 1.30 1.40 1.50 1.70 1.80 2.00 2.20 2.40 2.50 2.70 2.90 3.20 3.30 3.60 3.70 4.00 10.34 8.49 8.82 9.18 9.12 8.91 9.17 9.37 9.54 9.50 9.74 9.81 9.84 9.83 9.87 9.97 10.08

209、10.23 10.31 10.33 10.71 024681012200020042005200620072008200920102011201220132014201520162017201820192020202120222023Number of beds in medical institutions per 1,000 populationNumber of licensed(assistant)physicians per 1,000 populationNumber of registered nurses per 1,000 populationNumber of health

210、care institutions(100,000)Source:China Statistical Yearbook 2024.The basic medical insurance system has reduced the medical expense burden on the general public,while also rapidly increasing the utilization rate of medical services.In 2023,the number of diagnostic and treatment services provided by

211、medical and health institutions and the number of hospital admissions reached 9.55 billion and 302 million,respectively,up from 2.15 billion and 59.91 million in 2002,a 4.5-fold and 5-fold increase.In 2023,insured employees enjoyed benefits 2.53 billion times,a 20.45 per cent increase from the previ

212、ous year.This included 2.18 billion outpatient visits,270 million chronic disease treatments,80 million hospitalizations,and 2.3 billion pharmacy purchases.Insured residents enjoyed benefits 2.61 billion times,a 21.1 per cent increase from the previous year,including 2.08 billion outpatient visits,3

213、40 million chronic disease treatments,and 200 million hospitalizations.The hospitalization rates for both EBMI and RBMI patients have risen rapidly.For insured employees,the rate increased from 13.5 per cent in 2012 to 21.86 per cent in 2023,and for insured residents,it grew from 12.33 per cent to 2

214、5.34 per cent.In 2023,the number of designated medical institutions connected across provinces reached 550,400.Throughout the year,the number of cross-province direct settlements for inpatient services,general outpatient services,and outpatient chronic disease treatments reached 11.25 million,85.99

215、million,and 3.31 million person-times,respectively.The types of outpatient chronic diseases eligible for cross-province direct settlement increased from 5 to 10(SCIO,2024).Additionally,a medication guarantee mechanism for outpatient treatment of hypertension and diabetes was established.15XChinas ex

216、perience in pursuing universal health coverageWith regard to maternity insurance,data on maternity insurance entitlement were further standardized and unified in 2023,with prenatal check-ups and family planning included in the data.In 2023,28.34 million maternity insurance benefit payments were made

217、,an increase of 10.65 million payments,or 60.2 percent,over 2022.In terms of long-term care insurance,more than 1.34 million people from 49 pilot cities received the benefits,with 8,080 designated institutions and almost 302,800 care workers(NHSA,2024a).3.4 Strategic procurementWith the establishmen

218、t of the NHSA,the role of managing funds for the EBMI,URBMI and NRCMS schemes and for medical assistance previously carried out by different authorities was integrated into the NHSA,thus strengthening the mutual aid capacity of pooled funds.Recent years have witnessed continuous growth in funds reve

219、nue.In 2023,the aggregate revenue from national basic medical insurance funds reached 3.35 trillion yuan,of which 2.29 trillion yuan was from the EBMI fund and 1.06 trillion yuan from the RBMI fund.Revenue from long-term care insurance reached 24.36 billion yuan.In the same year,national basic insur

220、ance(including maternity insurance)funds expenditure totalled 2.82 trillion yuan(117.72 billion yuan from the maternity insurance fund),with a current balance of 504.03 billion yuan and a cumulative balance of 3.4 trillion yuan in the pooled fund.In addition,total expenditure from the long-term care

221、 insurance fund was 11.86 billion yuan(NHSA,2024a).Since its establishment,the NHSA has reformed the pharmaceutical procurement system and initiated national negotiations for the medical insurance medicine list,achieving strategic purchasing.The list is updated annually,with the new version typicall

222、y implemented at the beginning of the following year.The number of Western and traditional Chinese medicines increased from 2,196 in 2016 to 3,159 in 2024(NHSA,2024d;SCIO,2024),covering types of medications that account for over 90 per cent of the medication expenses in public medical institutions(S

223、CIO,2024).The quality of listed medicines has significantly improved,especially for cancer,rare diseases,hypertension,and diabetes,with many new mechanism and new target medicines included(Peoples Daily,2024).Negotiations for inclusion have become an important pathway for high-value innovative medic

224、ines,enhancing patient affordability.Additionally,advanced medical equipment and technologies,such as medical examinations,ultrasound,computed tomography(CT)scans,magnetic resonance imaging(MRI),painless surgeries,and minimally invasive surgeries,are now covered by medical insurance(SCIO,2024).Furth

225、ermore,31 provinces and the Xinjiang Production and Construction Corps have included assisted reproductive technologies,such as in vitro fertilization(IVF),in the medical insurance coverage.Centralized procurement of medicines and high-value medical consumables has effectively improved accessibility

226、(Peoples Daily,2024).Chinas basic medical insurance,which represents about 2 per cent of the gross domestic product(GDP),covers approximately 40 per cent of the countrys total medical and health expenses.This funding supports medical care for roughly one-sixth of the worlds population and provides e

227、conomic backing for the efficient allocation of medical resources.It also helps regulate diagnoses and treatments for both medical practitioners and patients.XChinas experience in pursuing universal health coverage163.5 Improvement in peoples healthThe establishment of the medical insurance system h

228、as significantly contributed to improvements in health in both urban and rural areas of China.According to the China Statistical Yearbook,Chinas per capita life expectancy increased from 71.40 years in 2000 to 78.6 years in 2023.Average life expectancy for men was 75.37 years and for women 80.88 yea

229、rs in 2023,up from 69.63 years and 73.33 years,respectively,in 2000.The substantial increase in per capita life expectancy reflects the better health of Chinas population.The national maternal mortality rate and the infant mortality rate,which reached as high as 1,500 per 100,000 and 200 per 1,000,r

230、espectively,before the founding of New China,dropped to 15.1 per 100,000 and 4.5 per 1,000,by 2023,according to the 2023 Statistical Bulletin on the Development of Chinas Health and Wellness Sector.Urban and rural maternal mortality rates,the under-five mortality rate and the neonatal mortality rate

231、 have seen sharp decreases,with a clear trend of improvements in health conditions in rural areas.Overall,major health indicators in China are now among the highest for upper-middle-income countries,a massive health achievement.4Challenges,experiences and prospects for Chinas medical insurance4.1 Ma

232、jor challenges facing the development of universal medical insurance coverage4.1.1 Persistent gaps in universal coverage and enrolment quality issuesThe participation rate in Chinas basic medical insurance has remained steady at around 95 per cent since 2011,signifying that UHC has very nearly been

233、achieved.However,progress has slowed since coverage was vastly expanded,with around five per cent of the population still to be reached the“last mile”in order for China to achieve full universal coverage.The EBMI and the RBMI constitute the countrys two basic medical insurance pillars,with the RBMI

234、covering more than 70 per cent of the population,or nearly three times the number of people enrolled in the EBMI.There is a need to improve the enrolment quality of both schemes.With continued urbanization,large-scale population flows between urban and rural areas and between regions,as well as the

235、growth of the Internet+,digital economy and new forms of employment,the number of EBMI participants reached 371 million(271 million active workers)in 2023(NHSA,2024a).However,there were approximately 470 million were employed in urban areas during the same year(NBS,2023),meaning that more than aroun

236、d 200 million urban employed persons were not enrolled in the EBMI.Small business owners Doctors discussing a patients condition,Beijing,2016.ILO17XChinas experience in pursuing universal health coverage18without employees,part-time workers not covered by their employers,and other types of flexible

237、workers are eligible to participate in the EBMI on a voluntary basis rather than a compulsory one.However,flexible workers often face challenges such as unclear employer liability,high mobility,generally low and unstable levels of income,and the burden of paying both personal and employer contributi

238、ons.These factors have reduced their willingness to participate in the EBMI,resulting in many eligible workers either not enrolling in the scheme or opting for the RBMI instead.In addition,impacted by the aging population and declining birth rate challenges,the ratio of active workers to retirees ha

239、s shown a downward trend,dropping from 4.09 in 1998 to 2.71 in 2023.Although government finance has played a major supporting role for the RBMI,covering over 70 per cent of the insured population,the continuous rise in medical expenses has led to reasonable adjustments in individual contribution sta

240、ndards in recent years to ensure the expenditure on insured benefits.However,under voluntary enrolment,some able-bodied people and rural-urban migrant workers have chosen not to enrol or renew their insurance(Qiu and Wang,2020),putting greater pressure on enrolment and the expansion of coverage,furt

241、her fuelling uncertainty regarding sustainability of the scheme.At the same time,although the enrolment rate of rural low-income populations within the national monitoring scope remains stable at over 99 per cent(NHSA,2024a),and some individuals are covered by other systems,a small number of people

242、are still unwilling to enrol despite consistent mobilization efforts.4.1.2 Inequities in benefits and insufficient level of protection Chinas basic medical insurance system follows a dual structure that combines the EBMI and RBMI schemes.Although there are unified lists of services and items that ar

243、e covered and the same policies on designated management,the two schemes have clear disparities in terms of financing mechanisms,financing levels and benefits provided.Furthermore,under the hierarchical management structure,pooling regions have greater autonomy in decision-making on medical insuranc

244、e,resulting in variations in medical insurance schemes and relevant policies among different regions.Each region largely utilizes government subsidies and medical insurance funds raised to provide medical insurance benefits,and the better the regional economy performs,the higher the level of the ben

245、efits.Due to the“fragmentation”of the system and the lower level of the pooled fund,the benefits of both the same scheme and different schemes show relatively large gaps in different regions,directly affecting fairness among different groups.In recent years,the proportion of inpatient expenses cover

246、ed by the pooled funds of EBMI and RBMI has stabilized at around 80 per cent and 70 per cent,respectively.For outpatient expenses,EBMI covers no less than 50 per cent,with a common cap set,while RBMI provides lower level of benefit.When facing major illnesses,expenses exceeding the cap and those not

247、 covered by the scheme catalogue can still impose a heavy financial burden on families.4.1.3 Inadequate financing mechanisms and low levels of pooled fundsThe current basic medical insurance system still suffers from challenges such as the lack of sound financing mechanisms,putting the equitable and

248、 sustainable running of the system at risk.As for the EBMI,although the reform of the mutual aid mechanism for covering outpatient medical expenses has reduced individual contributions,individual accounts still constitute a quarter of the total financing.This,to some extent,affects the mutual aid ca

249、pacity of the fund.The termination of contributions by retirees and their former employers and the net decrease of the working-age population(MOHRSS,2021)have led to a decline in EBMI contributors amid a continued expansion of benefit recipients,posing a huge challenge to the financing of the EBMI.I

250、n the case of the RBMI,while the flat-rate contributions are convenient in terms of payment collection,they foster financing inequity between high-income and low-income earners and are thus not a stable mechanism for financing growth.Meanwhile,in recent years,the ratio of government subsidies to per

251、sonal contributions has 19XChinas experience in pursuing universal health coveragebeen declining,resulting in a higher proportion of personal contributions.This also affects the sustainability of funding for the RBMI to a certain degree.Overall,the EBMI and RBMI schemes have established separate poo

252、led funds mostly at the municipal level.The small size of the pooled funds limits the role of basic medical insurance in risk-sharing.In addition,influenced by the financial system,most regions have established medical assistance pooling at the county level,resulting in significant disparities in th

253、e level of protection across different regions.4.1.4 Financial strain on medical insurance funds due to rapid growth in medical expenses According to data from Chinas seventh population census in 2020,the number of people aged 60 and above in China was more than 264 million,or 18.70 per cent of the

254、total population,an increase of 5.44 percentage points from 2010.The number of people aged 65 and above was 190.64 million,or 13.50 per cent of the total population,up 4.63 percentage points compared with 2010.This indicates a rate of increase for the two age groups of 2.51 and 2.72 percentage point

255、s,respectively(NBS,2021).The aging of Chinas population has been gradually accelerating,bringing dual risks to the medical insurance fund:on the financing side,the number of contributors to the system is decreasing as the in-service/retirement ratio is declining.On the expenditure side,chronic,non-c

256、ommunicable diseases can be controlled to a certain extent through surgical or pharmacological treatments,spurring medical demand.For example,total medical expenses incurred by retirees,who constitute around one quarter of EBMI participants,account for nearly 60 per cent of total medical expenses,fo

257、ur times that of active workers,and over 60 per cent of both inpatient medical expenses and expenses for outpatient treatment for chronic and special diseases.This“scissor gap”has put enormous pressure on the sustainability of the financing of the medical insurance system(Zhang et al.,2023).With the

258、 advent of economic and social development,the rapid increase and application of new medicines,materials,technologies and equipment,the introduction and growing popularity of medications for rare diseases as well as cellular therapy,gene therapy,and so forth,more diseases have shifted from being“inc

259、urable”to“treatable and controllable”(Xi,2022).Innovations in models such as Internet+healthcare and telemedicine have made it easier to access medical services and purchase medicines.The inclusion of new technologies and medicines in basic medical insurance has enabled more people to benefit from t

260、echnological advances and has contributed to further augmenting demand for medical and healthcare services.However,the disparity in the distribution of medical resources between urban and rural areas has led to an influx of insured patients to tertiary hospitals for medical treatment,resulting in a

261、continued rise in medical expenses and increasing pressure on the revenue and expenditure of the medical insurance funds.4.2 Experience in achieving universal medical insurance coverage Chinas rapid achievement of covering 1.33 billion people and attaining near-universal coverage,starting from a low

262、 level of basic medical insurance coverage,can be largely attributed to the Chinese Governments political will to commit to improving the well-being of its citizens,its growing economic strength and strong financial backing,broad public support,and the ability to learn from international experience

263、in a context-specific manner.4.2.1 Political will to improve the well-being of citizensChina has not yet ratified the Convention No.102,but the Chinese government is committed to gradually incorporating the principles of Convention No.102 into its social security laws and policies,continuing to enri

264、ch,standardize and improve Chinas social security system in line with international standards.Moreover,the Chinese Government actively supports the implementation of the health-related goals written into the XChinas experience in pursuing universal health coverage202030 Agenda for Sustainable Develo

265、pment at the global,regional and national levels,and is willing to strive to ensure UHC,leaving no one behind.In 2009,the Government invested 850 billion yuan in a new round of reform of the medical and healthcare system and proposed,for the first time,the overall goal of the reform,which was to“est

266、ablish a sound basic medical and healthcare system covering urban and rural residents”,specifying that rural and urban residents would be fully covered by the basic medical insurance system by 2011.In 2010,the introduction of the Social Insurance Law established the framework of Chinas medical insur

267、ance system.Since the 18th CPC National Congress,China has put the protection of peoples health in a more prominent position and formulated the Outline of the“Healthy China 2030”Plan,elevating the building of a“Healthy China”to the level of a national strategy.Thus,China entered a new stage of fully

268、 establishing a medical insurance system with Chinese characteristics.The establishment of the NHSA in 2018 has provided an organizational foundation for Chinas medical insurance system to move towards maturity,propelling the health sector to achieve all-round progress and historic achievements.4.2.

269、2 Economic and social development and strong financial supportChinas focus on economic development,underpinned by the principles of efficiency and equity,have led to a dramatic surge in GDP and per capita GDP.In 2023,Chinas GDP reached 126.06 trillion yuan,accounting for about 17 per cent of the glo

270、bal economy and ranking it second in the world in GDP terms.In 2019,per capita GDP in China reached 70,078 yuan,exceeding US$10,000 for the first time.In 2023,per capita GDP topped 89,358 yuan(US$12,681),signifying that China has attained upper-middle-income status(,2024;Qiushi.org,2024).The elimina

271、tion of absolute poverty in 2020 and the booming economy have created space for the development of UHC in China.In addition,total health expenditure as a percentage of GDP rose to 7.2 per cent in 2023 from 4.6 per cent in 2000(NHSA,2024c)while the per capita government subsidy standard for the RBMI

272、has increased massively,to 670 yuan in 2024 compared to 20 yuan in 2003.The States financial subsidy accounts for two thirds of the RBMI fund,and this support has played a significant role in the expansion of coverage towards UHC.Government finance provides support for both the supply and demand sid

273、es,thus contributing to the formation of a virtuous circle between the medical insurance system and the medical services system.4.2.3 Adapting international experience to local conditions Having established a social insurance system and faced with challenges in further advancing its basic medical in

274、surance system,China continues to learn from international experience,while adapting it to a local context.China is working to establish provincial-level pooling and provincial-level transfers of funds,developing the mutual aid system for covering outpatient medical expenses and promoting the reform

275、 of the DRG payment method,among other things,in order to continually adjust and improve its multi-tier medical insurance system.While learning from international experience,China has progressively reformed the medical insurance system,implementing reform measures in pilot areas and gradually scalin

276、g them to the whole country.Such reform has always been adapted to socio-economic development and affordability according to local conditions,and has gradually raised the level of benefits,therefore gaining broad public support.At the same time,the basic medical insurance system utilizes the technol

277、ogical dividends brought about by information technology to spur reform and reduce the cost of medical insurance administration,making scheme enrolment,settlement and supervision of funds more efficient and effective.21XChinas experience in pursuing universal health coverage4.2.4 Rapid development o

278、f medical insurance standardization and informatizationSince its establishment,NHSA has prioritized the standardization and informatization of medical insurance to modernize governance.By March 2022,a unified,efficient,compatible,convenient,and secure national medical insurance information platform

279、was fully operational.This milestone in informatization and standardization provides robust technical support for decision-making,governance,and delivering precise,high-quality,and efficient medical insurance services to the public.The national medical insurance information platform offers practical

280、 functions including enrolment,information inquiry,benefit application,and business handling.It also provides features such as medical insurance codes,mobile payments,electronic prescription transfers,and cross-region medical treatment and transfer of entitlements.By September 2024,1.39 billion peop

281、le held social security cards,covering 98.3 per cent of the population.Of these,1.03 billion had electronic social security cards,covering 73.4 per cent of the population.Additionally,1.17 billion people activated their medical insurance codes,allowing them to use their phones or other devices for m

282、edical treatment and reimbursement without a physical card(SCIO,2024).4.3 Policy recommendations for achieving universal medical insurance coverage 4.3.1 Accurately identify uninsured persons and improve the quality of enrolmentEnrolment in medical insurance is a prerequisite for ensuring that peopl

283、e receive basic medical protection.With the help of the national medical insurance information platform and the medical insurance code,it is recommended to:standardize the collection of basic information on scheme participants and conduct real-time verification of their enrolment in the scheme;enhan

284、ce information-sharing between medical security,public security,human resources and social security,education and civil affairs departments to accurately identify and analyse enrolment gaps,reduce duplicate enrolments and effectively expand insurance coverage.For the EBMI,attention should be given t

285、o flexible workers and NFE workers in order to encourage their participation in the scheme and ease their financial burden.Specifically,it is recommended to implement the policy shift from“enrolment at the place of household registration”to“enrolment at the place of residence”;utilize the tax system

286、 and the mechanism for unified collection of basic medical insurance contributions by tax authorities;and leverage information technology to effectively identify the insured individuals and their income.These measures would help improve the enrolment rate in the EBMI and reduce the States financial

287、burden.For the RBMI,awareness raising on participation should be effectively carried out,contribution payments strengthened,and the flat-rate contributions should be adjusted to rate-based contributions.Additionally,by leveraging the family mutual aid policy of EBMI individual accounts,savings in th

288、ese accounts can be used for family members to participate in RBMI and pay medical expenses.To improve the quality of insurance coverage,flexible workers and NFE workers should be motivated to participate in EBMI instead of RBMI,thereby gradually increasing the proportion of EBMI participants.If the

289、 total amount of government subsidies remains roughly unchanged,the per capita funding level for residents will increase due to fewer participants,thereby reducing the funding and benefit gap between the two systems.4.3.2 Promote the establishment of an equitable and unified mechanism for benefits m

290、anagementTo promote a fair and standardized medical insurance system,it is recommended to strictly implement the XChinas experience in pursuing universal health coverage22national benefits list and the unified policy formulation and adjustment.In terms of regional coordination,efforts should focus o

291、n achieving provincial-level pooling and fund transfers building on municipal pooling,coordination between the pooling level of medical assistance and basic medical insurance to enhance mutual assistance and the risk-resistance capacity of both funds,and balancing benefit disparities across differen

292、t cities within provinces,with the goal of establishing a fairer universal medical insurance system.To improve the level of overall benefits and ease the burden on individuals,it is necessary,on the one hand,to further leverage the role of pricing mechanisms for medical services and medical insuranc

293、e payments to strengthen diagnosis and treatment and encourage informed decision-making on medical services.At the same time,it is recommended to make full use of the strategic purchasing power of the medical insurance fund to increase the funds effectiveness and efficiency.On the other hand,focus s

294、hould be placed on establishing a robust mechanism for unified management of outpatient medical expenses while maintaining stable inpatient reimbursement.This would enhance general outpatient protection for insured individuals and reduce their medical burden.It is also recommended to appropriately i

295、ncrease the Governments input on medical expenses in order to reduce the share of individual expenditure on healthcare.Additionally,special attention should be given to pregnant women and other vulnerable groups.The reimbursement rate for prenatal and maternity-related medical expenses should be inc

296、reased.For unemployed couples,timely assistance should be provided through the medical assistance system for pregnant women who still face significant financial burdens after basic and critical illness insurance reimbursements.4.3.3 Establish a sound,stable and sustainable financing mechanismIt is r

297、ecommended to explore a dynamic financing mechanism linked to the level of socio-economic development,residents disposable income,and household affordability,and to set reasonable contribution rates to establish a stable growth mechanism for financing basic medical insurances.For the EBMI,the multi-

298、channel financing mechanism should be broadened in response to the aging population challenge.For the RBMI,individual contributions should be moderately raised as government subsidies are increased,promoting a reasonable sharing of financing responsibilities between the government and individuals.A

299、start can be made with the exploration of differentiated tiered payment systems,gradually transitioning to income-based contributions as personal income accounting systems improve.To expand sources of finance,policies on commercial medical insurances and social charitable donations within the multi-

300、tier medical security system should be improved.Finally,taxes on alcohol,tobacco,sugar-sweetened beverages,and other unhealthy products could be set or raised to supplement basic medical insurance funds,thereby reducing basic medical insurance fund expenditures by improving individual health.23XChin

301、as experience in pursuing universal health coverage Annex 1:Laws and policies on Chinas basic medical security systemName of the law/documentReleased byYear of enactmentKey implications for the reformSocial Insurance Law Standing Committee of the National Peoples Congress(NPC)2010Providing a legal b

302、ase for basic medical insuranceBasic Medical and Health Care and the Promotion of Health LawNPC Standing Committee 2020Clarifying citizens rights and obligations related to healthcareMedical Security Law(Draft for Public Comment)NHSA2021A programmatic and comprehensive law on medical security(pendin

303、g enactment)Decision on establishing a basic medical insurance system for urban employeesThe State Council 1998 Establishment of medical insurance for employeesDecision on establishing a new rural cooperative medical schemeGeneral Office of the State Council 2003Establishment of a new rural cooperat

304、ive medical schemeOpinions on the implementation of rural medical assistance Ministry of Civil Affairs and other authorities2003Establishment of rural medical assistance schemesOpinions on establishing a pilot urban medical assistance schemeGeneral Office of the State Council2005The establishment of

305、 an urban medical assistance schemeGuidelines on the pilot programme of basic medical insurance for urban residentsGeneral Office of the State Council2007Establishment of a basic medical care guarantee system for urban residentsGuidelines on the development of critical illness insurance for urban an

306、d rural residentsFormer NDRC and six other ministries 2012Establishment of a critical illness insurance system Opinions on further improving the medical assistance system and fully carrying out medical assistance for critical illness General Office of the State Council2015Improvement of medical assi

307、stance systemOpinions on fully implementing critical illness insurance for urban and rural residentsGeneral Office of the State Council2015Full implementation of the critical illness insurance for urban and rural residentsXChinas experience in pursuing universal health coverage24Name of the law/docu

308、mentReleased byYear of enactmentKey implications for the reformOpinions on integrating the basic medical insurance schemes for urban and rural residentsThe State Council 2016The merger of URBMI and NRCMS into RBMIOpinions on expanding the pilot programme of the State-organized centralized procuremen

309、t and use of medicines NHSA and eight other ministries 2019Expanded service coverage and reduced prices of medicinesOpinions on fully promoting the merger of maternity insurance and basic medical insurance for employeesGeneral Office of the State Council2019The merger of maternity insurance and EBMI

310、Circular of the list of pilot cities for diagnosis-related groups paymentNHSA and 3 other ministries 2019Launch of DRG payment pilot programmeCircular of the issuance of pilot work on diagnosis-intervention packet paymentGeneral Office of the NHSA2020Launch of DIP payment pilot programmeOpinions on

311、promoting the normalization and institutionalization of centralized medicine procurementGeneral Office of the State Council2021The nationwide normalization and institutionalization of centralized medicine procurementGuiding opinions on the centralized procurement and use of high-value medical consum

312、ablesNHSA and 7 other ministries2021The nationwide implementation of centralized procurement for medical consumablesRegulation on the supervision and administration of the use of medical security fundsGeneral Office of the State Council2021The first administrative regulation in the field of medical

313、securityOpinions on improving critical illness insurance and medical assistance systemGeneral Office of the State Council2021Improvement of critical illness insurance and medical assistanceOpinions on the establishment of a medical insurance benefits listNHSA and Ministry of Finance2021Establishment

314、 of a medical insurance benefits listGuidelines on establishing and improving the mutual aid system for covering outpatient medical expenses under the basic medical insurance for employeesGeneral Office of the State Council2021Establishment of a mutual aid system to address gaps in outpatient benefi

315、ts,and give full play to the effectiveness of the funds mutual assistance25XChinas experience in pursuing universal health coverageName of the law/documentReleased byYear of enactmentKey implications for the reformCircular of further improving the direct settlement of cross-provincial medical expens

316、es covered by basic medical insurance NHSA and the Ministry of Finance2022On-the-spot settlement of cross-provincial medical expenses Guidelines on improving the long-term mechanism for basic medical insurance enrolmentGeneral Office of the State Council2024Improving the structure and the quality of

317、 basic medical insurance enrolmentCircular of steadily expanding the types of outpatient chronic and special diseases covered by direct settlement of cross-provincial medical expensesGeneral Office of the NHSA,in conjunction with the General Office of the Ministry of Finance2024Expanding the coverag

318、e of outpatient chronic and special diseases under on-the-spot,cross-provincial settlement,and enhancing the effectiveness of administrative servicesXChinas experience in pursuing universal health coverage26 Annex 2:Overview of medical and healthcare institutions in China in 2022 and 2023 Type of in

319、stitution20222023Total1,0329,181,070,785Hospitals 36,97638,355Public hospital11,74611,772Private hospital25,23026,583Tertiary hospital3,5233,855 Secondary hospital11,14511,946Primary hospital12,81513,252Unclassified hospital9,4939,302Primary medical and healthcare institutions979,7681,016,238Communi

320、ty healthcare centre10,35310,070Community healthcare clinic26,09527,107Township health centre33,91733,753Village clinic 587,749581,964Medical room(infirmary)282,386318,938Specialized public health institutions12,43612,121Centre for disease control and prevention 3,3863,426Institute for specialist di

321、sease control 856823Maternal and child health institution3,0313,063Health inspection institute(centre)2,9442,791Family planning technical services787473Other institutions3,7384,071Source:2023 Statistical Bulletin on the Development of Health and Wellness in China27XChinas experience in pursuing univ

322、ersal health coverage Annex 3:Overview of health workforce in China,20052023YearNumber of health technical personnel per 1,000 populationNumber of licensed(assistant)physicians per 1,000 populationNumber of registered nurses per 1,000 population20053.51.561.0320063.61.61.0920073.721.611.1820083.91.6

323、61.2720094.151.751.3920104.391.81.5320114.581.821.6620124.941.941.8520135.272.042.0420145.562.122.220155.842.222.3720166.122.312.5420176.472.442.7420186.832.592.9420197.262.773.1820207.572.93.3420217.973.043.5620228.273.153.7120238.873.44Source:China Statistical Yearbook 2024XChinas experience in pu

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