From 1950 to the early 1980s, China’s rural health scheme depended mainly on Mao Zedong’s “barefoot doctors” and a remarkable public health network that was almost exclusively government funded and run. Rural health care coverage reached almost 90 percent during this time.
This was brought to a halt after the economic reforms of the late 1970s, when healthcare as a state-owned enterprise was transformed and privatized. Rural health insurance programs ceased operating, and urban schemes floundered under the crippling cost of health care and the inefficiency of state-run hospitals.
As the number of healthcare workers in the countryside plummeted in the wake of the reforms, the cost of medicine soared. Soon, pharmacies were closing, and by the late 1980s the rural healthcare system had all but collapsed, draining the countryside of quality healthcare workers.
Public dissatisfaction grew as health care costs continued to rise sharply and quality service became increasingly unaffordable. This scrutiny came to a head during the SARS outbreak in 2003, during which the public decried a system that provided little preventative and emergency care. Over the course of the next decade, the government rolled out one of the most extensive health care coverage systems in history.
In 2009 China unveiled its blueprint for health reform, guaranteeing that in three years its goal of universal coverage would be met. Authorities committed 850 billion RMB (about US $126 billion) to the “four beams” of reform: public health care, medical care, essential drugs and health insurance (including the Rural Cooperative Medical Scheme, the Urban Employee-based Basic Medical Insurance Scheme and the Urban Resident-Based Basic Medical Insurance Scheme).
While there has been undeniable progress, some groups still lack coverage. This is particularly true for disabled and vulnerable people in China’s countryside. Dr. Gry Sagli of the Institute of Health and Society, University of Oslo, who researches poverty and disability in China, explained that “high out-of-pocket expenses remain a major problem, the rates for reimbursement are far too low and the insurance covers only a narrow range of conditions.”
Care for individuals with disabilities remains problematic. Citing 2009 data from the China Disabled Persons’ Federation (CDPF), Dr. Sagli stated that “less than 10 percent of the people with disabilities in rural areas receive treatment and rehabilitation training. This did not change much in the period from 2007-2009 (8.4 percent in 2007, 9.0 percent in 2008 and 9.5 percent in 2009—the period of the new insurance). That is a positive, but small change.”
Because the rural health insurance program runs primarily on public funds, it is not able to provide generous drug reimbursement. Co-payments are still high and financial risk protection is limited, although there is a medical financial assistance program that targets people living below the poverty line.