China’s Universal Health Care Coverage

Despite being a developing country with approximately 1.4 billion people, China has managed to extend a basic health care safety net to more than 95 percent of its population over the past decade. What forces converged to make this achievement possible? Guided by the political economy theory on agenda setting developed by John Kingdon (1984), this chapter illustrates that achieving universal health coverage (UHC) in China has required the convergence of the following factors: heightened problem recognition, ideas/ideology for policy formulation, political institution willingness and available fiscal space. We also demonstrate, however, that official universal health insurance coverage in contemporary China has not yet equated to fully comprehensive and effective coverage in practice, as not every citizen has equal access to the same quality of health care. The success of China’s UHC was built on the simultaneous investment in, and development of, preventive and basic health services and the provision of insurance coverage for all. Still, stark health disparities between urban and rural residents remain, along with high health expenditures and inflation of health care costs caused by inefficiency and waste. Nevertheless, China’s policy journey still provides a valuable example to inform other nations as to what is needed to enable major health system reforms.