Health Insurance in China

Health insurance in China is the topic of this chapter. Up until the economic reforms of the 1980s, communities (a village or a group of villages) were managing the social welfare of their inhabitants. The system was extremely decentralized. With the collapse of the community medical system, existing public establishments were either replaced by private ones, or put into competition with them. As a result, the healthcare access system was no longer free of charge and became unaffordable to many. During the period of absence of a centralized public insurance system, this lack of access to treatment became a major problem; at first for the most vulnerable part of the population, and gradually for a greater and greater proportion of rural dwellers. As the question of healthcare costs causing widespread poverty became a pressing issue, different public health insurance programmes were implemented. Today, geographical inequity is still observed for these programmes. There is variability not only in terms of funding eligibility, types of illness or services to be covered, but also in terms of levels of benefits and payments methods. Concerning the private health insurance market, it was next to nothing in the early 2000s. Today, the rise of private health insurance schemes is supported by the Chinese government and is finding an audience among the emerging upper middle class.