China’s Health Insurance System

The United States gets a lot of internal criticism about the supposed failings of its health system, so every now and then it is interesting to take a closer look at what is going on in some other countries.  China is the largest nation in the world and has accomplished dramatic economic growth over the last 30 years as it turned toward a more free-market model.  An article in Health Affairs discusses the state of its health insurance system.   (HA Article)   The authors followed transitions in Chinese health insurance coverage from 1991 to 2011 and also examined aspects of hypertension and diabetes treatment.  China has several health insurance programs available, mostly public-financed but some private plans as well since 2004.   In 1991, only around 33% of all Chinese had some form of health insurance but by 2011 over 90% of the population did.  The largest single program is collective insurance, which is basically a pooling mechanism.  A significant effort was made to provide coverage for people in rural areas, where health insurance rates had been lowest.  Free, or fully publicly financed health plans, cover only 3.5% of the population in 2011.  Among the various types of insurance and across people with and without insurance, there were no differences in rates of prevalence or awareness of diabetes or hypertension, but people with insurance were more likely to leave some treatment for those conditions.  Similarly, rates of reporting being sick or injured were the same, but seeking treatment was more prevalent for those with insurance and insured people were more likely to seek preventive care.  When adjusted for health status and condition factors, some of these differences are minimized, indicating that, as in the US, people who perceive themselves as being healthy may be the least likely to feel they need or to seek insurance coverage.  As is pretty obvious from basic economics, it appears that the Chinese are more likely to get medical care if they perceive that someone else is paying most or all of the cost.  And, as research in the US indicates, it is not at all clear that having health insurance actually leads to better health or better health behaviors among the Chinese population.