Gakidou E: Health system reform in China 7: China’s health system performance

We created a comprehensive set of health-system performance measurements for China nationally and regionally, with health-system coverage and catastrophic medical spending as major indicators. With respect to performance of health-care delivery, China has done well in provision of maternal and child health services, but poorly in addressing non-communicable diseases. For example, coverage of hospital delivery increased from 20 % in 1993 to 62 % in 2003 for women living in rural areas. However, effective coverage of hypertension treatment was only 12 % for patients living in urban areas and 7 % for those in rural areas in 2004. With respect to performance of health-care financing, 14 % of urban and 16 % of rural households incurred catastrophic medical expenditure in 2003. Furthermore, 15 % of urban and 22 % of rural residents had affordability difficulties when accessing health care. Although health-system coverage improved for both urban and rural areas from 1993 to 2003, affordability difficulties had worsened in rural areas. Additionally, substantial inter-regional and intra-regional inequalities in health-system coverage and health-care affordability measures exist. People with low income not only receive lower health-system coverage than those with high income, but also have an increased probability of either not seeking health care when ill or undergoing catastrophic medical spending. China’s current health-system reform efforts need to be assessed for their effect on performance indicators, for which substantial data gaps exist