Chinese Social Health Insurance Reforms: Impact & Consequences - Essay Sample

Introduction

The review focuses on the implementation and the consequences of the social health insurance reforms in China. The article "Expansion of Chinese Social Health Insurance" by Xian Huang explains the state of social welfare in China, how it varies from other countries like Germany, Austria, Italy, and France, and if the difference exists, how politics impact it in the country. The Chinese government has always established measures in reforming its social health insurance systems. This process began in the year 1998, whereby the state council established urban Employee Basic Medical Insurance (UEBMI). At the beginning of 2003, there was an initiation of the New Rural Cooperative Medical Insurance (NRCMI) program (Huang, 2014). This program was successful in expanding services in some regions.

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In 2007, another program was introduced in urban areas to benefit those who lacked jobs. This initiative was referred to as the Urban Resident Basic Medical Insurance (URBMI). When the expansion of social insurance began in 2004, only a small number of Chinese nationals were covered (34.4 percent) (Huang, 2014). There are three factors needed for the expansion of an insurance program. Firstly, there is the development of the economy, which has an essential purpose in the issue of social health coverage for workers in urban areas. The more the income earned, the greater the capability of paying the social health insurance contribution. Secondly, a stable administration and proper financial management by the government ensure good progress. Lastly, a high density of trade unions contributes to the rapid expansion of the program; thus, more people are recruited (Huang, 2014). After full implementation of the insurance program in 2010, 90.62 percent of the Chinese were covered. Since then, China has established a health insurance system with global coverage. In as much as the coverage had increased, which was recommendable, the distribution of this health benefit was unevenly distributed.

China is a state with a large population, and so there are many regions with diverse economies. Healthcare provision systems in the regions as well differ. With the growth of the social health insurance program, the differences in healthcare provision have become worse. To begin with, people who live in urban areas often receive better social services than those who live in rural areas due to their small number (Huang, 2014). The employed urbanites further enjoy better healthcare benefits than those who are unemployed, such as the aged and those with disabilities. Finally, the social health insurance program has undergone multiple fragmentations such that the people employed by the government benefit more than those who are employed in other sectors of the economy. The article goes further to analyze the size differences of the beneficiary groups and their respective benefits. The social insurance program can be classified under two groups: 'employment-based programs' such as UEBMI and 'residence-based programs' such as URBMI (Huang, 2014). Residence based program is funded by an individual's taxes and premium payments.

On the other hand, the employment-based program is funded by employers and employees defined contributions. The chance of getting a social health insurance cover, which is an employment-based, is determined by socioeconomic status, job status, type of employment (informal or formal), and sector of employment (non-state industry or state). There's a division between rural and urban dwellers, the employed and unemployed, those who work for the state, and those who do not, and between formal and informal employees. All these groups of people are viewed differently, thus given different coverages, which makes getting rid of social inequality in China difficult.

According to the data collected by 'China Health and Nutrition Panel Survey (CHNS),' social health insurance coverage, which includes URBMI, UEBMI and NRCMI has increased from 37.39 percent in the year 2000 to 89.5 percent in 2009 in nine provinces in China (Huang, 2014). For the beneficiaries, statistics from the provincial level illustrate that those who depend on them and the peasants were the biggest beneficiaries of the Chinese social health insurance, the period between 2007 and 2010. However, the unemployed urbanites, the elderly, the students, and the self-employed increasingly got insured from 2007 onwards by URBMI, which was newly established.

Authoritative Chinese leaders play a significant role in the provision of healthcare benefits. According to the author, the leaders do not always view healthcare as a fundamental right of each individual. During the transition of a 'command economy' to a 'market economy' from nineteen seventy-eight to nineteen ninety-eight, the Chinese political leaders prioritized efficiency in the economy. This approach led to the abolishment of free healthcare provision. Furthermore, their move induced the state to retreat from social welfare, which led to social instability in the country. The authoritative leaders adopted the divide and rule tactic for the provision of social welfare services (Huang, 2014). This tactic served the leaders' interests in the maintenance of regime stability by promoting the division of social groups to prevent alliances that have the capability of questioning their actions. In doing so, they tie the social groups' loyalty to the state. In a fragmented society, the preferences and interests of individuals become divided in such a way that the strength to face the state on the problems being experienced becomes weakened. Therefore, proper healthcare cannot be delivered due to the non-conducive environment. Thus the government had to embrace good ideals and values that can only be acquired in a moral and just state.

A fragmented society cannot agree on anything and therefore, cannot come up with solutions to the issues which can be easily solved. As a result, the media, public scholars, and the press portray this fragmentation as one of the most considerable obstacles to the urbanization of China. Hu-Wen, who rose into power in the year 2003, had the vision of developing the country by bringing openness in the economy and expanding the social health insurance coverage (Huang, 2014).

The article illustrates the social health insurance program in China in terms of who receives the insurance, when, and how it is issued. The insurance programs include UEBMI, NRCMI, and UEBMI. These programs have been successful in the provision of essential social health services to Chinese nationals. The unemployed and peasants who before the reforms were made were excluded from health insurance, which was urban-based and is now covered. However, the country is still being faced with numerous challenges, such as differences in social and economic status as well as employment status. For example, in 2009, the government of China came up with the agenda of making a health reform that aimed at integrating the divided insurance programs with distinct significant changes (Huang, 2014). Nonetheless, this proved to be difficult, more than the expansion of these programs.

Conclusion

In conclusion, the article analyzes the role played by Chinese leaders in the expansion of the social health cover. In the beginning, these leaders did not support the expansion of the health insurance program, which they termed as a threat to the economic development of the country, which led to its total abolishment. This process was not a smart approach as it led to the provision of poor social health services to the citizens. However, in 2012, the top leaders of China came up with the idea of creating additional urban areas to improve the country's economic growth. With this move, the integration of the social insurance program was made possible.

References

Huang, X. (2014). Expansion of Chinese Social Health Insurance: who gets what, when and how?. Journal of Contemporary China, 23(89), 923-951.