Evaluation Of Health System Reform In Jiangsu Province In Perspective Of Universal Health Coverage

Objective: The concept of “universal health coverage” was put forward in the fifty-eighth World Health Assembly in 2005. Its purpose is to ensure that all people obtain health services without experiencing financial difficulties. China started a new round of health system reform in 2009, putting forward to finish the national basic medical and health care system in 2020, to make everyone have access to basic medical and health care. This article will evaluate the implementation of universal health coverage in Jiangsu Province, making a judgment about Jiangsu Province’s reform progress; then make suggestions on the problems in the implementation process to universal health coverage.Method: By literature review, we studied the guiding ideology, goals, key reform tasks and specific measures of health system reform in Jiangsu Province and we also studied the aims, connotations and assessment methods of UHC to choose the dimensions and indexes of assessment. We collected the data on the fourth and fifth NHSS in Jiangsu Province by site investigation, and searched the Jiangsu Health Annals in 2008 and 2013 from the official website. Compare the indicators of the two years to judge the changes. The comparison of average in different years used t test, and the comparison of rate and composition ratio in different years used chi-square test. Judge the fairness of indexes between different populations by Thayer index. Thayer index expand means fairness reduces, and vice. Evaluate the implementation of universal health coverage in Jiangsu Province according to the results of the two aspects, and then judge the progress of the health system reform in Jiangsu Province.Results: The progress in universal health coverage in Jiangsu Provice: the geographical accessibility of health services improved, and the gap between urban and rural areas, different regions narrowed; the number of health resources increased and the allocation of resources were more equitable, for instance the number of technical personnel per thousand population rose by 1.2, beds per thousand population rose by 1.3; survey area achieved universal health care in 2013, and the gap of the rate of joining insurance between different groups narrowed; immunization rates remained at high levels, and maternal antenatal examination rate, postpartum visit rate increased by 2.4% and 12.9% respectively; health service utilization improved significantly, for instance the proportion of patients with physician contact within two weeks increased from 60.3% to 87.8%, and the proportion of patients not in-hospital reduced from 24.4% to 11.4%, and the attendances were fairer; burden of medical costs reduced, the pay rate of the hospital costs reducing by 16.2%, hospital out-of-pocket costs accounted for the proportion of per-capita income reducing from 43.8% to 28.6%; cost were fairer betweem different groups.The problems in the implementation process to universal health coverage: allocation of health resources between regions was still unfair, for instance the resources in city were better than that in countryside, the resources in south Jiangsu were better than that in middle and north Jiangsu area; basic public health services utilization were unfair between different regions, for example, in 2013, the rate of Hypertension Prevention guide was 66.5% in urban, however, 87.9% in countryside, the rate was 89.2% in South Jiangsu, but was only 62.5% in north Jiangsu; the fairness of hospitalization services utilization reduced, and there was a large gap in outpatient service utilization between different health care system; the incidence of catastrophic health expenditure had not reduced, so residents’ medical expenses burden was still heavy; the gap of hospitalization expense proportion had widened, and there was still a large gap in cost levels between different social groups.Policy suggestions: Aiming at the outstanding problems that exist in the process to UHC in Jiangsu Province, the following policy suggestions were put forward. The government should increase the financial transfer payment in rural area, middle and north Jiangsu area; strengthen the construction of the public health service system. Comprehensive measures should be taken to control the growth of medical expenses, and among them, the most fundamental way is to promote the reform of public hospitals and the doctor’s salary system. Expand the financing channels of medical insurance to improve the reimbursement ratio. Establish the integration of the medical insurance system to realize the fairness. What’s more, the key point is to increase the attention to the low-income groups.