143.China’s “public health insurance”【Challenges】 Japan’s universal health insurance system faces three major challenges:①Rising medical expenses: As the number of elderlypeople increases, so does the use of medical services. Sinceolder people pay a lower share of their medical costs,this puts a growing financial strain on national and localgovernments.②Uneven distribution of medical resources: Doctors andmedical facilities are concentrated in urban areas, whilerural regions suffer from serious shortages. This goesagainst the core principle of universal health coverage:equal access to medical care for all. 【History 】 China’s public health insurance system has been in place for about 70 years, beginning with the introduction of medical coverage for employees of state-owned enterprises in urban areas in 1951. China has also aimed to achieve universal health coverage, a system in which all citizens are covered by some form of medical insurance. However, unlike Japan, China’s system is characterized by a combination of “mandatory” and “optional” insurance programs. > Types of Insurance> Co-payment systemUnlike Japan, China does not have a standardized co-payment rate for medical services.•While basic medical care is generally covered, thecost increases for those seeking higher-level ormore specialized treatment. Hospitals in China areclassified into three tiers (Level 1 to Level 3, withLevel 3 being the most advanced), and treatment athigher-level facilities tends to be more expensive.③An aging population and shrinking workforce: Thesystem relies on the working-age population to fundthe medical expenses for the elderly. As the number ofworking-age people decreases, it becomes more difficult tosustain the system in the long term. Let’s take a closer look at the current public health medical insurance system in China, including the types of insurance and how co-payments work.Unlike Japan, there is no free access to medical••services nationwide. In principle, patients whoreceive care outside the region where they pay theirinsurance premiums are required to cover the fullcost of their medical treatment.
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