Health financing reform towards universal insurance coverage: A case study of six cities in China

The Urban Resident Basic Medical Insurance (URBMI) is a core component of the ongoing health financing reform towards universal insurance coverage in China. This paper reviews the introduction of URBMI in six Chinese cities, based on comparative institutional analysis and use of publicly available data. In the early 21 ^st century, the Chinese government announced plans for universal health insurance. Rather than one populationwide scheme, however, it designed several separate schemes for specific populations, with a fair degree of autonomy and independent administrative responsibilities of the regions and large cities. In this study, we have selected six cities with different levels of economic development and fiscal resources. The cities also differ, as we will show, in their target populations, financing level, insurance coverage and benefits level, management of health services and referral rules. Following an analysis of the similarities and differences in the institutional features of the various URBMI schemes and an exploration of the underlying causes, we analyze the challenges and policy implications facing China as it moves towards universal coverage. To reduce the inequality in financing and benefits of insurance across cities, for example, we conclude that the central government should give priority to less-developed cities in the distribution of subsidies. Other concerns that require some form of collective action are the extension of the benefit package with outpatient care for all, strengthening primary care and developing a rational referral system. Two major challenges for the longer term are the establishment of wider risk pools for thehealth insurance and the merger of segmented insurance programs.