Exploring Chinese health insurance reforms that led to protests

February 27, 2023 – Recent changes to Chinese health insurance sparked protests by hundreds of older people in two cities, but the changes could make the health care system more equitable, according to experts at Harvard T.H. Chan School of Public Health.

Local Chinese governments have been planning for years to implement cost-saving health insurance reforms, even before COVID-19–related expenses left them with mounting debts. In general, there are two categories of insurance funds in China: a collective pool that covers hospital care and more serious illnesses, and personal savings accounts that individuals use to pay for medicine and outpatient care. The reforms reduce contributions to personal accounts, shifting more money to the collective pool.

“I think that the protest comes from an individual’s perspective,” said Winnie Yip, professor of the practice of global health policy and economics, in a February 17 NBC article. “They all of a sudden say, ‘Oh, now there’s less money going into my savings account.’”

However, the insurance changes could lead to more equitable health care by providing more funds for people who earn less or have who have more serious illnesses, Yip said.

William Hsiao, K.T. Li Professor of Economics, Emeritus, said in a February 16 article in Voice of America that the reforms are in keeping with health insurance practices that are standard in many advanced countries. “The principle of insurance is to prepare a centrally allocated fund, which pays for everyone’s medical need,” he said. He suggested that the public is questioning the changes because the finances of China’s medical system lack transparency.

Read the NBC article: Elderly in China protest changes to health insurance in rare show of dissent

Read the Voice of America article: Older Chinese protest health care reform that reduces benefits