A Wuhan field hospital last month. Only 5% of doctors in China are primary-care physicians.
Photo: Wang Yuguo/Associated PressChina has near-universal health insurance and the world’s most powerful surveillance state, yet it still failed to contain the initial spread of the new coronavirus in Wuhan. The disaster is bound to prompt some soul searching.
Two trends look likely to gain steam: the rapid expansion of commercial health insurance and burgeoning online health-care services.
Beijing’s renewed determination to support these sectors was enshrined in a document, “Opinions on Deepening Reform of the Medical Security System,” released by China’s cabinet in March as the epidemic in China began winding down. The endorsement is a sign that insurance development is moving up the policy-priority ladder.
One of the few meaningful parts of the recent Sino-U.S. trade deal was a Chinese commitment to expedite the elimination of caps on foreign ownership of insurers—for all overseas companies, not only American ones. Online health-care services such as Ping An Good Doctor also look increasingly well-placed in a country where citizens remain wary of crowds and doctors are in short supply.
China’s state-backed health insurance is impressively wide but not deep. A full 95% of citizens are covered compared with the 91.5% of Americans who had insurance in 2018. But coverage is usually fairly basic. Chinese citizens paid 29% of total health-care expenditures out of pocket in 2016, according to Chinese national health authorities and researchers at Australia’s University of Canberra, writing in the BMJ medical journal.
Americans paid 11%, and Germans paid 13%, according to the World Health Organization. China’s commercial health-insurance market, meanwhile, is relatively small and caters to wealthy buyers. Health insurance was 12% of the insurance market in 2017, according to CPIC Allianz Health, compared with 59% for life insurance.
A bigger, more competitive health-insurance market could solve several problems. First, it would help fund a larger basic medical-services industry. China has many private hospitals and clinics. But most Chinese still flock to big public hospitals, which are seen as more prestigious—and which they know state insurance will cover—despite long lines and overworked doctors.
Only 5% of doctors in China are primary-care physicians, well below international norms of 30%-60% according to the World Bank. Long lines at hospitals and rickety preventive care aren’t helpful when epidemics start. More revenue from private-insurance payments would help private clinics offer better service to a wider range of clients and to hire more primary-care physicians at attractive salaries.
A bigger insurance industry would also help with another longtime policy goal in the financial sector: boosting the firepower of big long-term institutional investors such as insurers in Chinese capital markets. Chinese academics have long complained that China’s bank-centric corporate-financing model is a cause of chronic economic problems such as overinvestment.
Online health care and big-data analytics, both emphasized in the March policy document, are obvious ways to ease the strains in China’s hospital-centric, doctor-scarce health-care model. If enough doctors aren’t available, or aren’t in the right area to meet demand, online consultations—or, eventually, diagnoses and screening assisted by artificial intelligence—could help.
The coronavirus pandemic has scrambled the insurance industry world-wide, including travel and health. But for insurers such as AXA and Allianz already making stronger moves into China, there may be a light in the Middle Kingdom at the end of this long, dark tunnel.
Write to Nathaniel Taplin at nathaniel.taplin@wsj.com
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