Political Dynamics of Universal Health Coverage in China : Reforms, Challenges, and the COVID-19 Pandemic

The landscape of Universal Health Coverage (UHC) in China has been contoured under different regimes and their policy priorities. Under Mao’s reign, the egalitarian and proactive state intervention significantly improved public health outcomes. Trammeled by ideological rigidity, however, health reforms hindered the potentially satisfactory medical services patients would have received. The post-Mao era of economic reforms was liberating for market forces but witnessed the collapse of the edifice of access and equity in health care. In the current regime, the public health issue is not immune from President Xi Jinping’s national rejuvenation project. Against this backdrop, this article examines the nature of UHC in China, particularly in the context of the COVID-19 pandemic. The article's organization is as follows. The first part provides an account of the evolution of UHC in light of political regimes’ priorities and policy approaches. In offering a critical examination, it underscores the public health outcomes associated with those policies. The second part deconstructs UHC from the perspective of President Xi’s state policy and the Chinese Dream. The third part evaluates UHC through the WHO framework of high-performing health systems in conjunction with China’s response to the pandemic. The final part concludes.