Equity of Implementing Universal Health Coverage With China’s National Essential Public Health Service Program in 2019

Background: To achieve and promote universal health coverage (UHC) and primary health care (PHC), China's National Essential Public Health Service Program (NEPHSP) was launched in 2009, funded by the government, providing a set of comprehensive service packages at primary health institutions. Packages encompassed health records, education, management of infectious diseases and public health emergencies, and vaccinations for the entire population, as well as health checkups, follow-ups, guidance, and disease management for maternal, children, older adults, and patients with key diseases. After a decade of implementation, the aim of our study was to provide a comprehensive assessment of the equity of China's national public health services. Methods: Data from the National Essential Public Health Services Program Monitoring System 2019. The Gini coefficient, Theil index, and service agglomeration degree (HSAD/PAD) were used to analyze the equity of residents' access to services. Analyses are conducted at both national and provincial levels. Results: We found that health records establishment and vaccination exhibited high equity (Gini < 0.2) both nationally and provincially in China. Health education and health and family planning surveillance coordination services were relatively equitable nationally (Gini = 0.3242 and 0.3181, respectively), with poor equity within several provinces, Xinjiang, Qinghai, and Beijing. China has done well in the provision of equitable maternal and child health services and the treatment and management services for older adults and key disease patients (Gini < 0.3), but poorly in prevention performance. Large gaps in infectious disease reporting and public health emergency management between 31 provinces (Gini = 0.4343 and 0.5601, respectively) as well as within provinces, indicated inequitable. The Gini coefficient for infectious disease reporting services is higher than 0.4 in 32.10% of the provinces, and 87.10% for public health emergencies, demonstrating the inequity at the city or county levels in China. Inequities primarily stem from differences within regions (Eastern, Central, and Western) rather than between regions from the Theil index. The average HSAD/PAD ratio in 18 provinces is below 1 (58.06%), indicating insufficient service agglomeration relative to population agglomeration in China. Most provinces in the Eastern and Northeastern regions exhibit inadequate service agglomeration, while central and western regions tend to have agglomeration ratios exceeding 1. Furthermore, individual health management programs perform better than population-based public health programs, with 10-17 provinces having HSAD/PAD ratios below 1 compared to 16-23 provinces. Conclusions: China's NEPHSP promotes UHC and PHC effectively, with high equity in health records, vaccination, and group-specific services. Disparities in infectious disease reporting and emergency management need attention. Improving intraregional equity, standardizing data reporting and assessment target setting, enhancing service agglomeration in underserved areas, and promoting prevention services should be priorities for policy recommendations.