What Works in Children’s Health: Lessons from Large-Scale Health Reform for the UK

Current challenges in child health inequalities

The UK faces widening child health inequalities, rising avoidable hospital admissions, pressure on NHS paediatrics, and persistent place-based and gender disparities. Despite universal NHS coverage, access frictions and regional variation continue to shape outcomes, particularly for children in deprived communities. These challenges make child health policy a critical priority for UK decision-makers.

At the same time, many developing nations face even sharper constraints, including fragmented coverage, high out-of-pocket costs, and limited primary care capacity. Evidence from large-scale reforms in these settings provides valuable insights into how system-level change can improve child health outcomes at scale, even under fiscal and institutional constraints.

Research findings

Large-scale health insurance reforms that improve coverage and reduce financial and administrative barriers to healthcare can cut childhood illness by around 30% relative to the mean. These effects strengthen 2–4 years after reform, highlighting the importance of long-term policy horizons and sustained political commitment. The scale of these gains is particularly notable given that they emerge in a middle-income country context, where baseline access constraints are more severe than in the UK but where lessons about simplification, integration, and prevention remain highly relevant.

Health improvements were driven by simpler access and reduced financial stress, with annual out-of-pocket spending falling by 526 yuan (around £56), a 43% reduction relative to the mean. These financial gains were accompanied by a 21.5% improvement in maths performance, a 12.4% reduction in monthly hospital use, a 7.4% rise in insurance enrolment, and improved parental satisfaction over time. The combination of health, educational, and system-level effects underscores how child health reforms in developing nations can generate broad human capital returns, reinforcing the case for integrated social policy approaches.

Health gains were larger for boys than girls and appeared earlier in urban areas than rural ones, showing the importance of equity-sensitive policy design. These patterns mirror challenges seen across many developing countries, where rural populations and girls often face compounded barriers to care, and they echo similar gradients observed within the UK.

What lessons can be learnt?

Large-scale health system reforms can dramatically improve children’s health, reduce hospital pressure, and support learning, but only if policymakers design for equity, allow time for benefits to emerge, and evaluate impacts beyond aggregate effects to understand who gains. Evidence from developing and middle-income countries demonstrates that even imperfect systems can deliver substantial child health improvements when fragmentation is reduced and access is simplified. The findings provide a rare, policy-relevant benchmark for what ambitious, prevention-focused child health policy can achieve at scale, with direct lessons for the UK’s current reform agenda.

Implications and policy actions for the UK

Even in universal systems, child health gains are uneven. One-size-fits-all policies risk widening inequalities. UK child health reforms should therefore track who benefits, where, and over what timeframe, drawing on methods increasingly used in developing-country evaluations.

Prevention-focused policies deliver benefits slowly but sustainably. Short funding cycles risk undervaluing effective interventions; multi-year commitments and long-horizon evaluation are essential.

Reduced hospital pressure comes from better access, affordability, and system coordination and supports continued investment in primary care, community services, and early intervention in high-need areas.

Improving child health also improves learning outcomes. Child health policy should be treated as human capital investment, requiring coordinated action across health, education, and local government, as increasingly recognised in global development policy.

The report

The reform studied is China’s Urban and Rural Resident Basic Medical Insurance (URRBMI), which unified previously fragmented urban and rural health insurance schemes into a single national system, simplifying access, expanding coverage, and improving reimbursement. Full details of the research findings are available at: https://onlinelibrary.wiley.com/doi/pdf/10.1111/jori.70037