Health system strengthening in China: progress, challenges and ways forward
https://doi.org/10.47093/3034-4700.2024.1.1.59-70
Abstract
China's health system reform, launched in 2009, has been a comprehensive effort to enhance healthcare accessibility and quality while addressing the challenges of escalating costs, an aging population, and the rise in non-communicable diseases. The reform has achieved near-universal health insurance coverage, leading to reduced out-ofpocket expenses and improved financial protection for citizens. It has also focused on public hospital reform, aiming to improve management efficiency, eliminate financial dependency on drug sales, and introduce new payment models to curb over-prescription. Strengthening primary care has been a cornerstone, with investments in infrastructure and workforce to enhance local healthcare services and introduce a family doctor system for continuous care. The Essential Medicines Program has made medications more affordable and accessible. Despite these advancements, challenges such as service delivery fragmentation, quality of care inconsistencies, and health financing issues persist. The Healthy China 2030 vision, building on these reforms, aims to further integrate health services, enhance governance, and promote preventive care to achieve a more equitable and sustainable healthcare system. The article underscores the importance of robust governance, financial investment, and policy innovation in realizing health reform goals and offers lessons for other nations facing similar health system challenges.
About the Authors
X. Liu
Peking University
China
China
Xiaoyun Liu, PhD, Professor, Deputy Director, China Centre for Health Development Studies
Beijing, 100191, P. R. China
H. Tang
Peking University
China
China
Haoqing Tang, PhD candidate, China Centre for Health Development Studies; Department of Health Policy and Management, School of Public Health
Beijing, P. R. China
References
1. Kieny MP, Bekedam H, Dovlo D, et al. Strengthening health systems for universal health coverage and sustainable development [published correction appears in Bull World Health Organ. 2017 Aug 1;95(8):608. doi: 10.2471/BLT.17.100817]. Bull World Health Organ. 2017;95(7):537-539. doi:10.2471/BLT.16.187476
2. Chen Z. Launch of the health-care reform plan in China. Lancet. 2009;373(9672): 1322-1324. doi:10.1016/S0140-6736(09)60753-4
3. Meng Q, Yin D, Mills A, Abbasi K. China's encouraging commitment to health. BMJ. 2019;365:l4178. Published 2019 Jun 21. doi:10.1136/bmj.l4178
4. Xu J, Mills A. 10 years of China's comprehensive health reform: a systems perspective. Health Policy Plan. 2019;34(6):403-406. doi:10.1093/heapol/czz026
5. Meng Q, Fang H, Liu X, et al. Consolidating the social health insurance schemes in China: towards an equitable and efficient health system. Lancet. 2015;386(10002):1484-1492. doi:10.1016/S0140-6736(15)00342-6
6. Li Y, Yang L, Wang L, et al. Burden of hypertension in China: A nationally representative survey of 174,621 adults. Int J Cardiol. 2017;227:516-523. doi:10.1016/j.ijcard.2016.10.110
7. Yuan B, Jian W, Martinez-Alvarez M, et al. Health system reforms in China a half century apart: Continuity but adaptation. Soc Sci Med. 2020;265:113421. doi:10.1016/j.socscimed.2020.113421
8. Xu J, Jian W, Zhu K, et al. Reforming public hospital financing in China: progress and challenges. BMJ. 2019;365:l4015. Published 2019 Jun 21. doi:10.1136/bmj.l4015
9. Fang H, Eggleston K, Hanson K, et al. Enhancing financial protection under China's social health insurance to achieve universal health coverage. BMJ. 2019;365:l2378. Published 2019 Jun 21. doi:10.1136/bmj.l2378
10. Yuan B, Balabanova D, Gao J, et al. Strengthening public health services to achieve universal health coverage in China. BMJ. 2019;365:l2358. Published 2019 Jun 21. doi:10.1136/bmj.l2358
11. He P, Sun Q, Shi L, Meng Q. Rational use of antibiotics in the context of China's health system reform. BMJ. 2019;365:l4016. Published 2019 Jun 21. doi:10.1136/bmj.l4016
12. Ta Y, Zhu Y, Fu H. Trends in access to health services, financial protection and satisfaction between 2010 and 2016: Has China achieved the goals of its health system reform? Soc Sci Med. 2020;245:112715. doi:10.1016/j.socscimed.2019.112715
13. Liu X, Li M, Zhu H, et al. Poverty alleviation and health services for the poor in China: evidence from national health service surveys in 2013 and 2018. Int J Equity Health. 2023;22(1):221. Published 2023 Oct 17. doi:10.1186/s12939-023-02000-7
14. Li X, Krumholz HM, Yip W, et al. Quality of primary health care in China: challenges and recommendations. Lancet. 2020;395(10239):1802-1812. doi:10.1016/S0140-6736(20)30122-7
15. Zhai T, Goss J. Health system reform in China: the challenges of multimorbidity. Lancet Glob Health. 2020;8(6):e750-e751. doi:10.1016/S2214-109X(20)30225-4
Review
For citations:
Liu X., Tang H. Health system strengthening in China: progress, challenges and ways forward. The BRICS Health Journal. 2024;1(1):59-70. https://doi.org/10.47093/3034-4700.2024.1.1.59-70
Views:
312
Email this article 