People's Republic of China Health System Review

Abstract

China has made great achievements in improving health status over the past six decades with a huge population that accounted for about 19% of total world population in 2012. The life expectancy at birth in China has increased from 35 years in 1949 to 75 years in 2012, mainly the result of government commitment to health, provision of cost effective public health programmes, coverage of health financial protection mechanisms, and a basic health care delivery network. China is facing many health challenges amid its demographic and epidemiological transition of rapid economic growth, urbanization and industrialization, population ageing, diseases and risk factors related to lifestyle and environmental pollution. The central government plays a dominant role in both legislation and administrative decision-making, although the health system in China has experienced many rounds of administrative reform with a view to streamlining administration and instituting decentralization. Local governments at all levels form and implement local plans and decisions based on the principles and directions established by central government. Strategic health planning in China includes planning for health system development and for earmarked programmes. Social health insurance schemes, including the rural cooperative medical scheme, urban employee-based health insurance scheme, and urban resident-based health insurance schemes, have reached universal population coverage. These are run by government subsidies and individual contributions and cover both outpatient and inpatient care. Governments provide subsidies for covering essential public health programmes. Access to health care has increased rapidly with the expanded coverage of financial protection mechanisms. Over the past decade, out-of-pocket payments as a proportion of total health expenditures have declined dramatically. Health service institutions in China include hospitals, primary health-care institutions and specialized public health institutions. Human resources for health in China have been developing rapidly. In 2012, there were xvi 4.94 health professionals per 1000 population. China has had a shortage of nursing staff for a long time. There are challenges in the human resource distribution between urban and rural areas. In 2012, there were 8.54 health-care professionals per 1000 population in urban areas and 3.41 in rural areas. Lack of personnel in primary health care institutions and their comparatively low education level are also major challenges. China established a three-tier health care delivery system in both rural and urban areas in the 1950s and 1960s. The structure and function of the health care delivery system have not radically changed, even if health needs have changed overtime. Centres for disease control and prevention (CDCs) are independently operated from the hospital and clinical service sector. How the health care delivery system is to be integrated and coordinated to address the rapid rise of noncommunicable diseases and population ageing is currently one of the top priorities on the health reform agenda. Since early 2009, China has been implementing a new round of health system reforms, aiming to achieve universal health coverage by 2020. While the reform has made good progress in expanding coverage of financial protection mechanisms across the population, providing essential public health programmes to all citizens, and strengthening the capacity and working conditions of health providers, it is also facing the challenges of cost escalation, fragmented health delivery system, and inequity in health. Consolidating the social health insurance schemes, integrating health providers, reforming the public hospital sector, adopting a strategic purchasing mechanism, and improving the quality of health care are the major current health system reforms in China.