Organization of Healthcare in China and its Reforms

  • Carine Milcent
Chapter

Abstract

The structure of healthcare supply in China is very specific. Indeed, as of 2011, more than 85% of all health personnel worked in public healthcare institutions. In addition, public hospitals provide a very large part of outpatient services on top of their inpatient provision. The goal of this chapter is to explain the reasons behind this very high provision and its consequences. The background presented makes a clear differentiation between rural and urban areas. For each geographical area, a historical and longitudinal reading aims at explaining the current situation. Shortly after the creation of the People’s Republic of China in 1949, a healthcare system organized in three tiers, known as the Community Medical System (CMS), was set up in rural locations. Patients had to enter the system through the first tier and were then funnelled into other tiers for the more severe cases. Patients whose affliction required very specific treatment were transferred to urban areas, into provincial or central hospitals. In urban areas, from 1949 to 1980, healthcare access was organized at company level. If, today, the general organization of the healthcare system remains in rural areas, economic as well as administrative reforms have deeply reshaped access to healthcare in these structures.

Keywords

Healthcare organization Ownership Three tiers Rural areas versus urban areas Hukou 

Bibliography

  1. Akin, J., W. Dow, and P. Lance, “Changes in Access to Health Care in China, 1989–1997,” Health Policy, Vol. 20, 2005.Google Scholar
  2. Bai, N., and Yupeng He, “Huiliu haishi waichu—Anhui Sichuan ersheng nongcun waichu laodongli huiliu yanjiu,” (Rentrer et émigrer? Etude sur les migrations de retour vers les zones rurales dans les provinces de l’Anhui et du Sichuan), Shehuixue Yanjiu, Vol. 3, 2002, pp. 64–78.Google Scholar
  3. “Baisse de la demande de soins dans les zones rurales en Chine,” C. Milcent, Under Revision for Revue Economique, 2013.Google Scholar
  4. Chen, Z., “Seize the Opportunity, Meet the Challenge, and to Accelerate the Healthy Development of Community Health Services,” Journal of Community Healthcare, Vol. 8, No. 5, 2009, pp. 305–309 (in Chinese).Google Scholar
  5. Division of Maternal and Child Health and Community Health of Chinese Health of Ministry, Department of Social Medicine and Health Management of School of Public Health of Tongji Medical College of Huazhong University of Science and Technology: The Base-line Survey Report of Chinese Community Health Service System Building of 28 Key Contact Cities. Beijing: HOM of P.R. China, 2008.Google Scholar
  6. Dong, L., H. Yan, and D. Wang, “Antibiotic Prescribing Patterns in Village Health Clinics Across 10 Provinces of Western China,” Journal of Antimicrobial Chemotherapy, Vol. 62, 2008, pp. 410–415.Google Scholar
  7. Dussault, G., and M. Franceschini, “Not Enough There, Too Many Here: Understanding Geographical Imbalances in the Distribution of the Health Workforce,” Human Resources for Health, Vol. 4, No. 1, 2006, p. 12.Google Scholar
  8. Eggleston, K., L. Congdong et al., Comparing Public and Private Hospitals in China: Evidence from Guangdong, China Rural Health AAA Background Paper, 2005.Google Scholar
  9. Eggleston, K., L. Li, Q. Meng, M. Lindelow, and A. Wagstaff, “Health Service Delivery in China: A Literature Review,” Health Economics, Vol. 17, 2008a, pp. 149–165.Google Scholar
  10. Eggleston, K., L. Ling, M. Qingyue, M. Lindelow, and A. Wagstaff, “Health Service Delivery in China: A Literature Review,” Health Economics, Vol. 17, No. 2, 2008b, pp. 149–165.Google Scholar
  11. Gu, X.-Y., and S.-L. Tang, “Reform of the Chinese Health Care Financing System,” Health Policy, Vol. 32, 1995, pp. 181–191.Google Scholar
  12. Health Bureau of Wushe County, “Serving the Establishment of Rural Household Contract System,” Chinese Rural Health Care Management, Vol. 7, 2002, pp. 28–30 (in Chinese).Google Scholar
  13. Hesketh, T., and X.Z. Wei, “Health in China. From Mao to Market Reform,” British Medical Journal, Vol. 314, 1997, pp. 1543.Google Scholar
  14. Hu, S., “Overview of NCMS Models in China,” Chinese Journal of Primary Health Care, Vol. 9, 2003, pp. 1–6 (in Chinese).Google Scholar
  15. Hutubessy, R.C., P. Hanvoravongchai et al., “Diffusion and Utilization of Magnetic Resonance Imaging in Asia,” International Journal of Technology Assessment in Health Care, Vol. 18, No. 3, 2002, pp. 690–704.Google Scholar
  16. Li, W., “Rethinking the Sale of Township Hospitals,” Chinese Health Economics, Vol. 4, 2000, pp. 12–14 (in Chinese).Google Scholar
  17. Li, H.L., X.D. Wang, and Y.Q. Xiao, “Explore on Improving the Ability of Community Health Service Centers through the Reform of Public Hospitals Direct Management,” Journal of Community Medicine, Vol. 11, No. 17, 2013, pp. 22–23 (in Chinese).Google Scholar
  18. Li, Qi, and Peng Xie, “Outpatient Workload in China,” The Lancet, Vol. 381, No. 8, 2013.Google Scholar
  19. Liu, L., F. Liu, H. Chen, and S. Wang, “Exploration and Practice of Integrated Medical Health Service System,” China Digital Medicine, Vol. 4, No. 9, 2009, pp. 11–14 (in Chinese).Google Scholar
  20. Liu, X., and J. Wang, “An Introduction to China’s Health Care System,” Journal of Public Health Policy, Vol. 12, No. 1, 1991 Spring, pp. 104–116.Google Scholar
  21. Liu, X., L. Xu et al., “Reforming China’s 50,000 Township Hospitals—Effectiveness, Challenges and Opportunities,” Health Policy, Vol. 38, No. 1, 1996, pp. 13–29.Google Scholar
  22. Lu, Z.X., J.H. Chen, K. Wang et al., Social Health Insurance Science, Beijing: People’s Medical Publishing House, 2, 2007.Google Scholar
  23. Lu, Z.X., Y.B. Li, F. Wang et al., “The Development, Effect and Concerned Issues of Pilot Work of National Community Health Service System Building in Key Contact Cities—Based on the Comprehensive Analysis of the Baseline Survey and Routine Monitoring Data,” Chinese Journal of Social Media. Vol. 26, No. 6, 2009, pp. 321–325.Google Scholar
  24. Lu, L., and J. Ma, “Research on Current Situation and Effectiveness of Various Cooperation Modes Between Hospitals and Community Health Service Centers in Wuhan,” Chinese Hospital Management, Vol. 31, No. 11, 2011, pp. 20–22 (in Chinese).Google Scholar
  25. Lu, Z.X., J. Xu, W.X. Wang, N.N. Wu, and W. Qin, “Analysis of Medical Insurance Reimbursement Rates of Community Health Stations Sponsored by Various Entities,” The Chinese Journal of Hospital Administration, Vol. 26, No. 3, 2010, pp. 205–208.Google Scholar
  26. Meng, Q., Review of Provider Organization Reforms in China, China Rural Health AAA Background Report, 2005.Google Scholar
  27. Meng, Q., and X. Liu et al., “Comparing the Services and Quality of Private and Public Clinics in Rural China,” Health Policy and Planning, Vol. 15, No. 4, 2000, pp. 349–356.Google Scholar
  28. Milcent, C., “Healthcare for Migrants in Urban China: A New Frontier,” China Perspectives, No. 2010/4, 2010.Google Scholar
  29. Milcent, C., “Healthcare Access and Hospital’s Violence: Digital as a Response for Inefficiency,” China Perspective, Vol. 4, 2016.Google Scholar
  30. Ministry of Health, Chinese Health Statistical Digest, Ministry of Health, Beijing, China, 2005.Google Scholar
  31. Ministry of Health, Hospital Management Appraisal Guide, MOH, Ministry of Health, Beijing, China, (in Chinese), 2000.Google Scholar
  32. Prescribing Patterns in Outpatient Clinics of Township Hospitals in China, “A Comparative Study Before and After the 2009 Health System Reform,” International Journal of Environmental Research and Public Health, Vol. 13, No. 7, 2016.Google Scholar
  33. Song, Y., Y. Bian, M. Petzold, L. Li, and A. Yin, “Effects of the National Essential Medicine System in Reducing Drug Prices: An Empirical Study in Four Chinese Provinces,” Journal Pharmaceutical Policy Practice, Vol. 7, 2014, p. 12.Google Scholar
  34. Wang, F., “Improve Rural NCMS in Poor Areas,” Guizhou Finance and Economics Journal, Vol. 6, 2003, pp. 62–64 (in Chinese).Google Scholar
  35. Wang, Z., S. He, and D. Zhou, “Why NCMS in Wuxue can be Sustained and Developed,” Chinese Rural Health Care Management, Vol. 2, 2003, pp. 25–26 (in Chinese).Google Scholar
  36. Wang, X., and L. Liu, “The Process of Reforming Ownership of Township Hospitals,” Health Economics Research, Vol. 3, 2002, pp. 3–5 (in Chinese).Google Scholar
  37. Wang, B., L. Wang et al., “CMS in Wuxue for 40 Years,” Chinese Rural Health Care Management, Vol. 1, 2004, pp. 10–13 (in Chinese).Google Scholar
  38. Wang, H., S. Wong, M. Wong, X. Wei, J. Wang, D. Li, Jin Ling Tang, G. Gao, and S. Griffiths, “Patients’ Experiences in Different Models of Community Health Centers in Southern China,” Annals Family Medicine, Vol. 11, No. 6, 2013, pp. 517–526Google Scholar
  39. Wang, B., and Y. Zhang, “The Investigation Analysis of 6 Private Hospitals,” Chinese Health Economics Magazine, Vol. 21, No. 1, 2002, pp. 52–54 (in Chinese).Google Scholar
  40. Xiao, Y., and X.M. Ruan, “Practice and Reflection on Regional Medical Consortium in Hubei,” Chinese Hospital Management, 2012, Vol. 32, pp. 12–13 (in Chinese).Google Scholar
  41. Xu, J., “No Choice or Right Choice: Ownership Reform in Township Hospitals,” Decision and Consultancy, Vol. 9, 2001, pp. 24–25, (in Chinese).Google Scholar
  42. Xu, Z., “Problems after Ownership Reform in Township Hospitals,” Jiangsu Health Care Management, Vol. 1, 2003, pp. 35–38 (in Chinese).Google Scholar
  43. Xu, J., R. Pan, R.W. Pong, Y. Miao, and D. Qian, “Different Models of Hospital–Community Health Centre Collaboration in Selected Cities in China: A Cross-Sectional Comparative Study,” International Journal of Integrated Care, Vol. 16, No. 1, 2016, p. 8.Google Scholar
  44. Xu, J., W. Wang, Y. Li et al., “Analysis of Factors Influencing the Outpatient Workload at Chinese Health Centres,” BMC Health Services Research, Vol. 10, 2010a, pp. 151.Google Scholar
  45. Xu, J., F. Wang, Z.X. Lu, “The Survey Analysis of the Health Insurance Compensation Impact on the Income of City Community Health Center in 28 Chinese Cities,” Chinese Health Econics, Vol. 4, 2010b.Google Scholar
  46. Xu, J., N.N. Wu, S.G. Jin, F. Wang, L.Q. Liu, Y.X. Wang, and Z.X. Lu, “The Analysis of Inpatient Bed Allocation Equity and Utilization in the City Community Health Service Centre of China,” Journal of Huazhong University of Science and Technology [Medical Science], Vol. 30, No. 2, 2010c, pp. 141–144.  https://doi.org/10.1007/s11596-010-0201-6
  47. Yang, L., C. Liu, J.A. Ferrier, W. Zhou, and X. Zhang, “The Impact of the National Essential Medicines Policy on Prescribing Behaviors in Primary Care Facilities in Hubei Province of China,” Health Policy Plan, Vol. 28, 2013, pp. 750–760.Google Scholar
  48. Yao, Q., C. Liu, J.A. Ferrier, Z. Liu, and J. Sun, “Urban-rural Inequality Regarding Drug Prescriptions in Primary Care Facilities—A Pre-post Comparison of the National Essential Medicines Scheme of China,” International Journal of Equity Health, Vol. 14, 2015, p. 58.Google Scholar
  49. Yip, W., and W. Hsiao, “The Chinese Health System at a Crossroads,” Health Affairs, Vol. 27, 2008, pp. 460–468.Google Scholar
  50. Yip, W., and W.C. Hsiao, “What Drove the Cycles of Chinese Health System Reforms?” Health Systems & Reform, Vol. 1, No. 1, 2015 Feb 25, pp. 52–61.Google Scholar
  51. Zhang, X., L.W. Chen, K. Mueller, Q. Yu, J. Liu, and G Lin, “Tracking the Effectiveness of Health Care Reform in China: A Case Study of Community Health Centers in a District of Beijing,” Health Policy, Vol. 100, No. 2–3, 2011, pp. 181–188.Google Scholar
  52. Zhang, L., R.Y. Yang, and D.F. Qian, “Evaluation on Collaborative Services Under Medical Group Model by Patients in Community Health Service Centers,” Chinese General Practice, Vol. 16, No. 10, 2013, pp. 3298–3300.Google Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Carine Milcent
    • 1
  1. 1.CNRS and Paris School of Economics (PSE)ParisFrance

Personalised recommendations