Health System in China
The health of China’s population improved dramatically during the first 30 years of the People’s Republic, established in 1949. By the mid-1970s, China was already undergoing the epidemiologic transition, years ahead of other nations of similar economic status, and by 1980, life expectancy (67 years) exceeded that of most similarly low-income nations by 7 years. Almost 30 years later, China’s 2009 health reforms were a response to deep inequity in access to affordable, quality healthcare resulting from three decades of marketization, including de facto privatization of the health sector, along with decentralized accountability and, to a large degree, financing of public health services. The reforms are built on earlier, equity-enhancing initiatives, particularly the reintroduction of social health insurance since 2003, and are planned to continue until 2020, with gradual achievement of overarching objectives on universal and equitable access to health services. The second phase of reform commenced in early 2012. China’s health reforms remain encouragingly specific but not prescriptive on strategy; set in the decentralized governance structure, they avoid the issue of reliance on local government support for the national equity objective, leaving the detailed design of health service financing, human resource distribution and accountability, essential drug lists and application of clinical care pathways, etc. to local health authorities answerable to local government, not the Ministry of Health. Community engagement in government processes, including in provision of healthcare, remains limited. This chapter uses the documentation and literature on health reform in China to provide a comprehensive overview of the current situation of the health sector and its reform in the People’s Republic.
KeywordsHepatitis Insurance Coverage Dementia Income Assure
Communicable disease control
Gross domestic product
Health system reform
Low- and middle-income countries
Maternal and child health
Millennium Development Goals
Management information system
Ministry of Health
National Development and Reform Commission
National Essential Drugs List
National Essential Medicines Scheme
National Health and Family Planning Commission
People’s Republic of China
Rural cooperative medical (insurance) scheme
Renminbi (unit of currency)
Traditional Chinese medicine
Total health expenditure
Urban employees basic medical insurance
Urban residents’ basic medical insurance
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