China's Healthcare System

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La musique
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China's healthcare system is a complex system encompassing multiple dimensions, including medical services, protection system, and regulatory mechanism, and in recent years, it has gradually formed a medical and healthcare development model with Chinese characteristics through continuous reforms. The following is a detailed analysis of the policy framework, service system, guarantee mechanism, and resource allocation:

Policy framework and history of medical reform

1. Top-level design and strategic planning

. Core policy documents:

The Outline of the “Healthy China 2030” Plan (released in 2016) establishes the development concept of “putting people's health at the center,” with the goal of achieving a per capita life expectancy of 79 years by 2030, and entering the ranks of high-income countries in terms of major health indicators.

The “14th Five-Year Plan” (2021-2025) emphasizes the expansion of high-quality medical resources, the promotion of hierarchical diagnosis and treatment, and the construction of intelligent medical care.

. The main line of healthcare reform:

Since the new healthcare reform in 2009, centering on “guaranteeing the basics, strengthening the grassroots, and building mechanisms”, the comprehensive reform of public hospitals (abolishing drug markups and controlling the ratio of drugs), the reform of healthcare insurance payment methods (DRG/DIP payment pilot), and the improvement of the capacity of primary healthcare services have been promoted.

2. Management System

. Competent authorities: the National Health Commission (coordinating the management of the healthcare industry), the National Healthcare Security Bureau (responsible for healthcare insurance policy formulation and fund management), and the State Administration of Traditional Chinese Medicine (promoting the development of traditional Chinese medicine).

. Regulatory mechanism: Quality of service is guaranteed through hospital level accreditation (Grade 3A/B/C), medical quality control centers (e.g., the National Clinical Laboratory Center), and the monitoring system for adverse reactions to medicines and devices.

the medical service system: stratification and characteristics

1. Three-tier diagnosis and treatment system

. Top public hospitals:

Peking Union Medical College Hospital , Shanghai Ruijin Hospital , and West China Hospital of Sichuan University represent more than 3,600 tertiary hospitals (as of 2024), which are responsible for the diagnosis and treatment of difficult and serious diseases, medical research and teaching, and are close to the top of the international community in terms of hardware equipment (such as proton reionization therapies and da Vinci surgical robots) and technical level.

. Primary care network:

There are more than 95,000 township health centers and community health centers nationwide, which are responsible for the treatment of common diseases, chronic disease management (e.g., the standardized management rate of hypertension patients is more than 70%), and public health services (vaccination, maternal and child health care). 2024, the proportion of primary care volume will reach 65%, but the problem of outdated equipment and shortage of talents still exists in some rural areas.

. Socially run hospitals:

By 2024, there will be more than 32,000 socially-run hospitals, accounting for more than 60% of the total, but most of them will be specialized hospitals (e.g., ophthalmology, medical aesthetics), and the ones with strong comprehensive strengths will include Shulan Healthcare and United Family Healthcare, which will mainly serve the middle- and high-end needs.

2. Combination of Chinese and Western medicine

Traditional Chinese Medicine (TCM) TCM system: There are more than 6,000 TCM hospitals nationwide, accounting for more than 15% of TCM outpatient visits, and playing a unique role in chronic disease management (e.g., diabetes), rehabilitation (acupuncture, tuina), and the treatment of future diseases. For example, in 2023, the State Administration of Traditional Chinese Medicine (SATCM) will promote a “TCM Advantage Diseases” diagnostic and treatment program covering more than 100 diseases.

. Integration model : More than 90% of tertiary general hospitals have TCM departments, and some hospitals have opened wards combining TCM and Western medicine (e.g., tumor radiotherapy combined with Chinese medicine to reduce toxicity), and in 2024, the catalog for reimbursement of TCM-type medical insurance will be expanded to more than 2,000 types of Chinese herbal medicinal tablets.

Medical insurance system: coverage and innovation

1. Basic health insurance system

Coverage Scope of coverage: urban workers' health insurance (about 350 million people), urban and rural residents' health insurance (about 1.01 billion people), with a total coverage rate of more than 95%, total income of the health insurance fund of more than 3.5 trillion yuan in 2024, and reimbursement of hospitalization expenses within the scope of the policy at a rate of more than 70%.

. Pharmaceutical protection: Through the national centralized band purchasing of medicines (eight batches will be carried out by 2024, covering 333 types of medicines), the average price reduction will be more than 50%, and the price reduction of anticancer medicines and medicines for rare diseases (e.g., medicines for spinal muscular atrophy) will be more than 90% after they are included in the medical insurance.

2. Multi-level protection and supplementation

. Commercial health insurance: premium income will exceed 1.5 trillion yuan in 2024, and “people's insurance” (e.g., Shenzhen 's “critical illness insurance” and Beijing 's “Beijing Huizhou insurance”) will cover more than 200 million people, with major reimbursement for The main purpose is to reimburse high-cost medical expenses not covered by the medical insurance catalog.

. Medical assistance: In 2024, the central government will arrange for over RMB 30 billion in assistance funds to provide subsidies for enrollment and reimbursement of medical expenses for low-income insurance, special hardship cases, and other groups in difficulty.

Resource Allocation: Achievements and Challenges

1. Notable Achievements

. Hardware investment: by 2024, the number of hospital beds per 1,000 population will reach 6.8 (close to the level of middle-income countries), the number of high-end equipment such as CT and MRI will be the highest in the world, and the hardware conditions of Tier 3 hospitals in first-tier cities will be comparable to those in Europe and the United States.

. Talent cultivation: In 2023, the number of practicing physicians will exceed 4 million, and the number of physicians per 1,000 population will reach 2.9, but the proportion of general practitioners will only be 10% (33% in the United States), resulting in a structural shortage.

2. Outstanding Challenges

. Regional and urban-rural imbalance: 80% of the three-A hospitals are concentrated in provincial capitals and above, while less than 5% of the hospitals in central and western counties are three-A, and the number of nurses per 1,000 population in rural areas is only 1/3 of that in cities.

The number of nurses per 1,000 population in rural areas is only 1/3 of that in urban areas. Pressure on service efficiency: the average annual outpatient volume of Tertiary hospitals exceeds 10 million (e.g. Peking Union Medical College Hospital), the average waiting time of patients is 2-3 hours, and the average daily number of doctors is more than 50, with limited time for communication.

. Shortcomings in innovation ability: 70% of high-end medical devices (e.g. MRI machines) rely on imports, and original drugs account for less than 10%, but in recent years, the market share of domestic innovative drugs (e.g. PD-1 inhibitors) has risen to 30%.

International Comparison and Global Role

. International Comparison and Global Role Gap with developed countries: per capita medical expenditure (about 600 US dollars in 2023, more than 12,000 US dollars in the United States), the number of general practitioners (3.5 per 10,000 people, 6.1 in the United Kingdom), and the fairness of the distribution of healthcare resources still has room for improvement.

. Developing country leadership: health insurance coverage, infectious disease prevention and control capabilities (e.g., the new crown vaccination rate of more than 90%), low-cost medical technology (e.g., artemisinin anti-malaria) has become the “Chinese program” exported to Southeast Asia and Africa, and Boao Lecheng International Medical Tourism Pioneer Zone in Hainan attracts tens of thousands of expatriate patients every year.

Future directions

. Sinking of high-quality resources : Through the construction of “national medical centers” (e.g., Beijing, Shanghai, Guangzhou , and Chengdu sub-centers) and “regional medical centers”, we will promote the radiation of top hospital technologies to the central and western regions.

. Upgrade of intelligent medical care: Promote AI-assisted diagnosis (e.g., Tencent Foraging's lung cancer screening) and remote surgery (e.g., 5G + robotic surgery), with the goal of realizing the coverage of “Internet + medical care” in more than 90% of secondary hospitals by 2025.

. Internationalization of Chinese medicine: Build 100 Chinese medicine centers in countries along the Belt and Road, and promote the inclusion of acupuncture, moxibustion, and Chinese medicine compounding in the International Classification of Diseases (ICD-11).

. Strengthening public health: Investing 200 billion yuan in the construction of the National Center for Disease Control and Prevention (NCDC) system, and improving the speed of infectious disease monitoring, early warning, and emergency response (targeting to shorten the reporting time of major outbreaks to within two hours).

Summarizing

China's healthcare system, characterized by “government-led + market-supplemented”, has demonstrated its institutional strengths in guaranteeing the basic healthcare needs of the entire population and responding to major public health events (e.g., the New Crown Epidemic), but it also faces structural problems such as unequal distribution of resources and optimization of the service experience. In the future, as the “Healthy China” strategy advances, China's healthcare will be transformed into a “high-quality, balanced, and intelligent” system, while enhancing the influence of global healthcare governance through international cooperation. For the general public, the top medical resources in first-tier cities have reached international standards, while improving the quality and efficiency of primary care remains a long-term reform priority.

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China's Healthcare System

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