The BMJ has launched a special collection of articles that analyse the achievements and challenges of China’s health system reforms that started in 2009. The collection was launched at a special event in Beijing on June 22, 2019.
The articles, written by leading Chinese experts, outline the progress made towards establishing an accessible, equitable, affordable, and efficient health system, and highlight the need for further reform to meet the growing health expectations of China’s 1.4 billion citizens.
In an editorial to mark the launch, two senior editors at The BMJ, Dr Kamran Abbasi and Dr Daoxin Yin, along with Professor Qingyue Meng at Peking University and Professor Anne Mills at the London School of Hygiene and Tropical Medicine, say the reforms are an encouraging commitment to health, but must be extended to deliver better outcomes. Before 2009, limited public health services were provided, they explain, with most focused on maternal and child health and control of infectious diseases.
The 2009 reforms therefore focused on strengthening the capacity of primary care, expanding social health insurance, delivering an essential public health package, revamping the public hospital sector, and establishing the essential medicines policy.
Promoting universal health coverage was also a central pillar of the reforms. After the reforms, government investment in healthcare increased and China expanded its three main social health insurance schemes to cover more than 95% of the population, they write.
Differences in maternal and infant mortality rates between rural and urban areas were reduced, and primary care facilities now provide essential public health services to all citizens that are free at the point of delivery.
An expanded public health package was designed to integrate health education, non-communicable diseases, and severe mental illnesses, and a performance based salary system was introduced to realign incentives for primary care practitioners, in an attempt to encourage better quality services.
An essential medicines list was also created to regulate prescriptions, combined with enhanced antimicrobial stewardship to curb misuse of antibiotics. But despite these improvements, China’s health system reform is a long term challenge, and many problems remain, they write.
They argue that “a well functioning health system of high quality and efficiency is integral to China’s desire to improve population health and shift to a health based national development model.”
This ambition is embodied in China’s commitment to achieving Healthy China 2030, a statement of political will to prioritise population health and respond to global commitments related to realising the United Nations sustainable development goals.
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