Healthcare reform: Where is China heading?

The People’s Republic of China has achieved spectacular improvements in healthcare since its founding in 1949. Its public health system developed from a very low base inherited from the old regime but underwent rapid development under the planned economy. During the period between 1950 and 1978, in spite of fluctuations as a result of political movements, mortality rates, however, were reduced significantly while the life expectancy of the Chinese population almost doubled. Major communicable diseases were curbed by mass mobilization through major public health campaigns. A three-tier public health network was established both in urban and rural areas with Prevention First held as the overall principle and widespread primary healthcare provided at low costs. From the late 1970s, China’s economic reform has brought about far-reaching implications to its health sector. Expensive accessibility (kanbing nan) and medical impoverishment (kanbing gui) have become the twin acute symptoms of the Chinese healthcare system that have drawn intense public discontent. A series of structural and institutional changes were made along the path of market transition in reforming the healthcare system. This chapter explains key reasons for the deterioration of the Chinese healthcare system and reviews the major waves of healthcare reforms in China as well as their implications for overall health system performance. Without doubt, the recent national healthcare reform programme will provide an unprecedented opportunity to strengthen the healthcare system with the massive budgetary allocations. In this chapter, we argue that greater emphasis in this new round of reforms should be put on improving the governance of administrative structures towards the implementation of policies and coordinating the organizational functions of provision, financing and regulation of healthcare with better realignment of incentives embedded in the system. Copyright © 2013 selection and editorial material, Litao Zhao; individual chapters, the contributors.