The Road ahead for China’s
Healthcare Reform and
Development
Dr. Jiefu Huang
Vice Minister
Ministry of Health, P. R.of China
Professor of Surgery in PUMC
Topics
1. China’s healthcare
2. Challenges facing today’s Chinese
healthcare
3. The roadmap for China’s healthcare
reform
2
1. China’s Healthcare
By incorporating western medicine with
its own traditional medicine and under
the influence of its local healthcare
environment and social-political
background, a national medical system
with Chinese characteristics has been
established.
3
Introduction of the
Western Medicine
Modern Medicine was first introduced to
China by Christian Missionaries in the
1830s
4
Evolution of Healthcare in
modern China (3 phases)
 The centralist system of unified state health
care was introduced after the foundation of
the New China.
 Market-oriented reform of the health sector
in the process of the economic transition.
 Progress toward universal coverage
(providing adequate and affordable health
services to all of its population).
5
☻ China used to be held up in the 1960-70s
as a shining example in health development
terms, such as: healthcare performance
indexes and barefoot doctor system.
6
The Development Stagnation
during Cultural Revolution
China’s urban and rural health service
system was severely undermined, causing
severe shortage of health resources.
7
 Nearly 3 decades of unprecedented
economy growth with transition from a
planned centralized economy to
market-driven, decentralized economy
followed by a market-oriented reform
of the health sector.
 Increased incomes coupled with
improved health awareness led to rapid
growth in healthcare demand.
8
Present Healthcare Situation in China
 Rapid expansion of the scale of health services
 Significant improvement of the facilities and
quality of health service organizations
 Advancement of the medical education and life
science
 The greater expectation on health services
from public and rising disparity in health
service
9
How Healthy is China?
 Present China’s state-run healthcare
delivery system has been shaped by a
combination of traditional culture and
social development.
 Both urban and rural health service
delivery center around a three-tier
network composed of medical and
preventive healthcare, with hospitals as
major vehicle for health delivery. (over
19,000 hospitals, 50,000 village clinics)
10
Healthcare System with Chinese Characteristics
 Hospital and health center beds: 2.83 per 1,000
 Doctors: 1.54 per 1,000
 Per capita health expenditure: 748.8 RMB
Urban: 1248.3 RMB
Rural: 361.9 RMB
 Total Health Expenditure (100 M): 9843.3
 Government Health Expenditure: 1778.9 (18.1%)
(2007)
11
Health Indexes of China in 2007
Average Life
Expectancy
Infant Mortality
Maternal
Mortality
73.0
15.3‰
36.6/100,000
WHO’s assessment on China’s healthcare performance
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2. Challenges Facing Today’s
Chinese Healthcare
➣ The collapse of the country’s primary
universal healthcare system and the rise of
profit-oriented state-owned hospitals
➣ The public’s access to healthcare in China
has been steadily declining for over two
decades
13
2. Challenges Facing Today’s Chinese Healthcare (Con’t)
➣ Demographic transition to an older society
(1-2-4 phenomenon)
➣ Rapid urbanization and migration to cities
(“floating” population and laid-off workers)
➣ Industrialization and emerging health risks
from environment and work-related
factors
14
Changing epidemiology of both
communicable & no-communicable diseases
SARS
 Infectious diseases: (Bird
Hepatitis
B, TB, malaria,
Flu
schistosomiasis etc) and new emerging disease
threats ( HIV/AIDS, SARS, Human influenza,
etc)
 Non-communicable diseases(NCDS)
(cancer, stroke, heart diseases and diabetes etc)
15
Inappropriate Health Service Delivery System
 Weak public health system
 Increasing disparities and inequalities in coverage,
efficiency, quality, access and outcome of healthcare
for different regions, different socio-economic
groups and by gender
 Fragmented profit-orientated hospital systems
leading to over provision, under provision and
misdirected provision in the healthcare delivery
system
16
Poor Health System Performance
 Irrational allocation of health resources, overuse
in tertiary hospitals and under utilization in
community health centers
 Rapidly advancing technology with specialization
& marketization of medical service lead to cost
escalation (growing at an annual rate of 16% and
declining of the public’s access to healthcare)
 Irrational incentives for service with health
institutions and deterioration of doctor-patient
relationship.
17
Diffuse Multi-ministries Health-related
Responsibilities and Poor Coordination

12 ministries deal with healthcare which only
consider their own interests and objectives
 The complex landscape of health care delivery
system: multiple actors
multiple levels
multiple partners
18
Inadequate Healthcare Financing
 Healthcare system is faced with the difficult task of
ensuring the affordability of healthcare at
reasonable expenditure level and on a sustained
basis
 Individual’s private out-of-pocket spending for
healthcare is soaring (59% of the total health
expenditure)
(80% of the rural population and 50% of the urban
population are entirely uninsured)
19
Weak Health Regulatory Mechanisms

Weaknesses in health regulation which
consist of evidence-based policies and
guidelines as well as enforcement and
monitoring for accreditation, standards
and legal statutes etc.

Lack of health policy to support the active
social participation in healthcare
(Private sector and NGO)
20
Increased Deep Engagement in
International Organization and Accords
The government of China has made
global commitments to improve health
(WTO entry, globalization and UN
Millennium’s goals) and to fulfill
international obligations.
21
3. The Roadmap for
China’s Healthcare Reform
Formidable Challenges
Considerable Constraints
Social Commitments
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 Establish a basic medical
& healthcare system and
improve the health of the
whole nation.
(Hu Jintao’s Report at 17th Party Congress)
 Maintain the public Welfare
nature of public medical &
healthcare services, always put
disease prevention first, center
on rural areas and attach equal importance to Traditional
Chinese Medicine & Western medicine.
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 Increase government responsibilities & spending,
improve the national health policy, to develop
systems of public health services, medical
services, medical security & medicine supply
 Improve the three-tier rural healthcare network
spanning the county, township & village and the
urban community-based healthcare system, and
deepen reform of public hospitals
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A way forward…step by step
Public Health Reforms
 Upgrade the infrastructure of the both urban &
rural public health system
 Concentrate on the agreed priority objectives in
public health problems (HIV/AIDS, Avian
Influenza, TB, Hepatitis B & cancer, heart diseases
etc.)
 Speed the transition from a cure-oriented system to
a prevention and care-oriented system
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Hospital System Reforms

The structure of the governmental hospitals must be
reformed (public, private or mix of both).
 Re-orienting healthcare services towards primary
medicine is a central thrust of the urban healthcare
delivery system reform.

Cost-quality mechanism, hospital’s accreditation
must go step-by-step to high standards in costeffective progression.
26
Health Regulatory Reforms
Strengthen regulatory framework to ensure cost
control, quality control and safety
 Strengthen the mandates for health regulation in
terms of human resources, facilities and services,
products and devices.
 Strengthen mechanisms for regulating
technological innovations & activities and enhancing
the capacities for standard development, health laws,
intellectual property protection and licensing.
27
Health Financing Reforms
➣ Government will increase investment & benefits
to make the national medical insurance schemes
more applicable to people.
➣ Developing a health insurance system under
public law, regulating its matters within the legal
framework conditions & making public-private
mix in health insurance field according to the
principle of solidarity.
28
Enhance international health cooperation
 Government and people-to-people channels
to introduce state of the art, managerial
experience, technology, human resources,
equipment and capital
 Promote the international sharing of disease
control experience and information and
participate in the major international
health actions
29
China has undertaken reform of its staterun system and is encouraging foreign
participation in its health industry.
The foreign companies are encouraged to
nurture the creation of a rational and viable
private healthcare service market by
systematically introducing international
expertise, capital and technology.
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Scope in China-Australia Healthcare Cooperation
 Development of new treatment and products
 Knowledge transfer
 Educational activities for healthcare
professionals
 Research alliances / cooperation
 Funding of project / initiatives
 Management and support systems
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A sustainable and quality
health care for all
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