As many other countries, China faces big challenges to meet the health care needs of her citizens, associated with a rapidly aging society and increasing burden of non-communicable diseases (NCDs). Also, health costs have been growing at a rate higher than GDP growth since 2008.
Since the launch of health reform in 2009, China has invested significantly in health infrastructure at the grassroots level and made progress in building the primary care doctors system. Basic public health services capacity has been significantly enhanced. China is progressing quickly to achieving universal health coverage and some of the reform achievements have attracted worldwide attention.
The reform commanded many innovative pilots in health financing and service delivery at the local level and provided a strong foundation for the next stage of reform. This report aim to support China during this reform phase by recommending 8 sets of strategic reform directions, referred to as “levers”. Each lever contains a set of core action areas and corresponding implementation strategies to guide the ‘what’ and ‘how’ of deepening service delivery reform, and are meant to provide policy guidance at all governmental levels. Broadly, these reforms focus on improving ‘downstream’ service provision as well as creating an enabling ‘upstream’ financial and institutional environment for that improvement.
At the core of the recommendations is the full adoption of a reformed service delivery model, referred to as people-centered integrated care (PCIC), in order to accelerate progress toward China’s vision of health service delivery reform and improve value for money. Second, continuous quality improvement is a foundational element of PCIC and creating a high value system, and is essential for gaining citizen trust. Third, recognizing the key role of patient trust for the success of the PCIC model, the report recommends that patients are empowered with knowledge and understanding of the health system and be actively engaged in the process of seeking care.
Other levers include a comprehensive package of interventions to deepen health reform by:
- Realign incentives in purchasing and provider payment
- Strengthen private sector engagement, aligned with the new shape of the delivery system
- Strengthening health workforce for PCIC
- Modernizing health service planning moving away from the traditional input-based planning towards capital investments based upon region-specific epidemiological and demographic profiles.
- World Bank Group, World Health Organization, Ministry of Finance, National Health and Family Planning Commission, Ministry of Human Resources and Social Security