The overall level of China's healthcare system has achieved leapfrog development over the past few decades, moving gradually from a lack of basic medical resources to a new stage of “medical care for the sick and good medical treatment”. While China's healthcare system has made remarkable achievements in terms of coverage, technological capacity and service efficiency, it also faces a number of structural challenges. The following is a comprehensive analysis of the core strengths, existing challenges, and international comparisons to help fully understand the current state of healthcare in China.
Core Strengths of China's Healthcare
1. Healthcare service system covers the entire population
China has built the world's largest basic medical insurance network :
. Coverage of the population: The basic medical insurance participation rate has stabilized at over 95% (2023 data), including the two systems of employee medical insurance and urban and rural residents' medical insurance, basically realizing "basic medical protection for all.
. Primary healthcare network: There are approximately 1 million healthcare institutions nationwide (2022), of which primary healthcare institutions (community healthcare centers, township healthcare centers, village healthcare offices) account for more than 95%, forming a “county-village-village” network. A three-tier “county-village-village” service network will be formed, ensuring that residents in remote areas will also have access to basic medical services.
2. Medical technology and specialized capabilities have been significantly upgraded.
China has reached international advanced levels in a number of medical fields, with some technologies leading the world:
. Diagnosis and treatment of difficult and serious diseases: top tertiary hospitals such as Peking Union Medical College Hospital and Shanghai Ruijin Hospital have mature technologies in the fields of oncology (e.g., precision treatment of lung cancer and liver cancer), cardiovascular and cerebrovascular diseases (interventional surgeries, cardiac bypasses), and organ transplants (the world's largest number of liver transplants per year), and some of these surgeries have been successful. The technology in these areas is mature, and the success rate of some surgeries is on par with that of top international institutions.
. Innovative drug and device R&D: Domestic innovative drugs (e.g., PD-1 inhibitors, CAR-T cell therapy), high-end medical devices (e.g., domestic surgical robots “da Vinci”, “Magnetic Suspension”), and other medical devices (e.g., “PD-1”, “PD-1”, “PD-1”). (such as the domestic surgical robot “da Vinci”, “magnetic levitation” artificial heart) accelerated to market, and some of the products entered the European and American markets through “going overseas” (such as Rongchang Bio's ADC drug, vedicilizumab, was recognized by the FDA as a breakthrough therapy).
. Features of Chinese medicine: Traditional therapies such as acupuncture and tuina have been incorporated into the International Classification of Diseases (ICD-11) by the World Health Organization (WHO), and Chinese medicinal preparations (such as Lianhua Qingdian and Xuesetong) play an important role in the management of chronic diseases and the prevention and control of epidemics. Some varieties of Chinese medicines have entered the international market through registration in the European Union.
3. Global Leadership in Public Health and Emergency Response
Public Health and Emergency Response Prevention and control of infectious diseases: establishing the world's largest infectious disease surveillance network (covering all medical institutions above the county level), building a direct reporting system for infectious diseases after SARS in 2003 (reporting within three hours), and rapidly isolating viral strains and developing vaccines (for new crown epidemics in 2020). virus strains, development of vaccines (inactivated vaccines, adenovirus vector vaccines, etc.), and more than 3.4 billion doses of inoculations, providing critical support for the global fight against the epidemic.
. Chronic Disease Management: The rate of standardized management of patients with chronic diseases such as hypertension and diabetes will exceed 70% by 2022, and through the “Family Doctor Contract” and “Community Health Record”, the number of patients with chronic diseases will be increased by more than 70%. Early screening and treatment will be realized through “family doctor contracting” and “community health records”, and the risk of complications will be reduced.
4. Modernization of medical infrastructure and equipment
. Hardware upgrading: Tertiary hospitals nationwide are generally equipped with high-end equipment such as 3.0T MRIs, PET-CTs, and da Vinci surgical robots, and county hospitals have basically realized the goal of “keeping major diseases out of counties” (2025 goal: 90% of major diseases will be solved within the county). (2025 target: 90% of major diseases will be solved within the county).
. Intelligent healthcare: Electronic medical records, mobile payment, remote diagnosis and treatment (5G+remote surgery) have been popularized, and some hospitals have launched “one-stop” service platforms (e.g., online registration, payment, and report checking) to enhance patient experience.
Existing challenges and directions for improvement
Despite the remarkable progress in China's medical care, the following problems still exist due to factors such as population size and unbalanced regional development:
1. Uneven distribution of quality medical resources
. Regional disparities : High-quality hospitals (e.g., tertiary hospitals) are concentrated in the eastern coast (e.g., Beijing, Shanghai, Guangzhou), while medical resources are relatively scarce in central, western, and rural areas.
. Differences in specialties: There is a shortage of doctors in pediatrics, general medicine, psychiatry and other specialties, and some grassroots institutions have difficulty in providing high-quality specialty services.
2. The burden of medical costs still needs to be optimized
. Individual out-of-pocket expenses: Despite the wide coverage of health insurance, the out-of-pocket expenses for some major diseases (e.g., cancer, rare diseases) are still high (some targeted drugs and imported consumables are not fully covered by the health insurance), and the proportion of individual health expenditure in the total health expenditure will be about 27% in 2022 (the average of OECD countries is about 18%).
. Pressure on the health insurance fund: population aging (more than 290 million people over the age of 60 in 2023) has led to an increase in health insurance expenditure, and the risk of “bottoming out” has emerged in some regions, requiring The reform of DRG/DIP payment methods (payment by type of disease) and collective procurement of medicines (lowering the price of medicines) are needed to control costs.
3. Doctor-patient relationship and service experience need to be improved.
. Overcrowding in large hospitals: the concentration of high-quality resources has made it difficult to see a doctor, and the average daily outpatient volume in tertiary hospitals often exceeds 10,000 people, with patients waiting for a long time for treatment (an average of 2-3 hours for some departments).
. Insufficient communication: Some doctors have a short time to communicate with patients due to the large number of outpatient visits (an average of 5-10 minutes per person), which can easily lead to misunderstanding.
International Comparison: The Position of China's Medical Care
. Coverage : China's basic health insurance coverage (95%+) far exceeds that of the United States (~88%) and India (~50%), and is close to the level of developed countries.
. Technological capability : Oncology, TCM, and some minimally invasive surgeries are on par with the international top level, but there is still a gap in innovative drug R&D (only 5 of the global Top 100 drug companies in China), and high-end devices (e.g., surgical robots' market share).
. Cost efficiency : China's healthcare costs account for about 7% of GDP (2022), lower than the average of OECD countries (9%), but per capita healthcare expenditure (about 5,000 yuan) is only 1/10 of that of the U.S., which is an outstanding cost-effectiveness.
Summary
The core advantage of China's medical care lies in its “universality” and “speed of technological catch-up”: universal health insurance coverage solves the problem of “universal coverage”. Through universal health insurance coverage, China has solved the problem of “availability” and achieved a breakthrough in “goodness” in some specialties, especially in responding to public health emergencies and the application of traditional Chinese medicine, etc. China's core advantage lies in ‘universality’ and “speed of technological catch-up”. Despite the problems of uneven resources and cost pressure, with the promotion of the “Healthy China 2030” strategy (such as the construction of county medical communities and the deepening of hierarchical diagnosis and treatment), the reform of medical insurance payments, and the increased investment in innovative drug research and development, China's medical care is shifting from “quantitative” to “qualitative” expansion, and from ‘quantitative’ to “qualitative” expansion. China's healthcare is shifting from “quantity” expansion to “quality” improvement, and is in a reliable stage of rapid development. For the general public, especially patients with common and chronic diseases, China's healthcare system has been able to provide safe and effective services; for patients with difficult and serious illnesses, the technical level of some of the top hospitals has become internationally competitive.