China's healthcare system has made remarkable achievements after years of development, especially in the areas of basic medical protection covering the whole population, public health system construction and technological innovation. However, due to factors such as population size and uneven regional development, there are still some challenges. The following is an analysis of the achievements, challenges and future directions:
Core Achievements: Universal Medical Insurance Coverage and Rapidly Progressing Medical Services
1. Basic medical insurance covers the entire population, alleviating the problem of “expensive medical treatment”.
. China has built the world's largest basic medical insurance network: by 2023, the participation rate of basic medical insurance has stabilized at more than 95%, covering 1.36 billion people. Among them, urban workers' health insurance and urban and rural residents' health insurance (integrating the former New Farmers' Cooperative Program) constitute the main body, while major disease insurance covers all urban and rural residents, and some regions are also piloting supplemental insurance such as the “Huimin Insurance” program.
. The cost burden has been significantly reduced: through centralized band purchasing of medicines (“collective purchasing”), health insurance negotiations and other means, a cumulative total of more than 700 kinds of medicines will be covered in 2023, with an average price reduction of more than 50% (e.g., anticancer medicines, antihypertensive medicines); the reimbursement rate for major disease insurance is generally more than 60%, and groups in difficulty can also apply for medical assistance. The risk of “poverty caused by illness and returning to poverty” has been greatly reduced.
2. Comprehensive improvement of medical service capacity, and double breakthroughs in infrastructure and technology.
. Total resource growth: in 2022, the total number of medical and healthcare institutions nationwide will exceed 1.03 million (of which 37,000 will be hospitals), with the number of practicing physicians per 1,000 population reaching 3.15 (compared with 1.94 in 2012) and the number of hospital beds per 1,000 population reaching 6.7 (compared with 4.24 in 2012).
. Progress in regional equalization: Through policies such as the “County Hospital Capacity Enhancement Project” and “Tertiary Hospitals Providing Support to Each Other,” county-level hospitals have been able to provide treatment for more than 90 per cent of common and frequently occurring diseases, and primary medical care institutions (community health service centers and township health centers) in some developed regions have also been able to provide treatment for more than 90 per cent of common and frequently occurring diseases, Some primary healthcare organizations in developed areas (community health service centers, township health centers) are also able to provide chronic disease management, rehabilitation, and other services.
. Accelerated technological innovation: early cancer screening (e.g. low-dose CT screening for lung cancer), cardiovascular and cerebrovascular interventions (e.g. popularization of domestically produced stents), organ transplants (the second largest number of liver transplants in the world annually), and 5G remote surgeries (e.g. robotic surgeries performed by experts from Beijing on patients in Xinjiang) have reached the international advanced level; AI-assisted diagnostics (e.g. identification of lung nodules, pathology analysis), and precision medical treatment (targeted medicines, genetic testing) are gradually applied to clinical practice. ) are gradually applied to clinical practice.
3.Strengthening of the public health system and outstanding ability to respond to major epidemics
. Infectious disease prevention and control network is perfect: a nationwide infectious disease monitoring and reporting system has been established (covering 99% of medical institutions above the county level), the vaccination rate has been maintained at more than 90% (e.g., the full vaccination rate of hepatitis B vaccine is more than 99%), and infectious diseases such as smallpox and polio have been eliminated or nearly eliminated.
. Efficient response to major events: In the 2020 New Crown Epidemic, China relied on the public healthcare system to rapidly build the Vulcan Mountain and Lei Shen Mountain hospitals, carry out large-scale nucleic acid testing (the highest number of people in a single day was more than 200 million), and popularize vaccination (the rate of the whole process of vaccination was more than 90%), effectively controlling the spread of the epidemic; at the same time, it provided anti-epidemic assistance to more than 120 countries, demonstrating the responsibility of global public health.
4. Equalization of basic public health services
The government invests more than 100 billion yuan each year to provide 12 types of basic public health services (such as maternal health care, childhood vaccines, health management for the elderly, and follow-up for hypertensive/diabetic patients) free of charge to urban and rural residents. in 2023, the health management rate for the elderly aged 65 and above will reach 73%, and the standardized management rate for hypertensive patients will be more than 70%, effectively lowering the risk of complications from chronic diseases.
Existing Challenges: Resource Distribution, Service Quality and Reshaping the Development Model
Despite its remarkable achievements, China's healthcare system still faces the following problems:
1. Regional and hierarchical imbalance of medical resources .
. Urban-rural disparity: high-quality resources are highly concentrated in developed regions in the east and in tertiary hospitals (accounting for about 8 percent of the nation's hospitals but carrying more than 50 percent of outpatient visits).2022 Data show that the number of hospital beds per 1,000 population in places such as Tibet and Qinghai is only 60-70 percent of the national average, and that there is a lack of general practitioners in some remote township hospitals.2023 The number of beds per 1,000 population in Tibet and Qinghai is only 60-70 percent of the national average.
. The “inverted pyramid” structure: patients are overly concentrated in large hospitals, and primary care organizations (communities/townships) account for only about 50% of the total number of consultations and treatments (compared with more than 80% in developed countries), leading to “overcrowding in large hospitals and a lack of services in small hospitals”.
2. Long-term pressure from aging and chronic diseases
China's population over the age of 60 has exceeded 290 million (accounting for 20.3% of the total population), with more than 300 million patients suffering from hypertension and diabetes, and more than 40 million disabled/semi-disabled elderly people. Medical needs from “treatment” to “prevention + long-term care”, but the current system is still mainly acute treatment, rehabilitation care, hospice and other services are not enough supply; health insurance funds are also facing the "bottoming out The health insurance fund is also facing the risk of “bottoming out” (in 2022, the growth rate of expenditure will be 1.5 percentage points higher than the growth rate of income).
3. Service quality and experience to be improved
. Problems of medical experience: it is difficult to register at large hospitals (especially for specialists), long waiting time for examination, and insufficient communication between doctors and patients are still common; some grassroots organizations have outdated equipment, limited skills of doctors, and low trust of patients.
. Cost burden differentiation: although centralized procurement has lowered the prices of drugs/consumables, the costs of medical services such as examination fees and surgery fees have risen, and some high-value innovative medicines (e.g., anticancer targeted drugs) still require out-of-pocket payment, with a heavier burden on low-income groups.
4. Limited complementary roles of commercial insurance and social medical management
Basic medical insurance is still the main protection, commercial health insurance coverage is only about 10% (2023), and the product homogenization is serious (mostly “million medical insurance” “critical illness insurance”), chronic diseases, elderly groups of coverage is insufficient; socially-run medical (private hospitals) Although the number of private hospitals accounted for more than 65%, but the service volume accounted for only 20%, some organizations have excessive medical problems.
Future direction: from “disease-centered” to “health-centered” transformation
In response to the above challenges, China is promoting reform of its healthcare system, focusing on the following directions:
1. Optimizing resource allocation, strengthening the grassroots and promoting balance
Promoting the construction of “county medical communities” and “urban medical groups,” pairing up tertiary hospitals with grassroots organizations, and upgrading the capacity of grassroots organizations through the sinking of talents and the sharing of technology.
Implementing the “Thousand Counties Project,” with the goal of having all county hospitals meet the basic standards for tertiary hospitals by 2025.
Developing “Internet+Medicine” to alleviate the uneven distribution of resources through remote diagnosis and electronic prescriptions.
2. Deepening the “Three Medical Linkages” (medical care, medical insurance, and medicine), and controlling unreasonable growth in costs.
Expanding the scope of centralized procurement of medicines (covering more than 80% of medicines by 2025), and exploring the centralized procurement of high-value consumables (e.g., orthopedic implants).
Pushing forward the reform of DRG/DIP payment method (pay per patient), and guiding hospitals to shift from “making money by doing more projects” to “controlling costs and improving efficiency”.
3. Building a full-cycle health management system
Promoting “prevention as the mainstay”: expanding programs such as early cancer screening and intervention for high-risk groups of cardiovascular and cerebrovascular diseases.
Developing rehabilitation and hospice care: supporting the transformation of hospitals below the second level into rehabilitation hospitals and nursing homes.
Responding to aging: exploring the model of “combining medical care and nursing care” (cooperation between hospitals and nursing institutions), and encouraging family doctors to sign up for services to cover the elderly.
4. Encourage social participation and improve multi-protection.
Supporting the development of commercial health insurance (e.g., covering more rare and chronic diseases under the “People's Insurance” program).
Regulating social medical management and guiding private institutions to provide differentiated services (e.g., high-end specialties and rehabilitation care).
To summarize
China's healthcare system has moved from a “lack of medicine” to “universal coverage and advanced technology,” and has demonstrated strong resilience in protecting basic health needs and responding to major public health events. In the future, the quality of China's healthcare system is expected to further improve with the equalization of resources, refinement of services, and diversification of protection. Of course, this process will take time, and will require the participation of the government, hospitals, enterprises, and the public.