China's ranking in healthcare needs to be analyzed comprehensively by combining assessment indicators (e.g., healthcare accessibility, quality, equity, health expenditure, life expectancy, etc.) from multiple international authorities. Below is a compendium of its global position and characteristics in terms of key dimensions:
Life Expectancy: Medium to High
Life expectancy is one of the core indicators of healthcare effectiveness. According to the World Health Organization (WHO) and the National Bureau of Statistics (NBS), life expectancy per capita in China will reach 78.2 years in 2023 (77.9 years in 2020), an increase of nearly 8 years compared with 2000, which is close to the level of developed countries (the average of OECD countries is about 81 years). Among 195 countries in the world, China ranks about 50th-60th (according to The Lancet Global Health Study 2023), significantly higher than equivalent income countries (e.g., about 70 years in India and 75 years in Vietnam).
Health system performance: medium to high, with significant regional differences
The overall performance of healthcare systems is usually assessed through “health system performance indices” (e.g. The Lancet Health Systems and Population Health study), covering dimensions such as prevention, treatment, and health equity.
The Lancet Global Study 2023: China is ranked 48th out of 195 countries (compared to 80th in 2010), a remarkable improvement, mainly due to improvements in infectious disease control, maternal and child health, and basic medical services.
Strengths: Outstanding performance in infectious disease control (e.g., tuberculosis, malaria prevention and control), vaccination rate (over 95% of children receiving routine vaccines throughout the course of their lives), and maternal mortality rate (15.7/100,000 by 2022, close to that of developed countries).
Challenges: there is still room for improvement in the efficiency of early screening and treatment of chronic disease management (e.g., cardiovascular disease, cancer); uneven distribution of medical resources between urban and rural areas and between regions (e.g., Tertiary hospitals are concentrated in large cities in the east).
health expenditure: total volume growth, structure to be optimized
China's total health expenditure as a proportion of GDP has been rising year by year, reaching 7.1% in 2022 (4.8% in 2010), but it is lower than the average level of OECD countries (about 9-10%), and lower than the United States (17%) and other high-income countries.
Government and Individual Sharing: Government health expenditure accounts for about 30% (average of OECD countries about 60%), and individual expenditure accounts for about 27% (average of OECD countries about 18%), suggesting the need to further strengthen the government's investment in order to reduce the burden on residents.
Medical insurance coverage: basic medical insurance covers more than 1.36 billion people (coverage rate of more than 95%), but the level of protection varies greatly among different types of medical insurance (employee medical insurance, resident medical insurance, New Farmers' Cooperative Medical Insurance), and there is still a need for improvement in cross-location settlement and reimbursement for serious illnesses.
Global health security: outstanding capacity to respond to public health emergencies
The Global Health Security Index (GHSI, published by the Nuclear Threat Initiative and Johns Hopkins University) evaluates the ability of countries to respond to risks of epidemics, bioterrorism, etc. In 2021, China's GHSI ranked No. 5 (the top four are the United States, the United Kingdom, Australia, and Canada), with excellent performance in the dimensions of “monitoring and response”, “medical resource reserves”, “emergency coordination”, etc. In particular, it has demonstrated rapid mobilization in the prevention and control of the New Crown Epidemic. China is ranked 5th in the GHSI in 2021 (the top four are the United States, the United Kingdom, Australia and Canada), with excellent performance in “monitoring and response”, “medical resource reserves” and “emergency coordination”, especially in the prevention and control of the new crown epidemic, where it has demonstrated its ability to rapidly mobilize and conduct large-scale testing.
Equity: Wide coverage but uneven quality
China has made remarkable progress in Universal Health Coverage (UHC), with more than 95% of the population covered by basic health insurance, but challenges remain in terms of equity in service quality:
Rural-urban gap: in 2022, there will be 4.2 practicing physicians per 1,000 population in urban areas and only 2.1 in rural areas; 80% of Tertiary hospitals are concentrated in the eastern part of the country.
Income gap: low-income groups rely more on primary healthcare institutions (e.g., community health service centers), but some primary institutions have limited equipment and technology, leading to the phenomenon of “crowding big hospitals for big and small illnesses”.
Summary: Remarkable progress, but still room for improvement
China's overall ranking in the healthcare sector has risen from a low level at the beginning of the 21st century to the middle to upper echelons of the world (e.g., The Lancet's ranking has risen from 188th in 2000 to 48th in 2023), with its core strengths being its rapidly rising life expectancy, efficient prevention and control of infectious diseases, and universal healthcare insurance coverage. In the future, the focus needs to be on addressing regional/urban/rural resource inequality, efficiency of chronic disease management, and level of health insurance coverage to achieve fairer and higher quality healthcare services.
(Note: Differences in the ranking methodology of different organizations may lead to fluctuations in the results, and the above analysis combines authoritative data from WHO, the World Bank, The Lancet, and GHSI).