China needs to further reform its health system with a number of critical steps to meet the growing health needs of the population and further control spending increases, despite impressive achievements in healthcare reform and rapid progress toward universal health coverage.
These include systemic and institutional reform and innovation, adoption of a tiered service-delivery system, a return to greater reliance on community health care and less on more expensive hospital care, according to a sweeping two-year study conducted by the World Bank Group, the World Health Organization, the Ministry of Finance, the National Health and Family Planning Commission, and the Ministry of Human Resources and Social Security of China.
“The report’s recommendations, built on robust, comprehensive research and close collaboration by five agencies representing three partners, will contribute positively to the formation of the 13th Five-Year Plan on health reform. We look forward to carefully studying and applying the report’s findings, so it will help us push ahead on health reform,” said Liu Yandong, Vice Premier of the State Council of China.
According to the study, Deepening Health Reform in China, Building High-Quality and Value-Based Service Delivery, China has lifted more than 600 million people out of poverty in the last three decades and achieved noteworthy successes in health.
Since the launch of the 2009 health reforms, China has substantially increased investment to expand health infrastructure; strengthened the primary-care system; achieved near-universal health insurance coverage in a relatively short period; reduced the share of out-of-pocket expenses—a major cause of disease-induced poverty—in total health spending; continued to promote equal access to basic public health services; deepened public hospital reform; and improved the availability, equity and affordability of health services. It has also greatly reduced child and maternal mortality and rates of infectious diseases, and improved the health and life expectancy of the Chinese people.
As in much of the rest of the world, China also faces many challenges in reforming and developing its healthcare system. The population is aging and there is a surge in non-communicable diseases such as cancer, diabetes and heart disease. The number of people over 65 years old in China is now at 140 million and is expected to increase to 230 million by 2030.
Infectious diseases have been replaced by non-communicable diseases as the greatest health threat to Chinese people, accounting for more than 80 percent of the 10.3 million deaths every year. Those diseases are exacerbated by high-risk behaviors such as smoking, sedentary lifestyles and alcohol consumption, as well as environmental factors such as air pollution. At the same time, with higher economic growth and personal incomes, people are demanding more and better health care.
Those factors have led to rising healthcare costs. Yet the slowdown in the economy will make it difficult to keep up with the current level of growth in health spending. The study makes an urgent case for China to reform and start instituting a “people-centered” integrated healthcare system to meet new challenges. The government of China has also recognized the need for a strategic change in the health system, and has taken many concrete steps in this direction.