Abstract
China’s health system reform (HSR) recently entered a second phase, the State Council and a multi-agency steering committee announced many important new initiatives. However, China’s social sectors are heavily decentralized, the Ministry of Health has limited influence on the detailed design and implementation of the HSR at sub-national level. Sub-national leaders in China are mostly driven by economic progress and revenue generation; health is generally regarded as consuming, not generating revenue. A new health management information system and performance-based management of health staff may enhance oversight. However, parallel reforms in governance, financing, and accountability are also needed in China, to ensure achievement of the equity objective of its HSR.
Highlights
The rationale for, components of, and intrinsic challenges to health system reform (HSR) in China are summarised in Box 1
The rationale for, components of, and intrinsic challenges to HSR in China are summarised in Box 1
Strengthening grassroots health care and ensuring universal access to basic primary and public health services are among its five pillars, and echo the outgoing national leaders’ overarching focus on social harmony through improving social services and poverty reduction [5]
Summary
David Hipgrave1*, Sufang Guo, Yan Mu2, Yan Guo, Fei Yan, Robert Scherpbier, Hana Brixi. April 2012 marked the end of the three years China set for implementation of the first phase of its health system reform (HSR), and several recent reports assessed progress in this massive undertaking [1,2,3]. Two of them identify impressive achievements in health insurance coverage, infrastructure development, and uptake of services [1,3], but all three reports draw attention to slow progress in several areas: quality of services at the community level, persisting financial risk for individuals, and the almost complete lack of independent tracking of progress in health outcomes. None of the reports attempted to place China’s HSR in the context of the nation’s evolving political economy, or to predict its influence on achievement of the major HSR objective—equitable and affordable access to quality health services
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