Public Hospital Reform Research Articles

Satisfaction with Public Hospital Reform and Associated Factors Among Medical Staff: A Cross-Sectional Survey in Wuhan, China.

PurposeTo assess whether medical staff are satisfied with public hospital reform and its influencing factors.MethodsA sample of 2000 medical staff from 13 public hospitals in Wuhan were surveyed with a self-administered questionnaire. Descriptive analysis and binary logistic regression were conducted to identify the status of the medical staff’s attitude to the reform and the influencing factors.ResultsA total of 61.4% of medical staff satisfied with the reform and the main reason was the promotion of their practice environment and social status brought by the reform. The logistic regression model indicated that the attitude to the reform of medical staff was positively associated with 9–11 hours of daily working time (OR = 2.373, as compared with less than 8 hours), higher income (OR = 1.966), the occupation of the nurse and medical technician (OR = 2.196–1.464 as compared with the doctor) as well as negative attitude towards the effectiveness of reform (OR = 3.676).ConclusionMore than half of medical staff are satisfied with the public hospital reform, while some still hold negative attitude to the reform because of the extra working hours, low salary and high expectations due to professional characteristics and high input costs (education and time). Thus, in the current epidemic of prevention and control, more attention should be paid to the work pressure and enthusiasm of medical personnel. Administrators should pay attention to increasing income and improving the practicing environment and social status to prevent medical staff from treating reforms negatively.

County-based demographics, patterns of treatment seeking, and disease burden for malignant tumor patients in China.

The mortality of malignant tumors in rural areas of China in 2015 was significantly higher than that in city areas (213.6 per 100,000 vs. 191.5 per 100,000), bringing huge economic pressure to individuals and the local community. The comprehensive reform of county-level public hospitals in Yun County has helped patients with critical disease receive appropriate treatment. Therefore, an analysis focused on the epidemiology and disease burden of malignant tumors in Yun County could provide guidance for administrators and health practitioners in other counties. This retrospective database study extracted data from the Yun County medical community (including two higher level hospitals: Yun County People's Hospital and Yun County Chinese Medicine Hospital, and 13 township central hospitals) from 1st Jul 2017 to 30th Aug 2020. Patients diagnosed as having a malignant tumor were enrolled and those with abnormal key baseline information were excluded. The epidemiology and disease burden for malignant tumor patients were assessed. A total of 3,792 patients were enrolled, and the most prevalent cancer in 2018 was thyroid (35.4 patients/100,000) and in 2019 this was lung cancer (30.6 patients/100,000). The mean outpatient visits per person for all-cause and tumor-specific visits were 9.99 and 3.94 visits across 2018 and 2019, respectively, and the mean inpatient visits per person in both years were the same at 2.56 visits. Total costs were 14.471 and 20.29 million in 2018 and 2019, respectively, and 71.7% and 73.0% of the total cost were covered by medical insurance over the 2 years. The medical environment has improved since medical system reform commenced in 2019 in Yun County, and medical insurance has decreased the disease burden for patients and their families significantly.

Discussion on the Participation of Social Capital in the Reform of Secondary Public Hospitals under IOT Mode--a Case of Hospital J in Hangzhou

With hospital J in Hangzhou as the research object, this paper tries to put forward some suggestions by analyzing the difficulties and problems in the process of social capital participation in hospital reform, cooperation, and operation of hospital J and provide a reference for social capital to participate in the exploration and practice of medical health industry.

Changes in efficiency of tertiary public general hospitals during the reform of public hospitals in Beijing, China.

In March 2009, the Chinese government formally launched a new round of healthcare reform. As the city with the highest concentration of high-quality medical resources in China, in the past 10 years, Beijing has also been exploring medical reforms. This article studied the performance and development of the 10 tertiary general public hospitals managed by Beijing Municipal Hospital Management Centre to provide policy basis for further deepening Beijing public hospital reform and improving hospital efficiency. The 2011, 2015 and 2018 'Beijing Health Work Statistics' were used to evaluate the performance of Beijing's tertiary public general hospitals, based on the Pabon Lasso model and the data envelopment analysis (DEA) model. Based on the Pabon Lasso model, 60%, 70% and 70% of the hospitals were entirely efficient (zone 3) in 2011, 2015 and 2018. It shows that among the 10 general public hospitals in Beijing, efficient hospitals accounted for the majority and further increased during the reform period. The DEA model further illustrates this point and shows more effective hospitals (80%) than the Pabon Lasso model, showing the efficiency of these hospitals to be improved during the reform period. The efficiency of the 10 hospitals has gradually improved during the reform period, and the difficulty of seeing a doctor in Beijing at a national medical centre has been relieved to a certain extent. Combining the Pabon Lasso model and the DEA model can analyse hospital efficiency more comprehensively, and can prompt initial information for improving hospital efficiency, but the results also reflect some problems.

Whether Public Hospital Reform Affects the Hospital Choices of Patients in Urban Areas: New Evidence from Smart Card Data.

The effects of public hospital reforms on spatial and temporal patterns of health-seeking behavior have received little attention due to small sample sizes and low spatiotemporal resolution of survey data. Without such information, however, health planners might be unable to adjust interventions in a timely manner, and they devise less-effective interventions. Recently, massive electronic trip records have been widely used to infer people’s health-seeking trips. With health-seeking trips inferred from smart card data, this paper mainly answers two questions: (i) how do public hospital reforms affect the hospital choices of patients? (ii) What are the spatial differences of the effects of public hospital reforms? To achieve these goals, tertiary hospital preferences, hospital bypass, and the efficiency of the health-seeking behaviors of patients, before and after Beijing’s public hospital reform in 2017, were compared. The results demonstrate that the effects of this reform on the hospital choices of patients were spatially different. In subdistricts with (or near) hospitals, the reform exerted the opposite impact on tertiary hospital preference compared with core and periphery areas. However, the reform had no significant effect on the tertiary hospital preference and hospital bypass in subdistricts without (or far away from) hospitals. Regarding the efficiency of the health-seeking behaviors of patients, the reform positively affected patient travel time, time of stay at hospitals, and arrival time. This study presents a time-efficient method to evaluate the effects of the recent public hospital reform in Beijing on a fine scale.

Effect of healthcare system reforms on public hospitals’ revenue structures: Evidence from Beijing, China

To reduce the heavy reliance of public hospitals on drug sales and use of advanced technologies and to contain the escalating medical expenditures, Beijing implemented two rounds of comprehensive public hospital reform in 2017 and 2019, respectively. The first round focused on separating drug sales from hospital revenue (reform1), and the second round extended to include zero markup on medical consumables and price adjustments for medical services (reform2). To estimate how these two rounds of reform have affected public hospitals' revenue structures, we used observational data of medical revenues from 2016 to 2019 covering 354 healthcare facilities. A Panel-interrupted time-series (PITS) model was used to analyze the effects. The results suggest that the reforms have changed the structure of public hospitals' revenues. The proportion of drug sales in hospital revenues fell from 43.96% in 2016 (pre-reform) to 34.08% in 2019 (post-reform); the proportions of medical consumables decreased by 0.73% after reform 2; and the proportion of medical consultation service fees increased from 15.16% in 2016 to 24.51% in 2019. PITS analysis showed that the proportion of drug sales dropped by 5.46% in the month of reform 1, and it dropped by 0.20% per month on average after reform 2(p < 0.001). The proportion of medical consumables decreased by 0.04% per month on average after reform 2 (p < 0.001). The proportion of medical consultation service increased by 7.13% in the month of reform 1, and it increased by 0.14% per month on average after reform 2(p < 0.001). Similar trends were seen in hospital revenue structures from both inpatient services and from outpatient and accident and emergency services. Thus, Beijing's reforms successfully contained rising medical expenditures and optimized hospitals' revenue structures. These reforms can provide a reference for further public hospital reforms in China and other countries with similar systems.

Supply-induced demand for medical services under price regulation: Evidence from hospital expansion in China

In 2009, China launched a nationwide reform to overhaul its enormous healthcare system. Subsequently, government spending on healthcare increased significantly. Simultaneously, public hospitals experienced rapid expansion. This study empirically examines whether supply-induced demand existed for public hospitals during the expansion process, based on hospital longitudinal data from 2007 to 2016, which is matched with individual patient data. We found that medical expenditure increased rapidly, while the quality of medical services did not change significantly during the hospital expansion. In addition, due to the price regulation of medical services, public hospitals mainly passed on the costs of expansion by inducing hospitalization and diagnostic over-testing. Furthermore, supply-induced demand was more obvious in diseases for which doctors had more asymmetric information. Based on the evidence provided in this study, the expansion of public hospitals has resulted in a waste of healthcare resources and a rise in the healthcare burden on patients. This has certain implications for further deepening the reform of public hospitals.

Efficiency Comparison of Public Hospitals under Different Administrative Affiliations in China: A Pilot City Case.

This study seeks to measure the efficiency disparity and productivity change of tertiary general public hospitals in Wuhan city, central China from the perspective of administrative affiliations by using panel data from 2013 to 2017. Sample hospitals were divided into three categories, namely provincial hospitals, municipal hospitals, and other levels of hospitals. Data envelopment analysis with bootstrapping technique was used to estimate efficiency scores, and a sensitive analysis was performed by varying the specification of model by considering undesirable outputs to test robustness of estimation, and efficiency evolution analysis was carried out by using the Malmquist index. The results indicated that the average values of provincial hospitals and municipal hospitals have experienced efficiency improvement over the period, especially after the initiation of Pilot Public Hospital Reform, but hospitals under other affiliations showed an opposite trend. Meanwhile, differences of administrative subordination in technical efficiency of public hospitals emerged, and the disparity was likely to grow over time. The higher efficiency of hospitals affiliated with municipality, as compared with those governed by province and under other administrative affiliations, may be attributed to better governance and organization structure.

Self‐efficacy, empowerment and power of middle nurse managers in Cyprus: A correlational study

To investigate the perceived self-efficacy, structural empowerment and power of middle nurse managers before the implementation of a major reform of public hospitals in Cyprus. Nurse managers' self-efficacy is important as it makes a difference in nurses' motivation and the way they feel, think and behave. Empowerment promotes workers' engagement at work, leading to positive performance outcomes. This is a descriptive correlational study with a sample of 175 nurse managers. It was conducted during March-April 2019. The results showed that nurse managers perceived relatively high scores of self-efficacy, moderate levels of empowerment and moderate levels of both formal and informal power. Access to resources has been recorded as low. Statistically significant correlations have been found between self-efficacy, age and work experience. Nurse managers with a bachelor's degree had a higher informal power than those with a master's degree. The present study provides recommendations for maintaining and enhancing the self-efficacy, empowerment and power of nurse managers in the evolving conditions of health care reforms. Nurse managers need to improve their access to empowerment structures and be involved in policy decision-making, future planning, organisation and control, aiming for the improvement of services and care that they provide.

Does the separating of hospital revenue from drug sales reduce the burden on patients? Evidence from China

BackgroundSince 2015, all pilot cities of public hospital reform in China have allowed the zero-markup drug policy and implemented the policy of Separating of Hospital Revenue from Drug Sales (SHRDS). The objective of this study is to evaluate whether SHRDS policy reduces the burden on patients, and to identify the mechanism through which SHRDS policy affects healthcare expenditure.MethodsIn this study, we use large sample data of urban employee’s healthcare insurance in Chengdu, and adopt the difference in difference model (DID) to estimate the impact of the SHRDS policy on total healthcare expenditures and drug expenditure of patients, and to provide empirical evidence for deepening medical and health system reform in China.ResultsAfter the SHRDS policy’s implementation, the total healthcare expenditure kept growing, but the growth rate slowed down between 2014 to 2015. The total healthcare expenditure of patients decreased by only 0.6%, the actual reimbursement expenditure of patients decreased by 4.1%, the reimbursement ratio decreased by 2.6%. and the drugs expenditure dropped by 14.4%. However, the examinations expenditure increased by 18.2%, material expenditure increased significantly by 38.5%, and nursing expenditure increased by 12.7%.ConclusionsAfter implementing the SHRDS policy, the significant reduction in drug expenditure led to more physicians inducing patients’ healthcare service needs, and the increased social healthcare burden was partially transferred to the patients’ personal economic burden through the decline in the reimbursement ratio. The SHRDS policy is not an effective way to control healthcare expenditure.

The Economic Situation Analysis of the Impact for Cancelling Drug Addiction on Public Hospitals’ Operations

Objective: Investigation of the impact of the reform of urban public hospitals in cancelling drug price addition on public hospitals’ operations and patient personal burdens, providing data support for the comprehensive reform of urban public hospitals. Methods: Using Excel 2007, the overall operation of the hospital, the workload of medical staff in the internal and external departments, the proportion of medicines, and the burden of medicines for patients were analyzed before and after the cancellation of drug sales in a public hospital. Results: The cancellation of drug price additions had little effect on the outpatient visits of the hospital, and had a greater impact on the hospital’s income structure and patient’s consumption structure. Conclusion: Simply relying on the cancellation of drug price addition cannot effectively adjust the structural contradiction of medical service prices in the reform of public hospitals in the urban areas. The transformation of medical institutions from “drug dependent doctors” to “doctors dependent doctors” requires the strengthening of hospital internal management, so that supporting medicine price reforms will ultimately improve the overall quality and efficiency of the hospital.

The Effects of County Public Hospital Reform on the Consumption and Costs of Antibiotics: Evidence from a Quasinatural Experiment in Jiangsu, China.

Background Overuse of antibiotics is a major driver for rapid spread of antimicrobial resistance worldwide, particularly common in China. The close linkage between hospital revenue and sales of drugs has become the key incentive for overprescription of antibiotics. Since 2009, the Chinese government implemented a series of measures to cut off the link, including removing the markup of drugs, increasing financial subsidies, and adjusting charges for medical service. Objective To evaluate the impacts of county public hospital reform on the consumption and costs of procured antibiotics in Jiangsu province. Methods A quasiexperiment design was conducted in Jiangsu province where 99 county public hospitals implemented the reform successively in different periods. Of these, 37 county public hospitals implemented the reform since January 2013, which were regarded as the intervention group, and the remaining 62 hospitals were included in the control group. A difference-in-differences (DID) analysis with generalized linear regressions was used on the procurement records of antibiotics from January 2012 to December 2013. Modified Park test was used for family distribution and Box–Cox test for log link. Placebo tests were employed to test the common-trend hypothesis of two groups. Results For the intervention group, the average volume of procured restricted antibiotics and injectable antibiotics increased by 24.12% and 2.75% while the costs increased by 19.01% and 9.09%, respectively. The average costs per DDD of restricted and injectable antibiotics were much higher than unrestricted and oral antibiotics. The DID results showed that the reform had a positive impact on the average volume (p = 0.005) and costs (p = 0.001) of nonrestricted antibiotics. In addition, the implementation of the reform was associated with a reduction in volume (p = 0.031) and costs (p = 0.043) of procured oral antibiotics. The reform also contributed to an increase in average costs per DDD of total antibiotics (p = 0.049). Conclusions The reform is effective in reducing the consumption and costs of unrestricted and oral antibiotics, but it has failed to reduce the consumption and costs of expensive restricted and injectable antibiotics, leading to increased burden of diseases. It is critical that the health policy initiatives can deincentivize overuse of antibiotics at both hospital and individual physician's levels. The reform should enforce government financial support, improve hospital governance, optimize performance evaluation, and establish specialized management approach for antibiotic use.

Assessing Productivity Development of Public Hospitals: A Case Study of Shanghai, China.

As the main provider of medical services for the general public, the productivity changes of public hospitals directly reflect the development of the healthcare system and the implementation effect of medical reform policies. Using the dataset of 126 public hospitals in China from 2013 to 2018, this paper improves the existing literature in both index selection and model formulation, and examines public hospitals’ total factor productivity (TFP) growth. Empirical results not only demonstrate the trend of productivity development but also point out the directions in how to improve the current running status. Our study demonstrates that there were no obvious productivity fluctuations in public hospitals during the recent observing years, indicating that the performance of China’s public health system was generally acceptable in coping with fast-growing medical demand. However, the effect of public hospital reform has not been remarkably shown; thus, no significant productivity improvement was observed in most hospitals. Tertiary hospitals witnessed a slight declining trend in TFP, while secondary hospitals showed signs of rising TFP. To effectively enhance the overall performance of public hospitals in China, practical suggestions are proposed from the government and hospital levels to further promote the graded medical treatment system.

The Performance Evaluation Mechanism Based on Information Construction for Large Stand-Alone Medical Equipment and Its Support for Decision-Making of Purchasing

Continuously deeper reform of public hospitals has put forward the need to innovate the philosophy and system of large medical equipment operation and management, and the phenomenon featuring "more attention to purchasing and less attention to management" need to be turned around. This research took use of information management to set up ID fields (unique number) for target stand-alone equipment; integrated statistics functions of HIS, PACS, LIS, RIS and equipment management system to get the basic operation data; informationized the work flow and reform technology to set up a post evaluation indictor system for the performance of stand-alone equipment; compared the service condition of newly purchased equipment with the feasibility application of relative department from various dimensions; designed objective post-evaluation indicators from various angles to scientifically manage existing medical equipment and support decision-making of new application for purchasing medical equipment. Application performance of stand-alone equipment and clinical departments were ranked in a standardized manner. Decision-making mode based on data case of stand-alone equipment was set up. Net present value was evaluated. However, re-purchasing the instrument did not continuously increase the contribution of each instrument. The laboratory can purchase new instruments again, while the imaging department is not recommended to purchase. The performance evaluation mechanism based on information construction for large stand-alone medical equipment and its support for decision-making of purchasing is of great significance to improve the service life of equipment, exert the maximum effect and reduce economic waste.

公立医院改革中医务人员的工作满意度和参与

公立医院改革中医务人员的工作满意度和参与

Containing medical expenditure: lessons from reform of Beijing public hospitals

Containing medical expenditure: lessons from reform of Beijing public hospitals

Understanding the Function Constitution and Influence Factors on Communication for the WeChat Official Account of Top Tertiary Hospitals in China: Cross-Sectional Study.

BackgroundWidespread adoption and continued developments in mobile health care technologies have led to the improved accessibility and quality of medical services. In China, WeChat, an instant messaging and social networking app released by the company Tencent, has developed a specific type of user account called WeChat official account (WOA), which is now widely adopted by hospitals in China. It enables health care providers to connect with local citizens, allowing them to, among other actions, send regular updates through mass circulation. However, with the diversity in function provided by WOA, little is known about its major constitution as well as the influence factors on the WeChat communication index (WCI). The WCI has been widely used in social media impact ranking with various types of WeChat content to fully reflect the dissemination and coverage of tweets as well as the maturity and impact of WOA.ObjectiveThere are two typical WOAs available to users, namely, WeChat subscription account (WSSA) and WeChat service account (WSVA). The biggest difference between them is the frequency of messages transmitted. This study aimed to explore the function constitution of WSVA adopted by top tertiary hospitals in China and the major contributors of the WCI score.MethodsA total of 681 top tertiary hospitals were selected from the Hospital Quality Monitoring System; the WOA of every top tertiary hospital was retrieved in the WeChat app. We divided core functional items of WSVAs using categorical principal component analysis. To elicit the factors that influenced the use of WSVA, quantile regression was employed to analyze the WCI score.ResultsFrom the 668 WOAs identified, adoption of WSVAs (543/668, 81.3%) was more than that of WSSAs (125/668, 18.7%). Functional items of WSVAs were categorized into four clusters: (1) hospital introduction, (2) medical services, (3) visiting assistants, and (4) others. With regard to the influence factors on the WCI, the impact of the activity index of WSVA and the total visiting number of outpatients and emergencies on WCI were statistically significant and positive in all quantiles. However, the year of certification, the type of hospital, the year of public hospital reform, and the number of beds merely affected the WCI at some quantiles.ConclusionsOur findings are considered helpful to tertiary hospitals in developing in-depth functional items that improve patient experience. The tertiary hospitals should take full advantage of times of posting and provide high-quality tweets to meet the various needs of patients.

Determinants of efficiency growth of county-level public hospitals-evidence from Chongqing, China

BackgroundThe reform of county-level public hospitals is a breakthrough in the new era of healthcare reform in China and has attracted considerable attention since 2012. Continuous and efficient operations of hospital are primary concerns of this reform. To ensure the effectiveness of county-based intervention reform measures in Chongqing, it is significant to understand how hospital and county characteristics are associated with county-level public hospital efficiency due to significant development differences between counties. This study identifies the trajectory of hospital efficiency over time and determinants. It will also provide preliminary references for advancing reform.MethodsThis study employs data from the Chongqing Regional Health Information Platform, Chongqing Health and Family Planning Statistical Yearbook, and Chongqing Statistical Yearbook for 2012–2016. A three-level growth model is used to estimate the efficiency growth trajectories within the contexts of hospitals and counties.ResultsThe intra-hospital level factors that affect the initial efficiency include government financial assistance, daily charge per bed, total assets turnover, number of hospital healthcare technicians, and medical costs per 100-yuan medical income. Inter-hospital variance is explained by hospital type. Inter-county level factors affecting the growth rate include the number of healthcare technicians per 1000 people and population density of the county. The interaction effect of the number of hospital healthcare technicians, hospital type, and number of healthcare technicians per 1000 people on hospital efficiency growth is significant.ConclusionsThis study identifies determinants that contribute to efficiency changes in public county-hospitals over time by using a three-level growth model. The differences in efficiency are associated with intra-hospital, inter-hospital, and inter-county characteristics in Chongqing, which provides useful insight into government decision-making and the progress of reform. The stability and reasonable increase in the number of healthcare technicians in a county are the key factors that improve the efficiency. Further reform should focus on maternal and child healthcare hospitals for increasing investment and implementing government compensation.

Status of healthcare workers after comprehensive reform of urban public hospitals in Beijing, China: sustainable supply, psychological perception, and work outcomes

BackgroundHealthcare reform in China has attracted worldwide interest and reached a new juncture. In an attempt to improve healthcare quality and patient satisfaction, the government of Beijing introduced comprehensive reform of urban public hospitals in 2016 and implemented new policies on personnel, compensation, management, and diagnosis and treatment. As the agents of healthcare service, and a target of reform measures, healthcare workers were greatly affected by these reforms but have not been carefully studied.MethodsThis study used mean value analysis, variance analysis, and qualitative content analysis to investigate the status of healthcare workers after comprehensive reform of urban public hospitals in Beijing.ResultsWe found a gradual but constant increase in the number of healthcare workers in poor health in Beijing public hospitals. After the reforms, this population reported high challenge stress, public service motivation, job satisfaction, job performance and quality of healthcare, moderate presenteeism, and low hindrance stress and turnover intention. The status of healthcare workers differed by subgroup and changed during the reform process.ConclusionsOur study provides data useful for policy recommendations regarding the implementation and extension of future reforms and offers important lessons for developing and developed countries that are reforming public hospitals to improve efficiency and reduce costs.

Ending tuberculosis in the sustainable development era in China: what are the health system challenges? A mixed-methods study

BackgroundThe UN Sustainable Development Goals include ending the tuberculosis epidemic globally by 2030. China is a high burden country of both drug-susceptible and multidrug-resistant tuberculosis. This study examined China's progress in meeting the tuberculosis milestones and targets laid out by the WHO End TB Strategy, and analysed key health system challenges to be overcome towards ending the tuberculosis epidemic in China. MethodsWe used estimates of tuberculosis incidence and number of tuberculosis deaths in China from the Global Burden of Disease Study 2016 to conduct current situation analysis and a projection for 2030. We also reviewed national strategy and implementation guidelines in relation to tuberculosis control in China. We conducted semi-structured qualitative interviews, including key-informant interviews with decision makers and policy implementers at national and provincial levels (n=4), and in-depth interviews with experts in tuberculosis control (n=3). Senior researchers invited participants to take part in interviews through personal contacts, and undertook the interviews after obtaining verbal consent from the participants. Thematic analysis was applied to identify themes and develop interpretations. FindingsBetween 1990 and 2016, the estimated tuberculosis incidence declined from 156 cases per 100 000 individuals to 86 cases per 100 000 individuals, and the number of tuberculosis deaths decreased from 178 515 to 40 120, in China. The tuberculosis incidence was projected to drop to 62 cases per 100 000 individuals, and the number of tuberculosis deaths to drop to 17 218 by 2030, both above the WHO 2030 targets of an 80% reduction in tuberculosis incidence (17 cases per 100 000 individuals) and a 90% reduction in the number of tuberculosis deaths (4130), compared with 2015. Of the four key informants, three said that many patients with tuberculosis, particularly multidrug-resistant tuberculosis, suffered from catastrophic payment for tuberculosis care. Qualitative interviews also revealed several key health system challenges in the access to high quality and affordable tuberculosis care, including: (1) insufficient funding and workforce for tuberculosis control; (2) difficulty in scaling up new tuberculosis and multidrug-resistant tuberculosis diagnostic tools; (3) inefficient cooperation across anti-tuberculosis health facilities; and (4) inconsistency among health insurance policies, public hospital reforms, and tuberculosis control strategies. InterpretationChina cannot meet the End TB Strategy targets by 2030, unless synergistic tuberculosis control policies and strategies can be developed and implemented, and multi-sector cooperation can be improved to enhance the delivery of tuberculosis care. FundingThe Bill & Melinda Gates Foundation (grant number OOP1148464).