The Health Care System

by

Jiwei Qian

• LAST REVIEWED: 14 October 2020
• LAST MODIFIED: 23 June 2021
• DOI: 10.1093/obo/9780199920082-0133

Introduction

According to the World Health Organization, a health-care system is defined as “the sum total of all the organizations, institutions and resources whose primary purpose is to improve health.” This article provides a selected bibliography for the health-care system in China. While the health-care system of contemporary China has been established since 1949, this article mainly focuses on research on the health-care system in the era after the 1980s. In particular, many of the studies cited in this article were published after the recent round of health reform in 2009. Health-care system is a broad category and the following major topics are selected. First, how the health-care system is financed (i.e., health-care financing) and production of health care is organized (i.e., health service delivery) are the key components of the health-care system. Second, pharmaceutical policy plays a significant role in both health financing and service delivery. Third, the recent round of health reform in 2009 has shifted the organizational, financial, and institutional organization in the Chinese health-care system. This article also includes major studies on the 2009 health reform. Fourth, health-care systems in different countries have country-specific institutional arrangements but also have similar policy goals, including affordability of health-care services and health equity. Given this, the article cites works comparing health-care systems in other countries with the Chinese health-care system. Fifth, for a transition economy such as China, increasing health inequality in the process of marketization is a critical issue. Sixth, public health is considered as a part of the health-care system in this article for two reasons. Many public health issues such as tobacco control have significant impacts over personal health services. Also, a significant amount of government’s financial and institutional resources in health care are allocated for public health. The experiences of the COVID-19 pandemic in China support both points above. Seventh, the role of the regulatory system and political institutions is critical for implementing health policies and initiating health reform. Eighth, we also select works studying the interaction between the health-care system and the socioeconomic changes in China, including urbanization, demographic changes, poverty reduction, and so on. Ninth, useful resources for researchers, including journals, data sources, and reference works, are covered.

General Overviews

There are a number of studies focusing on the institutional arrangements of the Chinese health-care system. Hsiao 2014 discusses the evolution of the Chinese health-care system since 1978, and major policy changes are covered. Eggleston 2012 reviews major components of the Chinese health-care system. Qian and Blomqvist 2014 discusses the health policy reform since 2009 and compares these reforms with international experiences and other social policy reform in China. World Bank and World Health Organization 2019 reviews the 2009 health reform and provide the outlook for the Chinese health system. Zheng 2008 reviews the Chinese health-care system between the 1980s and the early 2000s in the process of marketization. Wagstaff, et al. 2009 gives a comprehensive review of the rural health-care system in China. Given these institutional arrangements, some studies evaluate quantitative performance of the health-care system. Meng, et al. 2012 evaluates changes of performance of the health-care system after the recent round of health reform. Liu, et al. 2008 gives a quantitative measurement for the performance of the health-care system with various indexes. Yang, et al. 2013 provides a general picture of the health condition in China via assessing the disease burdens.

• Eggleston, Karen. “Health Care for 1.3 Billion: China’s Remarkable Work in Progress.” Milken Institute Review 2 (2012): 16–27.

  A brief overview about the evolution of the health-care system, including demographic transition and organization of health service delivery. The recent round of health reform and some relevant literature are also discussed in the paper.

• Hsiao, William. “Correcting Past Health Policy Mistakes.” Daedalus 143.2 (2014): 53–68.

  DOI: 10.1162/DAED_a_00272

  This work discusses the Chinese health-care system since 2000s. Service providers’ motivation to generate profit is identified as the major determinant for high health expenditure in China.

• Liu, Yuanli, Keqin Rao, Jing Wu, and Emmanuela Gakidou. “China’s Health System Performance.” Lancet 372 (2008): 1914–1923.

  DOI: 10.1016/S0140-6736(08)61362-8

  Compiles some quantitative indexes to measure the performance of different aspects of the Chinese health-care system, including public health, health financing, and health-care delivery.

• Meng, Qun, Ling Xu, Yaoguang Zhang, et al. “Trends in Access to Health Services and Financial Protection in China between 2003 and 2011: A Cross-Sectional Study.” Lancet 379 (2012): 805–814.

  DOI: 10.1016/S0140-6736(12)60278-5

  Evaluates changes in the health-care system performance between 2003 and 2011. By using the National Health Service survey, the authors report a substantial increase in insurance coverage and inpatient reimbursement. Utilization and equity of access to health-care service are improved significantly too. However, the large financial burden for patients is to be addressed.

• Qian, Jiwei, and Åke Blomqvist. Health Policy Reform in China: A Comparative Perspective. Singapore: World Scientific, 2014.

  DOI: 10.1142/8607

  Apart from reviewing the evolution of the health-care system in China, this book compares the Chinese health-care system with a number of health-care systems in developed countries. Also, this book compares the health reform with other social policy reforms in China to reveal the role of political and economic institutions in health reform.

• Wagstaff, Adam, Magnus Lindelow, Shiyong Wang, and Shuo Zhang. Reforming China’s Rural Health System. Washington, DC: World Bank, 2009.

  DOI: 10.1596/978-0-8213-7982-0

  A comprehensive review of the rural health-care system including health financing, health-care service delivery, and public health in rural China. Also, the authors provide a vision of the future rural health-care system.

• World Bank and World Health Organization. Healthy China: Deepening Health Reform in China; Building High-Quality and Value-Based Service Delivery. World Bank Publications. Washington, DC: World Bank, 2019.

  DOI: 10.1596/978-1-4648-1263-7

  Provides a comprehensive review of the recent round of health reform in China. The report also provides a glimpse of the future Chinese health system and what kind of challenges should be addressed.

• Yang, Gonghuan, Yu Wang, Yixin Zeng, et al. “Rapid Health Transition in China, 1990–2010: Findings from the Global Burden of Disease Study 2010.” Lancet 381 (2013): 1987–2015.

  DOI: 10.1016/S0140-6736(13)61097-1

  Provides a comprehensive assessment of disease burden in China between 1990 and 2010. The paper concludes that the urbanization, increasing incomes, and aging in China lead to a rapid rise of non-communicable diseases and chronic disabilities.

• Zheng Gongcheng 郑功成. Zhongguo shehui baozhang 30 nian中国社会保障 30 年. Beijing: Renmin Chubanshe, 2008.

  Reviews the evolution of the health-care system in the context of social policy reform in China between 1978 and 2007. Other social programs are also discussed in this book.