Since 1978 when it embarked on sweeping agricultural and industrial reforms, China's economic growth has been remarkable. Its success in transforming itself within just three decades from a very poor low-income country to a successful middle-income country is unparalleled. During this period, however, and in contrast to the first 30 years of the People's Republic, progress in the health sector has been disappointing. For example, during the period 1980-2007, China increased its income per head as a percentage of the OECD average from 3 percent to 15 per cent, but infant mortality fell no faste.

This volume provides a comprehensive review of China's healthcare system and policy reforms in the context of the global economy. Following a value-chain framework, the 16 chapters cover the payers, the providers, and the producers (manufacturers) in China's system. It also provides a detailed analysis of the historical development of China's healthcare system, the current state of its broad reforms, and the uneasy balance between China's market-driven approach and governmental regulation. Most importantly, it devotes considerable attention to the major problems confronting China, including chronic illness, public health, and long-term care and economic security for the elderly. Burns and Liu have assembled the latest research from leading health economists and political scientists, as well as senior public health officials and corporate executives, making this book an essential read for industry professionals, policymakers, researchers, and students studying comparative health systems across the world.

Although China’s new healthcare reform, launched in 2009, has achieved remarkable results in improving China’s medical and healthcare system, it is recognised that there is still room for further improvement. This is especially important as China’s population ages, the prevalence of chronic diseases increases and environment-related health risks worsen. This book reports on a major international research project which examined health trends, modes of health promotion, health finance systems, medical and healthcare innovations and environment-related health risks in China. For each of these key areas, the book considers the current situation in China and likely future trends, explores best practice from a wide range of foreign countries and puts forward proposals for improvements. Overall, the book provides a major assessment of China’s medical and healthcare system and how it should be reformed.

Especially since the 2003 SARS crisis, China’s healthcare system has become a growing source of concern, both for citizens and the Chinese government. China’s once praised public health services have deteriorated into a system driven by economic constraints, in which poor people often fail to get access, and middle-income households risk to be dragged into poverty by the rising costs of care. The New Rural Co-operative Medical System (NRCMS) was introduced to counter these tendencies and constitutes the main system of public health insurance in China today. This book outlines the nature of the system, traces the processes of its enactment and implementation, and discusses its strengths and weaknesses. It argues that the contested nature of the fields of health policy and social security has long been overlooked, and reinterprets the NRCMS as a compromise between opposing political interests. Furthermore, it argues that structural institutional misfits facilitate fiscal imbalances and a culture of non-compliance in local health policy, which distort the outcomes of the implementation and limit the effectiveness of insurance. These dynamics also raise fundamental questions regarding the effectiveness of other areas of the comprehensive New Health Reform, which China has initiated to overhaul its healthcare system.

China's New Rural Cooperative Medical Scheme (NCMS) aims to provide health insurance to 800 million rural citizens and correct distortions in rural Chinese health care. However, many questions about its impact on individuals and rural health care providers remain unanswered. The overall goal of this dissertation is to study the implementation of NCMS and its impact on all of the actors in China's rural health sector. To achieve my overall goal, I have four specific objectives, each pursued in the essays herein. The first objective is to determine the extent to which NCMS has been implemented in China's village households, and to examine the some of its strengths and weaknesses. The second is to measure the impact of NCMS and it's policy attributes on the most frequently visited primary health care providers in China: village clinics. My third objective is to examine the unique role of village clinics providing care and welfare benefits to the elderly, benefits that may be at risk under NCMS. Fourth, I measure the impact of NCMS and policy attributes on Township Health Centers (THCs), the main NCMS partner health facilities. Finally, in an appendix chapter, I place the recent health care reforms into a broader context of shifting public policy in China, and speculate on the potential implications of this policy shift. To achieve my objectives, I use a nationally representative set of panel data collected in 100 villages drawn from 5 provinces in China. Detailed modules for each of the major actors - including individuals and their specific illness episodes, the clinics and hospitals they visit, and the county-level public health offices that cover them - allow me to paint a nuanced picture of China's rural health system in transition. I find that NCMS has reduced out of pocket medical spending and yielded meaningful reductions in household risk. However, current versions are not adequately meeting participants' need (and desire) for catastrophic illness coverage. Evidence suggests that better reimbursement rates may increase the important benefits the program has had for THC finances. The program must also be better calibrated to support village clinics through efficient outpatient reimbursement and subsidies to offset additional work requirements. This is particularly important given the unique welfare role played by clinicians in village communities.

How efficient is the Chinese healthcare system? Milcent examines the medication market in China against the global picture of healthcare organization, and how public healthcare insurance plans have been implemented in recent years, as well as reforms to tackle hospital inefficiency. Healthcare reforms, demographic changes and an increase in wealth inequity have altered healthcare preferences, which need to be addressed. Significantly, the patient–medical staff relationship is analysed, with new proposals for different lines of communication. Milcent puts forward digital healthcare in China as a tool to solve inefficiency and rising tensions, and generate profit. Where China is leading in the digitalization of healthcare, other countries can learn important lessons. Chinese social models are also put into context with respect to current reforms and experimentation.

The report recommends that China maintain the goal and direction of its healthcare reform, and continue the shift from its current hospital-centric model that rewards volume and sales, to one that is centered on primary care, focused on improving the quality of basic health services, and delivers high-quality, cost-effective health services. With 20 commissioned background studies, more than 30 case studies, visits to 21 provinces in China, the report proposes practical, concrete steps toward a value-based integrated service model of healthcare financing and delivery, including: 1) Creating a new model of people-centered quality integrated health care that strengthens primary care as the core of the health system. This new care model is organized around the health needs of individuals and families and is integrated with higher level care and social services. 2) Continuously improve health care quality, establish an effective coordination mechanism, and actively engage all stakeholders and professional bodies to oversee improvements in quality and performance. 3) Empowering patients with knowledge and understanding of health services, so that there is more trust in the system and patients are actively engaged in their healthcare decisions. 4) Reforming public hospitals, so that they focus on complicated cases and delegate routine care to primary-care providers. 5) Changing incentives for providers, so they are rewarded for good patient health outcomes instead of the number of medical procedures used or drugs sold. 6) Boosting the status of the health workforce, especially primary-care providers, so they are better paid and supported to ensure a competent health workforce aligned with the new delivery system. 7) Allowing qualified private health providers to deliver cost-effective services and compete on a level playing field with the public sector, with the right regulatory oversight, and 8) Prioritizing public investments according to the burden of disease, where people live, and the kind of care people need on a daily basis.