What is the state of health in China?

China's health care situation has made remarkable progress over the past few decades, with a medical and health care system that covers the entire population, combines prevention and treatment, and emphasizes both traditional Chinese and Western medicine, basically realizing the principle of “treatment for the sick” (“Sickness is treated by a doctor”). The basic goal of “providing medical care for all” has basically been realized. Despite challenges such as regional disparities and cost pressures, the overall level of care has continued to improve through policy support, technological innovation and international cooperation. The following is a comprehensive analysis of the core progress, areas of strength, existing challenges and future directions:

Core Progress: Universal Coverage and Basic Capacity Enhancement

1. Largest medical insurance network in the world

China has built the world's most populous basic medical insurance system, with more than 95% of residents covered (2023 data):

. Basic medical insurance: Employee medical insurance (covering employees in enterprises/institutions) and urban and rural residents' medical insurance (covering the unemployed, rural and urban non-working residents) constitute the main body of the system, with more than 1.36 billion participants in 2023.

. Major Disease Insurance: secondary reimbursement for high-cost medical care, with a starting line of about 50% of the per capita disposable income of local residents, and a reimbursement rate of no less than 60%; .

. Medical assistance: for low-income insurance recipients, special hardship cases and other groups in difficulty, providing subsidies for enrollment, outpatient and hospitalization expenses (the proportion of assistance in some areas reaches 70-90%), effectively preventing “poverty caused by illness and returning to poverty due to illness”. The Government has also been working to improve the quality of health care services.

2. Improvement of the grass-roots medical service network

Based on the “county - township - village” three-tier network, grassroots medical and health institutions (community health service centers, township health centers, village health clinics) to become the residents of the “health gatekeeper”:

. Number and coverage: There are approximately 980,000 primary healthcare facilities nationwide (by 2023), accessible within 15 minutes' walk in urban areas and 30 minutes' drive in rural areas.

. Service capacity: 90% of primary care centers can provide treatment for more than 200 common diseases, and the standardized management rate of hypertension and diabetes patients exceeds 70%.

. Policy favoritism: the salaries, training, and investment in equipment for primary care doctors have continued to increase (e.g., the “rural-employed-village-employed” system), promoting the idea that “minor illnesses can be treated at the primary care level”.

3. Breakthroughs in medical technology and specialized capabilities

China's medical technology has reached international advanced levels in some areas, especially in the fields of difficult and serious diseases, traditional Chinese medicine, and public health:

. Diagnosis and treatment of difficult and serious diseases: top hospitals such as Peking Union Medical College Hospital (difficult diseases), Shanghai Ruijin Hospital (blood diseases), and Sun Yat-sen University Cancer Hospital (cancer) are leading the world in the fields of precision tumor treatment, organ transplantation (the annual volume of liver transplants is the largest in the world), and cardiovascular and cerebrovascular interventional surgery.

. Specialties of Chinese medicine: Acupuncture, Tuina, Chinese medicine, etc. have been included in the International Classification of Diseases (ICD-11) by WHO; Chinese medicinal preparations (e.g. Lianhua Qingdian, Xuesetong) play an important role in the management of chronic diseases and the prevention and control of epidemics.

. Public Health Emergency Response: Relying on the world's largest infectious disease surveillance network (covering 100,000 medical institutions) and nucleic acid testing capacity (single-tube testing capacity of more than 80 million tubes / day), the new crown of the epidemic during the rapid control of the spread of the demonstration of the “level of emergency combination”. The rapid control of transmission during the Xin Guan epidemic demonstrated the strong resilience of the “combination of emergency” healthcare system.

Advantageous areas: unique highlights of China's medical care

1. “China's solution” that emphasizes both Chinese and Western medicine

Chinese medicine is one of the core strengths of China's healthcare, and has formed a whole chain service system of “prevention, treatment and rehabilitation”:

. Institutional coverage: There are more than 4,500 TCM hospitals nationwide (by 2023), 90% of general hospitals above the second level have TCM departments, and the coverage rate of grass-roots TCM centers has exceeded 90%.

. Recognition of therapeutic effects: Chinese medicine has significant advantages in the management of chronic diseases (such as hypertension, diabetes), sub-health care, and post-operative rehabilitation, reducing patients' dependence on chemical drugs; .

. Policy support: The Chinese Medicine Law specifies the policy of “giving equal importance to both Chinese and Western medicines”, and simplifies the approval of Chinese medicine (management of the catalog of classical prescriptions), and tilts the medical insurance (higher reimbursement rates for items such as Chinese herbal medicinal tablets, acupuncture, etc.). The approval of traditional Chinese medicine has been simplified (management of the catalog of classical prescriptions), and health insurance is favorable (higher reimbursement rates for traditional Chinese medicine tablets, acupuncture and moxibustion).

2. Improvement of the primary medical services network

Based on a three-tiered network of “county-village-village”, primary medical and health-care institutions (community health-care centers, township health centers, and village health clinics) have become the “health gatekeepers” of the population:

. Number and coverage: There are approximately 980,000 primary healthcare facilities nationwide (by 2023), accessible within 15 minutes' walk in urban areas and 30 minutes' drive in rural areas.

. Service capacity: 90% of primary care centers can provide treatment for more than 200 common diseases, and the standardized management rate of hypertension and diabetes patients exceeds 70%.

3. Breakthroughs in medical technology and specialized capabilities

China's medical technology has reached international advanced levels in some areas, especially in the fields of difficult and serious diseases, traditional Chinese medicine, and public health:

Advantageous areas: unique highlights of China's medical care

1. “China's solution” that emphasizes both Chinese and Western medicine

Chinese medicine is one of the core strengths of China's healthcare, and has formed a whole chain service system of “prevention, treatment and rehabilitation”:

. Recognition of therapeutic effects: Chinese medicine has significant advantages in the management of chronic diseases (such as hypertension, diabetes), sub-health conditioning, and post-operative rehabilitation, reducing patients' dependence on chemical drugs; .

2. “China's Speed” in Responding to Public Health Emergencies

China has demonstrated its ability to mobilize efficiently in the prevention and control of infectious diseases through the strategy of “prevention as the mainstay, combining prevention and treatment”:

. Monitoring and early warning: the national direct reporting system for infectious diseases (covering medical institutions above the county level) has realized the reporting of epidemics within three hours, and the monitoring coverage rate of influenza, new crowns and other infectious diseases will exceed 95% by 2023; .

. Emergency response: during the new crown epidemic, the Vulcan Mountain and Thunder Mountain hospitals will be built within 10 days, and the decisive results of the defense of Wuhan will be achieved in about three months; .

. Vaccine R&D: The speed of vaccine R&D for XK vaccine is the highest in the world (3 routes in parallel), with a total of over 3.4 billion doses, providing key support for the global fight against the epidemic.

3. Improvement of medical cost affordability

Through measures such as health insurance reform and drug collection, the personal burden of medical expenses in China has been significantly reduced:

. Wide coverage of medical insurance: the participation rate of basic medical insurance has stabilized at over 95 percent, and low-income groups have been able to “get all the coverage they need” through medical assistance.

. Collective mining to reduce drug prices: since 2018, the state has organized seven batches of drug collection (covering 294 types of drugs), with an average price reduction of more than 50% (e.g., cardiac stents were reduced from 13,000 yuan to 700 yuan, and the anticancer drug ositinib was reduced from 17,000 yuan per box to 5,300 yuan).

. Strong protection for major diseases: major disease insurance provides secondary reimbursement for high costs, and “one-stop” settlement in some areas reduces the pressure on patients to advance funds.

Existing challenges: imbalances and shortcomings in development

Despite significant progress, China's healthcare still faces the following structural challenges:

1. Uneven distribution of quality medical resources

. Regional disparities: High-quality hospitals (e.g., tertiary hospitals) are concentrated on the east coast (Beijing , Shanghai, Guangzhou ), while resources are scarce in central and western China and rural areas .

. Specialty gaps: Shortage of doctors in pediatrics, general practice, psychiatry, etc., making it difficult for grassroots organizations to provide high-quality specialty services; .

. Rural-urban gap: the level of medical equipment and talents in rural areas is lower than that in cities, and residents in some remote areas have to travel long distances to seek medical treatment.

2. The burden of medical costs still needs to be optimized

. Individual out-of-pocket expenses: In 2023, individual health expenditure will account for 18.8% of total health expenditure (average 18% in OECD countries), which is lower than that of some developed countries, but the out-of-pocket expenses for major diseases such as cancer and rare diseases may exceed the annual income of a family (e.g., a family with an annual income of 100,000 yuan will pay 100,000 yuan out-of-pocket for cancer treatment), resulting in “catastrophic healthcare expenditure” and “catastrophic medical expenditure”. resulting in “catastrophic medical expenditures”).

. Pressure on the health insurance fund: the aging population (over 290 million people over the age of 60) has led to an increase in expenditures, and in some areas there is a risk of “bottoming out”, which requires the adoption of the DRG/DIP payment reform (based on the “DIP” principle). DIP payment reform (payment by type of disease) is needed to control costs.

3. Doctor-patient relationship and service experience needs to be improved.

. Overcrowding in large hospitals: the average daily outpatient volume of tertiary hospitals exceeds 10,000 people, and the waiting time for patients is long (2-3 hours on average for some departments).

. Insufficient communication: some doctors have too many outpatient visits (50-100 patients per day), and the communication time with patients is short (5-10 minutes/person), which is easy to cause misunderstanding; .

. Differences in service quality: the service capacity of primary institutions is weak (e.g., pediatrics, emergency medicine), and patients prefer to choose higher-level hospitals, exacerbating the "difficulty in seeing a doctor.

4. International Recognition and Talent Mobility

. Limitations of international accreditation: The number of Chinese hospitals in international authoritative rankings (e.g., U.S. News & World Report's World's Best Hospitals) is relatively small (only five finalists in 2023), and international accreditation (e.g., JCI) coverage is limited; .

. Loss of high-end talents: some top medical talents choose to go overseas for further study or practice, which needs to be attracted back by optimizing the research environment and improving remuneration.

Future direction: from “quantity” to “quality” upgrade

China's healthcare is transforming from “extensive coverage” to “high quality”, and the core directions include:

1. Deepening medical reform and optimizing resource allocation .

Deepening medical reform and optimizing resource allocation Graded diagnosis and treatment: promoting the sinking of high-quality resources (e.g., the construction of “national medical centers” and “regional medical centers”), and upgrading the capacity of grassroots services; .

. Payment Reform: Promote DRG/DIP payment (payment per patient) to control unreasonable growth of medical costs; .

. Drugs and consumables: Expanding the scope of centralized procurement (e.g., biological drugs, proprietary Chinese medicines) to reduce inflated prices.

2. Strengthening the grassroots and promoting balanced development

. County Medical Community: Integrate county, township and village medical institutions within the county to realize resource sharing and unified management.

. Sinking of talents: Encouraging doctors to practice at the grassroots level through the system of “county-controlled and township-employed” and “township-employed and village-employed”.

. Telemedicine: Utilizing 5G and AI technologies to carry out remote diagnosis and surgical guidance to narrow the gap between urban and rural medical care.

3. Innovation-driven, upgrading technology

. Innovative drug R&D: Increase investment in R&D of domestically produced innovative drugs (e.g. PD-1 inhibitors, CAR-T cell therapies) and promote “going overseas”; .

. High-end devices: develop domestic surgical robots and high-end imaging equipment (e.g. 3.0T MRI) to reduce import dependence.

. Digital healthcare: Promote Internet hospitals and AI-assisted diagnosis (e.g. lung nodule screening) to enhance service efficiency.

4. Collaboration between Chinese and Western medicine, giving full play to the advantages of specialties

. Primary Chinese medicine services: promote appropriate Chinese medicine techniques (e.g. acupuncture, tuina) in community health centers and township health centers; .

. Combined Chinese and Western medicine treatment: formulate guidelines for combined Chinese and Western medicine treatment (e.g., for tumors and chronic diseases), and enhance the comprehensive efficacy of treatment.

. Upgrading of the TCM industry: Strengthening quality control of TCM (e.g., certification of herbs) and promoting the internationalization of TCM ($8.5 billion in TCM exports by 2022).

Summary

China's healthcare situation has moved from a lack of medical care and medicines to a situation where patients are provided with medical treatment and good solutions, and has demonstrated significant strengths in terms of universal coverage, emergency response capacity, and technological breakthroughs, making it the world's largest developing country's model for healthcare. Despite the challenges of uneven resources and cost pressure, with the advancement of the “Healthy China 2030” strategy (e.g., the construction of county medical communities and the expansion of high-quality resources), China's healthcare is gradually developing in the direction of being “fairer, more efficient, and smarter,” and contributing “China's solutions” to global health governance. Contribute to the “China Program” for global health governance.

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