1932

Abstract

China experienced both economic and epistemological transitions within the past few decades, greatly increasing demand for accessible and affordable health care. These shifts put significant pressure on the existing outdated, highly centralized bureaucratic system. Adjusting to growing demands, the government has pursued a new round of health reforms since the late 2000s; the main goals are to reform health care financing, essential drug policies, and public hospitals. Health care financing reform led to universal basic medical insurance, whereas the public hospital reform required more complex measures ranging from changes in regulatory, operational, and service delivery settings to personnel management. This article reviews these major policy changes and the literature-based evidence of the effects of reforms on cost, access, and quality of care. It then highlights the outlook for future reforms. We argue that a better understanding of the unintended consequences of reform policies and of how practitioners’ and patients’ interests can be better aligned is essential for reforms to succeed.

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2017-03-20
2024-10-06
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Literature Cited

  1. Allen P, Cao Q, Wang H. 1.  2014. Public hospital autonomy in China in an international context. Int. J. Health Plan. Manag. 29:141–59 [Google Scholar]
  2. Babiarz KS, Miller G, Yi H, Zhang L, Rozelle S. 2.  2012. China's new cooperative medical scheme improved finances of township health centers but not the number of patients served. Health Aff. 31:1065–74 [Google Scholar]
  3. Barber SL, Borowitz M, Bekedam H, Ma J. 3.  2014. The hospital of the future in China: China's reform of public hospitals and trends from industrialized countries. Health Policy Plan 29:367–78 [Google Scholar]
  4. Brown PH, Theoharides C. 4.  2009. Health-seeking behavior and hospital choice in China's New Cooperative Medical System. Health Econ 18:S47–64 [Google Scholar]
  5. Burns R, Liu GG. 5.  2016. China's Healthcare System and Reform Cambridge, UK: Cambridge Univ. Press [Google Scholar]
  6. Chen C, Dong WZ, Shen JJ, Cochran C, Wang Y, Hao M. 6.  2014. Is the prescribing behavior of Chinese physicians driven by financial incentives?. Soc. Sci. Med. 120:40–48 [Google Scholar]
  7. Chen G, Liu G, Xu F. 7.  2014. The impact of the urban resident basic medical insurance on health services utilisation in China. PharmacoEconomics 32277–92 [Google Scholar]
  8. Chen M, Wang L, Chen W, Zhang L, Jiang H, Mao W. 8.  2014. Does economic incentive matter for rational use of medicine? China's experience from the Essential Medicines program. PharmacoEconomics 32245–55 [Google Scholar]
  9. Chen MS, Fang GX, Wang LD, Wang ZH, Zhao YX, Si L. 9.  2015. Who benefits from government healthcare subsidies? An assessment of the equity of healthcare benefits distribution in China. PLOS ONE 10e0119840 [Google Scholar]
  10. Chen MS, Zhao YX, Si L. 10.  2014. Who pays for health care in China? The case of Heilongjiang province. PLOS ONE 9e108867 [Google Scholar]
  11. Chen Y, Jin GZ. 11.  2012. Does health insurance coverage lead to better health and educational outcomes? Evidence from rural China. J. Health Econ. 311–14 [Google Scholar]
  12. Cheng L, Liu H, Zhang Y, Shen K, Zeng Y. 12.  2015. The impact of health insurance on health outcomes and spending of the elderly: evidence from China's New Cooperative Medical Scheme. Health Econ 24672–91 [Google Scholar]
  13. Cheng L, Zhang Y. 13.  2012. The New Rural Cooperative Medical Scheme: financial protection or health improvement?. Econ. Res. J. 1120–33 (In Chinese) [Google Scholar]
  14. 14. Communist Party China Cent. Comm., State Counc 2009. Guidelines for deepening the reform of health care system. Xinhua April 6. http://www.gov.cn/jrzg/2009-04/06/content_1278721.htm [Google Scholar]
  15. Deng GY, Dou CB, Gong QL. 15.  2013. Medical institution ownership, medical expenditure and service quality. Econ. Rev. 1120–29 (In Chinese) [Google Scholar]
  16. Eggleston K, Li L, Meng Q, Lindelow M, Wagstaff A. 16.  2008. Health service delivery in China: a literature review. Health Econ 17:149–65 [Google Scholar]
  17. Eggleston K, Shen Y-C, Lau J, Schmid CH, Chan J. 17.  2008. Hospital ownership and quality of care: What explains the different results in the literature?. Health Econ 17:1345–62 [Google Scholar]
  18. Fan M, Liu GG, Li L. 18.  2013. Effect of medical institutions ownership on medical expenditures: an empirical analysis based on nine cities across the country. China Econ. Q. 5:59–69 (In Chinese) [Google Scholar]
  19. Fang Y, Wagner AK, Yang S, Jiang M, Zhang F, Ross-Degnan D. 19.  2013. Access to affordable medicines after health reform: evidence from two cross-sectional surveys in Shaanxi province, western China. Lancet Global Health 1:e227–37 [Google Scholar]
  20. Feng J, Liu F, Chen Q. 20.  2010. Impact of New Cooperative Medical System on health care price. Econ. Res. J. 11:127–40 (In Chinese) [Google Scholar]
  21. Gao C, Xu F, Liu GG. 21.  2014. Payment reform and changes in health care in China. Soc. Sci. Med. 111:10–16 [Google Scholar]
  22. Guan H, Liu GG, Xiong X. 22.  2013. Impact of urban resident basic medical insurance on equity of hospitalized service utilization. Chin. Health Econ. 1:42–44 (In Chinese) [Google Scholar]
  23. Guan X, Liang H, Xue Y, Shi L. 23.  2011. An analysis of China's National Essential Medicines policy. J. Public Health Policy 32:305–19 [Google Scholar]
  24. Hou ZY, Van de Poel E, Van Doorslaer E, Yu BR, Meng QY. 24.  2014. Effects of NCMS on access to care and financial protection in China. Health Econ 23:917–34 [Google Scholar]
  25. Huang F, Gan L. 25.  2010. Excess demand or appropriate demand? Health insurance, medical care and mortality of the elderly in urban China. Econ. Res. J. 6105–19 (In Chinese) [Google Scholar]
  26. Huang F, Gan L. 26.  2015. The impacts of China's urban employee basic medical insurance on healthcare expenditures and health outcomes. Health Econ doi: 10.1002/hec.3281 [Google Scholar]
  27. Huang F, Wu C. 27.  2009. Estimating the effects of public health insurance on mortality of the elderly in urban China. Nankai Econ. Stud. 6126–37 (In Chinese) [Google Scholar]
  28. Huang X. 28.  2014. Expansion of Chinese social health insurance: Who gets what, when and how?. J. Contemp. China 23:923–51 [Google Scholar]
  29. Jian W, Lu M, Chan KY, Poon AN, Han W. 29.  et al. 2015. Payment reform pilot in Beijing hospitals reduced expenditures and out-of-pocket payments per admission. Health Aff. 341745–52 [Google Scholar]
  30. Jian WY, Chan KY, Reidpath DD, Xu L. 30.  2010. China's rural-urban care gap shrank for chronic disease patients, but inequalities persist. Health Aff 29:2189–96 [Google Scholar]
  31. Jiang MH, Yang SM, Yan KK, Liu J, Zhao J, Fang Y. 31.  2013. Measuring access to medicines: a survey of prices, availability and affordability in Shaanxi province of China. PLOS ONE 8e70836 [Google Scholar]
  32. Jiang MH, Zhou ZL, Wu L, Shen Q, Lv B. 32.  et al. 2015. Medicine prices, availability, and affordability in the Shaanxi province in China: implications for the future. Int. J. Clin. Pharm. 3712–17 [Google Scholar]
  33. Lan X, Liu GG, Li L. 33.  2014. The impact of ownership on the quality of medical services: empirical analysis based on the micro data from China's pilot cities. China Econ. Stud. 267–78 (In Chinese) [Google Scholar]
  34. Li X, Zhang W. 34.  2013. The impacts of health insurance on health care utilization among the older people in China. Soc. Sci. Med. 8559–65 [Google Scholar]
  35. Liu GG, Cai C, Li L. 35.  2011. Medical insurance and medical care demand for the elderly in China. Econ. Res. J. 395–107 (In Chinese) [Google Scholar]
  36. Liu GG, Krumholz S. 36.  2014. Economics of health transitions in China. The Oxford Companion to the Economics of China S Fan, R Kanbur, S-J Wei, X Zhang 449–55 Oxford, UK: Oxford Univ. Press [Google Scholar]
  37. Liu GG, Li L, Hou X, Xu J, Hyslop D. 37.  2009. The role of for-profit hospitals in medical expenditures: evidence from aggregate data in China. China Econ. Rev. 20:625–33 [Google Scholar]
  38. Liu H, Zhao Z. 38.  2014. Does health insurance matter? Evidence from China's urban resident basic medical insurance. J. Comp. Econ. 421007–20 [Google Scholar]
  39. Liu K. 39.  2016. Insuring against health shocks: health insurance and household choices. J. Health Econ. 46:16–32 [Google Scholar]
  40. Liu K, Wu QB, Liu JQ. 40.  2014. Examining the association between social health insurance participation and patients’ out-of-pocket payments in China: the role of institutional arrangement. Soc. Sci. Med. 113:95–103 [Google Scholar]
  41. Liu XT, Wong H, Liu K. 41.  2016. Outcome-based health equity across different social health insurance schemes for the elderly in China. BMC Health Serv. Res. 16:9 [Google Scholar]
  42. Meng D, Zhang B, Wang Y. 42.  2009. The impact of New Rural Cooperative Medical Insurance on healthcare utilization: the example of Jiangsu. Econ. Rev. 369–76 (In Chinese) [Google Scholar]
  43. 43. Natl. Health Family Plan. Comm 2014. Guiding opinions on further improving the remote medical billing of the basic medical insurance Nov. 18. http://www.mohrss.gov.cn/SYrlzyhshbzb/ldbk/shehuibaozhang/yiliao/201412/t20141224_147142.htm [Google Scholar]
  44. 44. Natl. Health Family Plan. Comm 2015. Notice on promoting the national new rural cooperative medical information platform Health Lett. Oct. 26. http://www.nhfpc.gov.cn/jws/s3581sg/201510/c9cd0cb2af624c67b1ca4e4e192d2acd.shtml [Google Scholar]
  45. 45. Natl. Health Family Plan. Comm 2015. Opinions to promote and regulate the practice of multi-site practitioners. Natl. Health Med. No. 86. http://www.nhfpc.gov.cn/yzygj/s3577/201501/8663861edc7d40db91810ebf0ab996df.shtml [Google Scholar]
  46. 46. Off. State Counc 2009. Administration of National Essential Medicines List Pres. Decree 45, Sept. 1. http://www.moh.gov.cn/zwgkzt/pfl/200909/42684.shtml [Google Scholar]
  47. 47. Off. State Counc 2015. Opinion on the full implementation of urban and rural resident catastrophic illness insurance State Counc. No. 57, Aug. 2. http://www.gov.cn/zhengce/content/2015-08/02/content_10041.htm [Google Scholar]
  48. 48. Off. State Counc 2016. Opinion on the integration of urban and rural resident health insurance Jan. 12. http://www.gov.cn/zhengce/content/2016-01/12/content_10582.htm [Google Scholar]
  49. Pan J, Lei X, Liu GG. 49.  2015. Health insurance and health status: exploring the causal effect from a policy intervention. Health Econ 25:1389–402 [Google Scholar]
  50. Pan J, Liu D, Ali S. 50.  2015. Patient dissatisfaction in China: What matters. Soc. Sci. Med. 143:145–53 [Google Scholar]
  51. Pan J, Liu GG, Gao C. 51.  2013. How does separating government regulatory and operational control of public hospitals matter to healthcare supply?. China Econ. Rev. 27:1–14 [Google Scholar]
  52. Pan J, Pan X, Liu GG. 52.  2013. Does health insurance lead to better health?. Econ. Res. J. 4:130–42 (In Chinese) [Google Scholar]
  53. Pan J, Qin XZ, Li Q, Messina JP, Delamater PL. 53.  2015. Does hospital competition improve health care delivery in China?. China Econ. Rev. 33:179–99 [Google Scholar]
  54. Pan J, Tian S, Zhou Q, Han W. 54.  2016. Benefit distribution of social health insurance: evidence from China's Urban Resident Basic Medical Insurance. Health Policy Plan 31:853–59 [Google Scholar]
  55. Pan X, Dib HH, Zhu M, Zhang Y, Fan Y. 55.  2009. Absence of appropriate hospitalization cost control for patients with medical insurance: a comparative analysis study. Health Econ 18:1146–62 [Google Scholar]
  56. Porter ME, Teisberg E. 56.  2007. How physicians can change the future of health care. J. Am. Med. Assoc. 297:1103–11 [Google Scholar]
  57. Powell-Jackson T, Yip W, Han W. 57.  2015. Realigning demand and supply side incentives to improve primary care seeking in rural China. Health Econ 24:755–72 [Google Scholar]
  58. Ratigan K. 58.  2015. Too little, but not too late? Health reform in rural China and the limits of experimentalism. J. Asian Public Policy 8:69–87 [Google Scholar]
  59. Shi L, Yang H, Cheng G, Meng Q. 59.  2014. Time trends and determinants of pharmaceutical expenditure in China (1990–2009). PharmacoEconomics 32257–64 [Google Scholar]
  60. Shi LY, Lee DC, Liang HL, Zhang LW, Makinen M. 60.  et al. 2015. Community health centers and primary care access and quality for chronically-ill patients—a case-comparison study of urban Guangdong province, China. Int. J. Equity Health 14:Art. 90 [Google Scholar]
  61. Song Y, Bian Y, Petzold M, Li LG, Yin AT. 61.  2014. The impact of China's National Essential Medicine Systems on improving rational drug use in primary health care facilities: an empirical study in four provinces. BMC Health Serv. Res. 14:507 [Google Scholar]
  62. Sun X, Jackson S, Carmichael G, Sleigh AC. 62.  2009. Catastrophic medical payment and financial protection in rural China: evidence from the New Cooperative Medical Scheme in Shandong province. Health Econ 18:103–19 [Google Scholar]
  63. Sun X, Liu X, Sun Q, Yip W, Wagstaff A, Meng Q. 63.  2016. The impact of a pay-for-performance scheme on prescription quality in rural China. Health Econ 25:706–22 [Google Scholar]
  64. Tan J, Liu GG, Wu H, Zhao S, Xia J. 64.  2012. Analysis of the outcomes of multi-spot medical practice trial in Kunming. Chin. J. Hosp. Adm. 28:241–45 (In Chinese) [Google Scholar]
  65. Tian X, Song Y, Zhang X. 65.  2012. National Essential Medicines list and policy practice: a case study of China's health care reform. BMC Health Serv. Res. 12:401 [Google Scholar]
  66. Wagstaff A, Lindelow M, Jun G, Ling X, Juncheng Q. 66.  2009. Extending health insurance to the rural population: an impact evaluation of China's new cooperative medical scheme. J. Health Econ. 28:1–19 [Google Scholar]
  67. Wagstaff A, Yip W, Lindelow M, Hsiao W. 67.  2009. China's health system and its reform: a review of recent studies. Health Econ 18:S7–23 [Google Scholar]
  68. Wang H, Liu Y, Zhu Y, Xue L, Dale M. 68.  et al. 2012. Health insurance benefit design and healthcare utilization in northern rural China. PLOS ONE 7e50395 [Google Scholar]
  69. Wang H, Zhang L, Yip W, Hsiao W. 69.  2011. An experiment in payment reform for doctors in rural China reduced some unnecessary care but did not lower total costs. Health Aff. 30:2427–36 [Google Scholar]
  70. Wang J, Chen L, Ye T, Zhang Z, Ma J. 70.  2014. Financial protection effects of modification of China's New Cooperative Medical Scheme on rural households with chronic diseases. BMC Health Serv. Res. 14:305 [Google Scholar]
  71. Wang S, Liu LH, Li L, Liu JC. 71.  2014. Comparison of Chinese inpatients with different types of medical insurance before and after the 2009 healthcare reform. BMC Health Serv. Res. 14: 443 [Google Scholar]
  72. 72. World Bank 2010. Fixing the Public Hospital System in China China Health Policy Note No. 2 Washington, DC: World Bank [Google Scholar]
  73. Xiao YH, Zhang J, Zheng BW, Zhao L, Li SJ, Li LJ. 73.  2013. Changes in Chinese policies to promote the rational use of antibiotics. PLOS Med 10e1001556 [Google Scholar]
  74. Xu J, Liu G, Deng G, Li L, Xiong X, Basu K. 74.  2015. A comparison of outpatient healthcare expenditures between public and private medical institutions in urban China: an instrumental variable approach. Health Econ 24:270–79 [Google Scholar]
  75. Xu S, Bian C, Wang H, Li N, Wu J. 75.  et al. 2015. Evaluation of the implementation outcomes of the Essential Medicines System in Anhui county-level public hospitals: a before-and-after study. BMC Health Serv. Res. 15:403 [Google Scholar]
  76. Yang G, Kong L, Zhao W, Wan X, Zhai Y. 76.  et al. 2008. Emergence of chronic non-communicable diseases in China. Lancet 372:1697–705 [Google Scholar]
  77. Yang GH, Wang Y, Zeng YX, Gao GF, Liang XF. 77.  et al. 2013. Rapid health transition in China, 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet 381:1987–2015 [Google Scholar]
  78. Yang L, Cui Y, Guo SF, Brant P, Li B, Hipgrave D. 78.  2013. Evaluation, in three provinces, of the introduction and impact of China's National Essential Medicines Scheme. Bull. World Health Organ. 91:184–94 [Google Scholar]
  79. Yang LP, Liu CJ, Ferrier JA, Zhou W, Zhang XP. 79.  2013. The impact of the National Essential Medicines Policy on prescribing behaviours in primary care facilities in Hubei province of China. Health Policy Plan 28:750–60 [Google Scholar]
  80. Yao Q, Liu CJ, Ferrier JA, Liu ZY, Sun J. 80.  2015. Urban-rural inequality regarding drug prescriptions in primary care facilities—a pre-post comparison of the National Essential Medicines Scheme of China. Int. J. Equity Health 1458 [Google Scholar]
  81. Yi H, Zhang L, Singer K, Rozelle S, Atlas S. 81.  2009. Health insurance and catastrophic illness: a report on the New Cooperative Medical System in rural China. Health Econ 18Suppl. 2S119–27 [Google Scholar]
  82. Yi HM, Miller G, Zhang LX, Li SP, Rozelle S. 82.  2015. Intended and unintended consequences of China's zero markup drug policy. Health Aff 34:1391–98 [Google Scholar]
  83. Yip W, Eggleston K. 83.  2001. Provider payment reform in China: the case of hospital reimbursement in Hainan province. Health Econ 10:325–39 [Google Scholar]
  84. Yip W, Hsiao W. 84.  2009. China's health care reform: a tentative assessment. China Econ. Rev. 20:613–19 [Google Scholar]
  85. Yip W, Hsiao W. 85.  2014. Harnessing the privatisation of China's fragmented health-care delivery. Lancet 384:805–18 [Google Scholar]
  86. Yip W, Powell-Jackson T, Chen W, Hu M, Fe E. 86.  et al. 2014. Capitation combined with pay-for-performance improves antibiotic prescribing practices in rural China. Health Aff 33:502–10 [Google Scholar]
  87. Yip WC-M, Hsiao WC, Chen W, Hu S, Ma J, Maynard A. 87.  2012. Early appraisal of China's huge and complex health-care reforms. Lancet 379:833–42 [Google Scholar]
  88. Yu D. 88.  2015. Does basic medical insurance for urban residents raise medical service utilization? An empirical evaluation of system running effect. J. Financ. Econ. 5:117–28 (In Chinese) [Google Scholar]
  89. Zhang C, Lei X, Strauss J, Zhao Y. 89.  2016. Health insurance and health care among the mid-aged and older Chinese: evidence from the National Baseline Survey of CHARLS. Health Econ doi: 10.1002/hec.3322 [Google Scholar]
  90. Zhang H, Hu HM, Wu C, Yu H, Dong HJ. 90.  2015. Impact of China's public hospital reform on healthcare expenditures and utilization: a case study in ZJ province. PLOS ONE 10e0143130 [Google Scholar]
  91. Zhang W-Y, Li Y-R, Li Y-J, Li X-Q, Zhao W-G, Lu R-Z. 91.  2015. A cross-sectional analysis of prescription and stakeholder surveys following Essential Medicine reform in Guangdong province, China. BMC Health Serv. Res. 1598 [Google Scholar]
  92. Zhang X, Wu Q, Liu G, Li Y, Gao L. 92.  et al. 2014. The effect of the National Essential Medicines Policy on health expenditures and service delivery in Chinese township health centres: evidence from a longitudinal study. BMJ Open 4: e006471 [Google Scholar]
  93. Zhang Y, Ma Q, Chen Y, Gao H. 93.  2016. Effects of public hospital reform on inpatient expenditures in rural China. Health Econ doi: 10.1002/hec.3320 [Google Scholar]
  94. Zhao S, Zang W, Fu S, Liu GG. 94.  2013. Health of the uninsured under mandatory medical insurance system. Econ. Res. J. 7118–31 (In Chinese) [Google Scholar]
  95. Zhong H. 95.  2011. Effect of patient reimbursement method on health-care utilization: evidence from China. Health Econ 20:1312–29 [Google Scholar]
  96. Zhou Q. 96.  2014. Health shock: What did current health insurance system do. Econ. Rev. 678–90 (In Chinese) [Google Scholar]
  97. Zhou Q, Liu GG. 97.  2016. The difference of benefits from health insurance: based on the study of the local population and migrants. Nankai Econ. Stud. 177–94 (In Chinese) [Google Scholar]
  98. Zhou Q, Liu GG, Sun Y, Vortherms SA. 98.  2016. The impact of health insurance cost-sharing method on healthcare utilization in China. China J. Soc. Work 938–61 [Google Scholar]
  99. Zhou Z, Zhou Z, Gao J, Yang X, Yan J. 99.  et al. 2014. The effect of urban basic medical insurance on health service utilisation in Shaanxi province, China: a comparison of two schemes. PLOS ONE 9e94909 [Google Scholar]
  100. Zuo CV. 100.  2015. Promoting city leaders: the structure of political incentives in China. China Q. 224:955–84 [Google Scholar]
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