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People's Republic of China Health System Review

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People's Republic of China Health System Review Health Sy Health Systems in Transition Vol. 5 No. 7 2015 s t ems in T r ansition V ol. 5 No. 7 2015 People’s Republic of China Health System Review The Asia Pacific Observatory on Health Systems and Policies (the APO) is a collaborative partnership of interested governments, international agencies, People’s Republic of China Health System Review foundations, and researchers that promotes evidence-informed health systems policy regionally and in all countries in the Asia Pacific region. The APO collaboratively identifies priority health system issues across the Asia Pacific region; develops and synthesizes relevant research to support and inform countries' evidence-based policy development; and builds country and regional health systems research and evidence-informed policy capacity. OF THE C PHIL LI IP B P U IN P E E S R D* * E H P T F LI L LO U R OP A EAT S P R SALUBRITA A T E M OF H ENT Health Systems in Transition Vol. 5 No. 7 2015 People’s Republic of China Health System Review Written by: MENG Qingyue, China Center for Health Development Studies, Peking University YANG Hongwei, China National Health Development Research Center, National Health and Family Planning Commission CHEN Wen, School of Public Health, Fudan University SUN Qiang, Center for Health Management and Policy, Shandong University LIU Xiaoyun, China Center for Health Development Studies, Peking University Edited by: Anne Mills, Viroj Tangcharoensathien i WHO Library Cataloguing-in-Publication Data People’s Republic of China health system review (Health Systems in Transition, Vol. 5 No. 7 2015) 1. Health care reform. 2. Health expenditures. 3. Health system plans – organization and administration. 4. China. I. Asia Pacific Observatory on Health Systems and Policies. II. World Health Organization Regional Office for the Western Pacific. ISBN 978 92 9061 728 0 (NLM Classification: WA 540 JC6) © World Health Organization 2015 All rights reserved. Publications of the World Health Organization are available on the WHO website (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications–whether for sale or for non-commercial distribution–should be addressed to WHO Press through the WHO web site (www.who.int/about/licensing/copyright_form/en/index.html). For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines (fax: +632 521 1036, email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. The named authors alone are responsible for the views expressed in this publication. ii Contents Preface ................................................................................................................ viii Acknowledgements ............................................................................................. x List of abbreviations .......................................................................................... xii Abstract ................................................................................................................ xv Executive summary ......................................................................................... xvii 1 Introduction ................................................................................................. 1 Chapter summary ................................................................................................. 1 1.1 Geography and sociodemography ............................................................ 2 1.2 Political context ........................................................................................... 3 1.3 Economic context ........................................................................................ 5 1.4 Health status ................................................................................................ 8 2 Organization and governance ................................................................ 16 Chapter summary ............................................................................................... 16 2.1 Overview of the health system ................................................................ 17 2.2 Historical background .............................................................................. 22 2.3 Organization ............................................................................................... 26 2.4 Decentralization and centralization ....................................................... 34 2.5 Planning ...................................................................................................... 39 2.6 Intersectorality .......................................................................................... 44 2.7 Health information management ........................................................... 49 2.8 Regulation .................................................................................................. 51 2.9 Empowerment ........................................................................................... 62 3 Financing .................................................................................................... 66 Chapter summary ............................................................................................... 66 3.1 Health expenditure .................................................................................... 67 3.2 Sources of revenue and financial flows ................................................. 75 3.3 Overview of the statutory financing system .......................................... 78 3.4 Out-of-pocket payments .......................................................................... 95 3.5 Private medical insurance ....................................................................... 97 3.6 Payment mechanisms ............................................................................ 100 iii 4 Physical and human resources ............................................................106 Chapter summary ............................................................................................. 106 4.1 Physical resources .................................................................................. 106 4.2 Human resources for health ................................................................. 116 5 Provision of services ..............................................................................130 Chapter summary ............................................................................................. 130 5.1 Public health ............................................................................................ 131 5.2 Patient pathways ..................................................................................... 137 5.3 Primary health care services ................................................................ 139 5.4 Medical services provided by secondary and tertiary hospitals ...... 140 5.5 Emergency medical services ................................................................. 142 5.6 Pharmaceutical care ............................................................................... 144 5.7 Rehabilitation care .................................................................................. 146 5.8 Long-term care ........................................................................................ 147 5.9 Services for informal carers .................................................................. 149 5.10 Palliative care ........................................................................................... 149 5.11 Mental health ........................................................................................... 149 5.12 Dental care ............................................................................................... 151 5.13 Complementary and alternative medicine .......................................... 152 5.14 Health services for specific populations ............................................. 153 5.15 Family planning services ........................................................................ 155 5.16 Clinical blood supply and management .............................................. 156 6 Major health reforms .............................................................................159 Chapter summary ............................................................................................. 159 6.1 Historical perspective ............................................................................. 160 6.2 Analysis of recent
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