Summary Fragmentation in social health insurance schemes is an important factor for inequitable access to health care and financial protection for people covered by different health insurance schemes ...in China. To fulfil its commitment of universal health coverage by 2020, the Chinese Government needs to prioritise addressing this issue. After analysing the situation of fragmentation, this Review summarises efforts to consolidate health insurance schemes both in China and internationally. Rural migrants, elderly people, and those with non-communicable diseases in China will greatly benefit from consolidation of the existing health insurance schemes with extended funding pools, thereby narrowing the disparities among health insurance schemes in fund level and benefit package. Political commitments, institutional innovations, and a feasible implementation plan are the major elements needed for success in consolidation. Achievement of universal health coverage in China needs systemic strategies including consolidation of the social health insurance schemes.
Summary In this Review we examine the progress and challenges of China's ambitious 1998 reform of the world's largest health professional educational system. The reforms merged training institutions ...into universities and greatly expanded enrolment of health professionals. Positive achievements include an increase in the number of graduates to address human resources shortages, acceleration of production of diploma nurses to correct skill-mix imbalance, and priority for general practitioner training, especially of rural primary care workers. These developments have been accompanied by concerns: rapid expansion of the number of students without commensurate faculty strengthening, worries about dilution effect on quality, outdated curricular content, and ethical professionalism challenged by narrow technical training and growing admissions of students who did not express medicine as their first career choice. In this Review we underscore the importance of rebalance of the roles of health sciences institutions and government in educational policies and implementation. The imperative for reform is shown by a looming crisis of violence against health workers hypothesised as a result of many factors including deficient educational preparation and harmful profit-driven clinical practices.
Summary Inappropriate incentives as part of China's fee-for-service payment system have resulted in rapid cost increase, inefficiencies, poor quality, unaffordable health care, and an erosion of ...medical ethics. To reverse these outcomes, a strategy of experimentation to realign incentives for providers with the social goals of improvement in quality and efficiency has been initiated in China. This Review shows how lessons that have been learned from international experiences have been improved further in China by realignment of the incentives for providers towards prevention and primary care, and incorporation of a treatment protocol for hospital services. Although many experiments are new, preliminary evidence suggests a potential to produce savings in costs. However, because these experiments have not been scientifically assessed in China, evidence of their effects on quality and health outcome is largely missing. Although a reform of the provider's payment can be an effective short-term strategy, professional ethics need to be re-established and incentives changed to alter the profit motives of Chinese hospitals and physicians alike. When hospitals are given incentives to achieve maximum profit, incentives for hospitals and physicians must be separated.
Abstract Background China has a vast and complex system of health-professional education, which underwent fast changes beginning in 1998. Because of the notable shortage of international published ...work on quantitative characteristics of the system, we aimed to analyse the scale, distribution, and changes of this system. Methods Using previously unreleased datasets from China's Ministry of Education, we did a time-series analysis by studying the changes and tendency of health-professional education institutions, students, faculty members, and infrastructures from 1998 to 2012. Only routine statistics of education institutions were analysed, and no informed consent was necessary. Findings In 1998–2012, the number of health-professional education institutions increased from 189 to 590 in the field of regular higher education. 123 private institutions existed in 2012, compared with zero in 1998. In the same period, the number of health-professional students increased from 0·3 million to 2·1 million, with an average growth rate of 14·9% per year. By contrast, a much slower growth rate or a decreased rate was seen for faculty members (7·6%), campus area per student (–1·4%), classroom area per student (1·9%), number of library books per student (–5·6%), and number of computer per 100 students (5·7%). Furthermore, a widening gap was seen between western China and the other two parts of the country (eastern and central China) in terms of health-professional educational resources and output. Interpretation Expansion of health-professional education has a positive role in addressing the shortage of health workforce in China. Nevertheless, the quality of education might be compromised because of the rapid increase in the number of students without commensurate strengthening of faculty and infrastructure. The widening gap in educational resources and output among different regions might worsen the unequal distribution of health professionals in the country. Funding Chinese Academy of Engineering.
Summary In terms of economic development, China is widely acclaimed as a miracle economy. Over a period of rapid economic growth, however, China's reputation for health has been slipping. In the ...1970s China was a shining example of health development, but no longer. Government and public concerns about health equity have grown. China's health-equity challenges are truly daunting because of a vicious cycle of three synergistic factors: the social determinants of health have become more inequitable; imbalances in the roles of the market and government have developed; and concerns among the public have grown about fairness in health. With economic boom and growing government revenues, China is unlike other countries challenged by health inequities and can afford the necessary reforms so that economic development goes hand-in-hand with improved health equity. Reforms to improve health equity will receive immense popular support, governmental commitment, and interest from the public-health community worldwide.
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