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The rate of infectious disease outbreaks has been accelerating over the past two decades, from the SARS epidemic in 2003 to COVID-19 in 2020. Termed by some as the twenty-first century's first pandemic, SARS originated in China and alerted the country to the importance of public health and epidemic response. After SARS, China improved its health infrastructure and reformed its political and legal health governance system. The emergence of COVID-19 from Wuhan in late 2019 put those reforms to the test. This paper analyses China's public health and epidemic response policies from a historical perspective, tracing the evolution of Chinese public health policies after the SARS outbreak in 2003. This paper assesses China's response to COVID-19 and how post-SARS policy reforms, particularly in epidemic response, played out on the ground in Wuhan. What policies worked well? What were the challenges faced? Based on the policy analysis, this paper presents recommendations for how China can improve its epidemic response through strengthened infectious disease surveillance, more transparent political coordination, and expanded public health infrastructure. [ABSTRACT FROM AUTHOR]

As the COVID-19 pandemic continues to unfold, the approach of the Chinese government remains under the spotlight, obscuring the complex landscape of responses to the outbreak within the country. Drawing upon the author's social media experiences as well as textual analysis of a wide range of sources, this paper explores how the Chinese public responded to the outbreak in complex and nuanced ways through social media. The findings challenge conventional views of Chinese social media as simply sites of self-censorship and surveillance. On the contrary, during the COVID-19 outbreak, social media became spaces of active public engagement, in which Chinese citizens expressed care and solidarity, engaged in claim-making and resistance, and negotiated with authorities. This paper situates this public engagement within a broader context of China's health-care reforms, calling attention to persistent structural and political issues, as well as the precarious positionalities of health-care workers within the health system. [ABSTRACT FROM AUTHOR]

As the population aging, China's government expenditures, including general fiscal expenditure, healthcare and social security expenditure, will grow more rapidly than government revenues, tending to elevate government debt. Local governments undertake overwhelming 85% of total general fiscal revenue and are responsible for healthcare and social security, and their debt has been growing. Fiscal reforms are imperative, including tax reforms, the structure of government spending reforms, social security reforms, healthcare reforms, local public finance reforms, and central and local government's fiscal relationship reforms. This paper will explore the fiscal challenges China faces and discuss how to reform the fiscal system to cope with these challenges. [ABSTRACT FROM AUTHOR]

Pension inequality resulting from fragmented arrangements among different population groups – such as public sector employees, enterprise workers, rural residents, and urban informal workers – has become an essential obstacle to China's socioeconomic development. This commentary analyzes the impacts of the 2015 pension reform on the inequality within China's pension system. We claim that the unification of pension rules should be considered the greatest achievement in mitigating pension inequality. However, the integrated pension rules do not necessarily reduce gaps in pension opportunity and benefits among groups because of differentiation in their labor incomes as well as pension attributes. In addition, although the pension structures were flattened at the basic level, structural disparities exist at the supplementary level, strengthening unequal pension benefit outcomes. We argue that the 2015 pension reform enables public sector employees' privileged status to continue while enterprise employees and rural residents and urban informal workers remain at the pension system's margins. [ABSTRACT FROM AUTHOR]

The Chinese government has been prioritising the strengthening of its primary care system over the past two decades. This study reviews China's national policies in this domain from 2003 to 2018, incorporating academic literature and interviews with health officials and primary care providers. The aim is to assess these policies in alignment with the government's reform agenda and the ideal primary care system advocated in the public health literature. Initially focusing on network and infrastructure development, the Chinese government has progressively shifted its focus towards enhancing human resources and improving the service attributes of primary care facilities. Supported by detailed guidelines and increased funding, substantial progress has been made. Despite these advancements, significant gaps persist when comparing the current state of China's primary care system to the envisioned ideal. To gain a comprehensive understanding of these gaps, it is crucial to consider the Chinese government's agenda and the country's unique development trajectory, which has been influenced by its history of planned economy. [ABSTRACT FROM AUTHOR]

The phenomenon of elderly patients staying in hospital emergency department observation units for extended time in urban China poses a challenge to China’s healthcare system and presents a social problem of inequality. In this paper, we analyse statistics collected from 16 major public hospitals in Beijing to assess the extent and intensity of the problem and examine interviews of medical professionals to understand the mechanisms linking the issue to the Chinese healthcare system. We study the issue with the literature on market transition theory and on China’s recent healthcare reforms and view this age-based inequality as an outcome of the economic and social transformations in China. We make a few policy recommendations including using age-specific bed turnover and mortality rates for evaluating performance, employing three different release-status dependent mortality rates of emergency department patients for the evaluation of hospitals, and improving the capacity of post-acute, ambulatory care and geriatric care services in urban China. [ABSTRACT FROM AUTHOR]

Patient advocacy and media coverage are important strategies for changing health policies. China is no exception. Through 31 interviews and content analysis of 1,136 news stories related to hepatitis B, this study revealed how members of Chinese health advocacy groups strategically built a coalition with the news media, actively played the role of 'policy entrepreneurs', and successfully affected the framing of hepatitis B. As a result, China's grassroots civil societies not only successfully attracted public attention to the previously ignored problem of discrimination against people affected by hepatitis B but also impacted on the state's rewriting of public policies on this disease. [ABSTRACT FROM AUTHOR]

Equity is one of the goals of China’s new round of health care reform. Results from existing empirical studies provide evidence for the existence of highly unequal distribution of insurance benefits under China’s current social health insurance programmes. This paper aims to explain inequity in health insurance by connecting the ways through which insurance programmes are financed with benefit distribution. A theoretical approach is employed, and we find that the inconsistency between insurance premiums and expected benefits among different income levels is the main source of inequity in social health insurance programmes. Our results suggest that the design of premium and reimbursement schemes should be aligned with the income level of the insurant. [ABSTRACT FROM AUTHOR]

The government of Hong Kong has been trying to reform the territory's health care financing system since the early 1990s and is finally on the verge of succeeding. The objective of this paper is to assess the reform efforts and explain the causes of repeated failures and eventual success. It will argue that the government's fortunes changed only after it abandoned the core reform goal and decided to pursue peripheral objectives. It will explain the abandonment with reference to the peculiar political system in Hong Kong that makes it difficult for the government to adopt substantial policy reforms in the face of even moderate opposition. The reason for the government's policy incapacity is the existence of liberalism in a non-democratic setting, which allows the government to neither suppress opposition nor mobilize popular support. This has been illustratively evident in its health care reforms when its proposals to improve the system's fiscal sustainability invariably met an early death because they imposed costs on employers, the population or both. The current proposal has fared better not only because it addresses a simpler peripheral problem but also because it offends almost no one and pleases many among the powerful. [ABSTRACT FROM AUTHOR]

Education and income have been considered two primary determinants to affect individuals' health outcomes. China initiated a comprehensive health reform in 2009, with the goals to provide equal access yet sufficient healthcare to all residents. However, social disparities continue to persist following this large reform. This research hypothesized that older adults' years of education and income are determinants of participation in each social insurance scheme following the 2009 health reform. Multilevel logistic regression models were used with a nationally representative sample (n = 5,274) to investigate the education and income disparities in each social insurance scheme for older adults, with random effects among provinces at the national level. The analyses show that years of education was not associated with enrollment in three social insurances, with the exception of the association between 11 years of formal education or above and the rural coverage. Participants with higher levels of household income had greater odds of having urban social insurances, but had lower odds of having the rural scheme. Further research should continue to investigate the disparities of enrollment of each social insurance. Chinese policy makers should consider these social factors carefully to reach a true universal coverage. [ABSTRACT FROM AUTHOR]

From 1986 to 2009, China's health system reform first adopted a market-oriented approach and later reemphasized the role of the government starting from 2002. China's oscillating health care financing policies present us a unique opportunity to examine the consequences of government-led financing and market-oriented financing measures. This study uses the Urban Household Survey, a diary data in China that covers the period of 1986 to 2009, to examine the long-run trends in the incidence and intensity of catastrophic health expenditure and medical impoverishment. Four major findings emerge. First, the incidence and intensity of catastrophic health expenditure in urban Chinese households increased rapidly between 1986 and 2002, whereas they stabilized after 2002. Second, the incidence of medical impoverishment and its depth in the poverty gap remained stable before 2002 and decreased rapidly after 2002. Third, income and regional inequality in measures of catastrophic health expenditure widened from 1986 to 2002. They narrowed in the 2000s but remain wide. Fourth, income and regional inequality in medical impoverishment remained unchanged between 1986 and 2002 and narrowed substantially after 2002. All these results suggest that China's two cycles of health care reform generated significantly different outcomes in financial protection, holding lessons for the ongoing health care reform in China and other countries. [ABSTRACT FROM AUTHOR]

The Chinese government first Introduced principles of health-care development for the nation in 1952. During the next thirty years, life expectancy increased by ten years. This paper provides an introduction to health development and different phases of health-care reforms in China. The first round of health-care reform began in the early 1980s, focused on holding hospitals fiscally accountable. The second round, aimed at balancing social and economic benefits, started in 1996. The third round began in 2007 and called for reducing individual medicalcare burdens. [ABSTRACT FROM AUTHOR]

This paper aims to examine the UK National Health Service (NHS) in the historical context of its background reforms and to investigate future developmental strategies for China's health system. We focus on the central issues facing China's future healthcare development: equity and access. China and the UK have approached healthcare reform from opposite perspectives, the NHS has maintained the core principle of providing universal health coverage throughout the decades. However, due to increasing demand, reforms to improve and sustain efficiency have meant increasing government funding while introducing elements of a market system. Conversely, China has moved from a centrally planned system to a fee-for-service system, but serious problems of inequity and access call for new methods of organisation and financing. With the future of both systems under constant debate, international experience will play a vital role in formulating health system reform strategies. [ABSTRACT FROM AUTHOR]

This paper presents a chronology of the development of the Chinese rural health system and its responses to environment-related health problems. During the early years of the People's Republic, the health system was very successful in reducing the transmission of infectious diseases through environmental improvements. Since the transition to a market economy, environment-related preventive programmes have been given less priority and a variety of new environment-related health problems and risks have emerged. More recently, the Chinese government has made strong commitments to improve the performance of the health system and increase access by all. Its focus has been on strengthening medical care and developing new forms of health finance. It has paid little attention to environment-related problems. However, as the pace of health reform accelerates, it will be important to ensure that it take environment-related problems into account. [ABSTRACT FROM AUTHOR]

The Maoist period (1949–76) is considered an outstanding stage in Chinese history for its improvements in public health and welfare. In particular, the decrease in infectious diseases led to reduced mortality rates and increased life expectancy. This success can be attributed to the policies implemented in the health-care system during this period. However, different stages defined this process. The aim of this article is to determine whether health inequality in China was evident and consistent during the whole period. To determine this, provincial data were drawn on to undertake a comparative study in the allocation of health resources in different regions. In order to understand the dynamics of the health system during this period, the article focuses on one province in particular, that of Henan. The findings indicate that there were variations in the distribution of health resources among provinces during the Maoist era. The available figures indicate that there was a general increase in health resources in China. However, this did not prevent Henan province from experiencing a great decline in its health system during the Cultural Revolution (1966–76). Future research must be carried out to determine whether the inequality of health inputs in China during the Maoist period was positively correlated with the inequality of the health outputs nationwide. [ABSTRACT FROM AUTHOR]

China's rapid economic reforms, coupled with the changes in age composition of the demographic structure, have greatly affected the traditional family support system. In response to these changes, efforts to develop new models of community-based long-term care (CBLTC) for elders in China have received growing attention. This paper provides a systematic analysis of the current status of emerging CBLTC systems in Shanghai, China. It covers several domains of the system: service delivery, workforce, financing, and quality of care management. Several main issues involved in the development of the emerging system are addressed, and relevant policy implications are presented in the paper. [ABSTRACT FROM AUTHOR]

This paper uses multi-year, individual-level data to evaluate the effects of the current Chinese urban employee health insurance reform on equity in health care financing. It found that the new Urban Employee Basic Health Insurance Scheme financed by personal medical savings accounts (MSAs) plus a social-risk pooling account (SPA) is regressive. The contributions to the SPA, although slightly regressive, played an important role in equalizing health care financial burden; the payments from the SPA favored low-income insured employees. The introduction of MSAs has resulted in more resources being available for high-income insured employees and an increased burden on low-income ones. The amount of resources currently collected by the new program would achieve equity in health care financing if they were pooled in a social insurance fund without MSAs. These results have important policy implications for both China and other countries contemplating implementing MSAs. [ABSTRACT FROM AUTHOR]

Health insurance was prioritized as one of the four key areas for reform in China's Health Care Reform Plan released in April 2009. The Plan aimed to expand coverage, enhance security, and improve payment methods, but implementation was sluggish. In 2011, the government announced that social health insurance (SHI) schemes had reached a coverage rate of 95%, but official statistics did not match the claim. Universal coverage is still an unfinished mission, while inadequate financing and benefit design remain major challenges. Despite a substantial increase in government funding over the past decade, SHI schemes have so far never accounted for more than 54% of national health care expenditure. Surplus has also become a serious policy issue for SIH funds. Finally, payment methods still require further reform and improvement. Traditional fee-for-service payments prevail in many localities, and new payment methods, such as capitation, global budgets, diagnosis-related groups (DRGs), per diem payments, and mixed payments, are only in the stage of experimentation. The health care delivery system still lacks sufficient governance structure and incentives. Health insurance reform is an important part of welfare-state building, and China still has a long path ahead before it reaches its goals in this respect. [ABSTRACT FROM AUTHOR]

Sub-national governments in China have substantial responsibility for policy development as well as for direct implementation of circumscribed policy options set out by higher levels of government, and much policy discourse emphasizes the importance of sub-national flexibility and creativity in policy implementation. Discourses of government innovation aim to encourage local initiative in policy formulation and solving of systemically-important policy problems, and policy experimentation/innovation are increasingly credited as important elements of the Chinese government toolbox in managing reform. Recent studies have tended to treat experimentation/innovation as systemic phenomena, and there are few analyses of how local governments respond to central ‘experimental’ policy frameworks and develop locally- or systemically-useful policy solutions. Given concerns around the capacity of local governments, this is highly relevant in understanding how locally-generated policy relates to systemic reform. The article presents a case study of a low tech and ‘second best’ reimbursement mechanism developed sub-nationally under the New Cooperative Medical Scheme, China’s rural health insurance framework, and its spread and incorporation into national policy. It argues for the importance of local government development of ‘appropriate’ policy mechanisms (jizhi) as underpinning central reforms and system adaptation. [ABSTRACT FROM PUBLISHER]

In 2009, the Chinese government passed the Zero-Markup Drug Policy, which strives to contain the costs of medicines and ultimately reduce the financial burden to the public, especially those in low-income settings. This study aims to evaluate the impact of the Zero-Markup Drug Policy on health care provision, revenue structures in county hospitals, and demand for fiscal compensation from the government. Our study employs a difference-in-difference model to measure the difference in several indicators between two hospitals, Ningshan County Hospital, which implemented the policy, and Zhenping County Hospital, which had not. The main indicators include health care provision, drug revenue as a part of total hospital revenue, and level of government subsidy. The data come from hospital financial statements and operation reports. The findings of the study show that for Ningshan County Hospital the zero-markup policy led to an increase in health care provision and a sustained total hospital income despite a decrease in drug revenue. The enhancement in outpatient and inpatient visits also represents progress from the lens of the government, whose mission is to ensure greater access to care for the population. The study demonstrates that with minimal or no subsidy, the government can catalyse the zero-markup policy and potentially generate positive outcomes for county hospitals. [ABSTRACT FROM AUTHOR]

The article discusses various reports published within the issue, including one by Jiguang Wang on sustainable development and poverty reduction in Western China, one by Hongwen Zhao and Xlngyuan Feng on health care reforms in China, and one by Rongchun Jiang and Yonghong Chen on service outsourcing industry of China.

China's health care system, under the direction of the central government, has undergone continuous reform in recent decades. Many problems have been encountered, with successive measures attempting to deal with shortcomings and failings of previous reforms. To what extent can implementation failures account for the recurring problems, and what explains these failures? The analysis adopts the theoretical lens of structural-instrumental and cultural-institutional perspectives, respectively, and draws also on recent developments in implementation theory. The historical trajectory of health reform is described, with particular reference to why health policies formulated by the central government during different periods repeatedly failed to achieve their objectives. The empirical analysis finds that structural factors, such as departmentalism and regional separation resulting in complex, overlapping horizontal and vertical actor patterns, have been a primary reason for implementation failures and suggests that they will continue to dog future reform efforts. [ABSTRACT FROM PUBLISHER]

The public healthcare system of China has witnessed a series of reform since the 1980s, with considerable impact on the working conditions and well-being of its nursing workforce. This study examines the employment terms and conditions of clinical nurses in the public hospitals in China, using qualitative data from three case study hospitals. We explore issues relating to their employment contract, grading and work organization, remuneration and representation through an institutional perspective to highlight the role of various actors, existing or emerging, who co-shape the employment environment within the healthcare system. We also deploy hierarchy theory to identify sources of power, or the lack of it, of these institutional actors (e.g. the State, the hospital employer, the trade union, the clients and the nursing workforce) within the administrative and operational structure of hospitals to understand the relative positions of the nurses and their experience of work and employment outcomes. [ABSTRACT FROM PUBLISHER]

China's new health reform initiative aims to provide quality accessible health care to all, including remote rural populations, by 2020. Public health insurance coverage for the rural poor has increased, but rural women have fared worse because of lower status and lack of voice in shaping the services they need. Use of prenatal care, safe delivery and reproductive tract infections (RTIs) services is inadequate and service seeking for health problems remains lower for men. We present findings from a study of gender and health equity in rural China from 2002 to 2008 and offer recommendations from over a decade of applied research on reproductive health in rural China. Three studies, conducted in poor counties between 1994 and 2008, identified problems in access and pilot tested interventions and mechanisms to increase women's participation in health planning. They were done in conjunction with a World Bank programme and the global Gender and Health Equity Network (GHEN). Reproductive health service-seeking improved and the study interventions increased local government commitment to providing such services through new health insurance mechanisms. Findings from the studies were summarised into recommendations on gender and health for inclusion in new health reform efforts. [ABSTRACT FROM AUTHOR]

As result of its spectacular economic growth, millions of Chinese have been lifted out of poverty, making China a model for impoverished countries. Although, for many, economic growth has led to prosperity, ever-growing disparities exist between those who have benefited from the economic advancement and those left behind. Massive gaps in development exist between: regions, urban and rural and social groups. This contribution is to develop a detailed understanding of the health disparity in China by examining the discrepancies in major health indicators. Current efforts to reduce the disparities, and its challenges, opportunities and global implications are also assessed. [ABSTRACT FROM PUBLISHER]

China's health care reform of the 1990s has not yielded much success. The market-oriented health system has resulted in declines in fairness of health services and efficiency of investment in the health sector. Further health care reform will be required. Among many options, asset-based policy has demonstrated some potential in domestic policy development. To provide evidence to inform health policy development in China, this study focuses on the effects of household assets on health in China. Specifically, the current study examines how household assets may affect health status and how assets differ from income in predicting health status. Using a random sample of Chinese elderly, we find that asset holding in the form of household durables and household utilities has both direct and indirect effects on health status. Household assets directly affect access to medical care and indirectly affect health by influencing health behaviour and psychological condition. In other words, in addition to economic effects, household assets appear to have behavioural and psychological effects on health. Interestingly, these effects appear to be associated with assets, but not with income. Implications for asset building policy are suggested as a complement to existing health care models. [ABSTRACT FROM AUTHOR]

Focuses on the trajectories of healthcare finance reforms in Hong Kong and Shanghai, China. Information on basic health indicators, such as life expectancy, infant mortality, maternal mortality and health expenditure; Details of the hospital bed utilization rates; Discussion on problems with user fees and overprescription.

Contemporary health sector reform is frequently underpinned by market-influenced public policy "prescriptions." Such prescriptions provide details of what policies ought to look like, but little by way of how they should be implemented. This article compares the experience of New Zealand and Hong Kong, two locations in which recent health reforms were based upon the policy prescription. Where the respective health policies bear similarities, implementation styles differ with interesting consequences. New Zealand's apparent "success" in implementation may ultimately prove counterproductive; it seems more likely that Hong Kong, whose implementation success has been, to date, moderate, will achieve objectives of providing a better public health service. [ABSTRACT FROM AUTHOR]