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Analysis China’s Health System Reforms: Review of 10 Years of Progress

What can we learn from China’s health system reform?

BMJ 2019; 365 doi: (Published 19 June 2019) Cite this as: BMJ 2019;365:l2349

China's health system reforms: review of 10 years of progress

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  1. Qingyue Meng, professor1,
  2. Anne Mills, professor2,
  3. Longde Wang, professor3,
  4. Qide Han, professor4
  1. 1Peking University China Center for Health Development Studies, Beijing, China
  2. 2London School of Hygiene and Tropical Medicine, London, UK
  3. 3China Association of Preventive Medicine, Beijing, China
  4. 4Peking University Health Science Centre, Beijing, China
  1. Correspondence to: Q Meng qmeng{at}

Qingyue Meng and colleagues assess what China’s health system reform has achieved and what needs to be done over the next decade

The Chinese central government started a first round of health system reform in 1996. The effectiveness of the reform was questioned after several years of implementation for a number of reasons. Firstly, complaints from the public about access to and affordability of healthcare increased. At that time, most people had no financial health protection and made high out-of-pocket payments for healthcare, which accounted for about 60% of total health expenditure. A large proportion of the population could not afford the healthcare they needed.12 Secondly, the outbreak of severe acute respiratory syndrome in China in 2003 highlighted the importance of health for human development, and the government began to recognise the contribution of the health system to overall social and economic development. Thirdly, a leading state research institute published a report in 2005 which concluded that the 1996 health system reform had failed, which provoked more discussions about reform.

To respond to the concerns about the health system, the Chinese government began to plan another round of health system reform in 2007 and asked national and international organisations to provide reform proposals. Several ministries, coordinated by the National Development and Reform Commission and Ministry of Health, worked together to produce the master policy document for the reform. In March 2009, the Central Committee of the Communist Party of China and the State Council issued the Opinions on Deepening Health System Reform.3 The aim of the reform was to establish an equitable and effective health system for all people (universal health coverage) by 2020 by strengthening healthcare delivery, health security, and provision of essential medicines.

China’s health system reform is a large scale, long term social …

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