Findings from the Field

China Health Study, with input from PHCPI partners, recommends strengthening primary health care to improve outcomes and value

China will soon launch a comprehensive overhaul of its health care system following the recommendations of the groundbreaking China Health Study. The Study--a collaboration between the World Bank Group, the World Health Organization, and China's Ministry of Finance, National Health and Family Planning Commission, and Ministry of Human Resources and Social Security--established a blueprint for improving quality, reducing fragmentation, and controlling rising costs, largely through strengthening the country’s primary health care system. The Primary Healthcare Performance Initiative played a key role in the generation of recommendations for pathways to improve the healthcare system in China and deliver high-quality, affordable care through person-centered, integrated primary health care.

The aim of the China Health Study was to assess China’s current healthcare system and recommend strategies to curb rising costs, improve outcomes, and offer better value for money.  After a successful phase of healthcare reform in 2009 that raised the percentage of insured citizens to 95% and reduced out-of-pocket expenditures, China now faces rising costs and demographic shifts that are straining its current system.  Health expenditures in China are projected to grow at a much faster rate than the country’s gross domestic product, while an aging population will result in 230 million seniors seeking care in 2030 compared to 140 million today.  China’s system has also become over-reliant on hospitals for basic health care needs, which incentivizes over-prescription and results in unnecessary utilization and overcrowding.  Without dramatic change, the World Bank warns that China is at risk of developing into a “high-cost, low-value” health system.

A key recommendation arising from the China Health Study to correct these emerging issues is to establish a person-centered, integrated primary health care system that moves away from a hospital-centered approach and instead prioritizes primary care, integration and quality improvement across levels of the health system, and patient engagement. The reforms will be guided by the Eight Tenets of Primary Health Care Improvement, which were developed by Ariadne Labs for the study. The Ariadne Labs Primary Health Care team, led by Dr. Asaf Bitton, derived the tenets from the analysis of 22 successful person-centered, integrated care system reforms from around the world. These tenets comprise a valuable framework for understanding the characteristics of high-performing middle and high-income country primary health care systems.

In addition to the Eight Tenets, PHCPI members Dr. Hong Wang of the Bill and Melinda Gates Foundation and Dr. Jeremy Veillard of the World Bank Group played a substantial role in the formation of several key recommendations arising from the report, most notably regarding financing policy, public hospital reform, improving quality, and engaging citizens through eHealth and mHealth strategies. More information about the China Health Study and its recommendations can be found in the recently released Policy Summary.

Hannah Ratcliffe, MSc is a Primary Health Care Research Specialist at Ariadne Labs, a joint center between Brigham and Women’s Hospital and the Harvard T. H Chan School of Public Health.

Kyle Engleman is a Program Manager at Ariadne Labs