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The Health Sector in China


By 2016, China’s health care sector accounted for 6% of the country’s GDP and is expected to absorb a 10% share in the coming years.


Although the overall health of the population has improved in China since the 1980s, there has been a widening gap in access to health care and public health.

  • The Chinese health system must therefore be reformed, but the considerable efforts made can not mask the persistent difficulties.

The economic reforms initiated in China in the early 1980s led to an increase in the standard of living and, at the health level, great qualitative progress in the care, equipment and hospitals of the health workforce. Similarly, the health status of the population has improved overall.

China is going through a crucial period of transition for the development of its health system and for its reforms.

The current healthcare system reflects the ongoing structural changes, with increasingly unequal access to quality care, due to insufficient health insurance coverage and a heterogeneous organization of the health system .

As a result of the disappearance of the management system by the working units and the people’s communes and a less developed prevention, part of the farmers and the urban population still has limited access to care, It is a question of assuming long, expensive and / or chronic treatments.

It is now considered that the disease is one of the main causes of poverty for the Chinese population. In this crucial period of reform of the health and welfare system, progress is still uncertain.

In addition, the public health issues are considerable.

Although life expectancy has risen sharply (74 years in 2009) with infant mortality, which has dropped significantly, the latter remains high compared to developed countries: 17.2 ‰ in 2009 (versus 3.6 ‰ in France) .

In terms of child care facilities, the number of paediatricians remains inadequate and pediatric hospitals are still in short supply (68 out of 13,000 hospitals) and equipment still obsolete in western China Less developed).

Recent studies show that the incidence of cardiovascular disease and associated mortality will increase significantly in China by 2030, expected to grow by more than 73%.



The recognition of these difficulties and evolutions in progress has led the Chinese authorities to want to initiate reforms.

The SARS crisis in 2003 (Severe Acute Respiratory Syndrome) and the various recurrent food and safety scandals (eg melamine milk in 2008) led health authorities to initiate several attempts to overhaul the system and Of health insurance, without much success.

But since 2006, after the complete reorganization of the health surveillance and surveillance system in the aftermath of SARS, reform of the health system is under way to establish a system of basic medical care and medical insurance accessible to all. This is a complex task as all sectors of health are engaged in these changes.

The reform aims to:

Improve access to health insurance coverage (ambitious goal of health insurance coverage for 100% of the population by 2020 – end of September 2011, 95% of the Chinese, ie 1,295 million people are covered by health insurance).

  • This involves considerable efforts, since health insurance coverage, which had hardly existed since the economic reforms, has been gradually re-established since the 2000s (coverage estimated at 15.7% in 2004);
  • To improve the supply of quality care, both outpatient and healthcare, in urban areas and in disadvantaged or remote rural areas (such as in western China).

The Ministry is therefore focusing on quality of care by developing recommendations for good practice (for 112 most common diseases);

Develop community-based care with the construction or renovation of community health centers and the training of general practitioners (nearly 20,000 trained in 2011)

(A minimum of 307 medicines determined at national level), fully or largely reimbursed, at the rates negotiated with the companies.

Modernize public hospitals

Modernize public hospitals with the start of pilot projects in 16 cities in 16 cities to improve status, management, operation, funding and quality in voluntary and selected health facilities. This reform was extended to hospitals in 37 provinces at the end of 2010, and the city of Beijing hired 22 of its public hospitals in 2011.

  • Since 2009, an investment plan of 850 billion yuan (more than 92 billion euros) is devoted to this reform.

In three years, expenditure was higher than expected, requiring the allocation of an additional 280 billion yuan (366 million euros).

Health care Demand

Despite undeniable progress in the organization of health care, the most challenging task of the Chinese Health Minister remains to improve basic services, particularly in district hospitals (which provide almost 70% of hospital care in rural areas ) And community health centers.

  • According to him, this must be done through an ambitious program of training for general practitioners and the organization of primary care.

Moreover, the most difficult and difficult part remains, according to the minister, the implementation of the reform of public hospitals, which still receive the vast majority of patients regardless of the level of severity of the pathologies.

China is going through a crucial period of transition for the development of its health system and for its reforms.

Its decision-makers, through pragmatic choices to improve the organization of their healthcare system and reduce disparities and inequalities in access to care, are making real societal choices, affecting the level and quality of life of their population and The scale of which is out of all proportion to what has been done in previous decades.

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