Table 2

Summary of the main reform initiatives and achievements, 2009 to present

Reform areasMain reform initiativesAchievements
Health insurance systemExpanding the population coverage of the basic health insurance schemes.More than 95% of the population covered by social health insurance schemes in 2018.
Extending the health service package of the basic health insurance schemes.The number of pharmaceuticals on the drug list was expanded to 2643 in 2019; government subsidies per capita for the URBMI and NRCMS have increased more than fivefold in 2018 compared with 2009.
Developing the MFA for people living in extreme poverty.In 2018, a total of ¥42.46 billion was spent from medical assistance funds nationwide to subsidise 76.739 million people to participate in basic medical insurance, and 53.61 million people received outpatient and inpatient assistance.
Developing the CMI for those people with catastrophic medical expenditure.Since 2013, CMI has covered 1.01 billion people in China and benefited more than 11 million people (60% of whom are rural residents), and reimbursement payments have exceeded ¥30 billion.73
Integrating basic health insurance systems of rural and urban residents: merging NRCMS and URBMI into the URRMI.Unifying insurance coverage, funding policies, insured treatment, reimbursement catalogues, management of contracted medical institutions and fund management: for example, the number of drugs covered in the insurance drug list is unified to 2643 in 2019, and the per-capita premium is unified to ¥693 in 2018.
Reforming the payment system.65% of public hospitals above the second level have carried out reforms of the disease category-based insurance payment in 2017; announcing a list of 30 pilot cities for DRG payment reform in 2019.
Drug supply and security systemZero mark-up policy on drug sales.All public hospitals nationwide have removed the medicine mark-ups in 2017.
Formulating and expanding the NEML.Issuing a revision of the NEML in 2009 including a list of 307 essential medicines, and expanding the list to 520 medicines in 2012 and 685 medicines in 2018.58
Supplying and evaluating the generic drugs.Publishing the first list of 34 generic drugs on June 2018; as of 28 August 2019, 313 product specifications have passed the generic drug consistency evaluation.74
Reforming the drug tendering and procurement system.11 pilot provinces and 200 pilot cities have implemented the ‘two invoice policy’ tendering system by the end of 2017; the drug procurement costs of the corresponding varieties in 11 pilot cities fell from ¥7.7 billion to ¥1.9 billion, and the cost dropped by 75.3%.
Promoting rational use of essential drugs.Rates of antibiotic use in inpatient and outpatient care decreased by 50% in selected tertiary hospitals.75
Medical service systemIncreasing investment in the primary healthcare system, including strengthening the infrastructure of PHC facilities.Government subsidies to PHC institutions have increased substantially: from 2009 to 2017, subsidies as a proportion of total PHC income increased from 12.3% to 32.5%.76
Expanding human resources for primary care through incentives and supporting projects.Compared with 2012, the total number of primary healthcare workers in 2017 increased by 7.1% to 3.863 million, and the number of general practitioners per 10 000 population increased from 0.8 to 1.8.
Developing a tiered service delivery system by establishing HCAs and providing family practitioners contracted services.Tiered healthcare system started by 95% of municipalities by the end of 2017; all 2134 tertiary public hospitals in China participated in the establishment of HCAs in 2018.
Improving pricing policies: removing mark-up of drugs as a source of finance for all public hospitals, increasing the price of medical services that can reflect the value of medical staffs’ technical services.In 2017, 27.5% of the medical revenue of public hospitals reflected the value of technical services of medical staff (medical service income), an increase of 2.8 percentage points over the previous year. Drugs and consumables accounted for 48.0% of the total revenue, 4.2 percentage points lower than the previous year. Among them, the proportion of medicines dropped to 34.7%.
Implementing telemedicine to improve the delivery of services to people living in remote and low-income areas.More than 13 000 medical institutions implemented telemedicine services, which have covered all national poverty counties.
Public health service systemProviding basic public health service package to all people through government subsidies.Increased government public funding was invested to expand the services (from 9 categories in 2009 to 14 categories in 2017) and availability of the basic public health package to almost everyone; an average of ¥15 was allotted per capita in 2009 and was increased to ¥55 in 2018.
Supporting programmes to control the main public health problems.
  • Adapted from Meng et al [62]. Data sources are from the Central People's Government of the People's Republic of China website, the National Health Commission website and the National Healthcare Security Administration website.

  • ¥7=US$1.

  • CMI, Catastrophic Medical Insurance; DRG, diagnosis-related group; HCA, healthcare alliance; MFA, Medical Financial Assistance; NEML, National Essential Medicines List; NRCMS, New Rural Cooperative Medical Scheme; PHC, primary healthcare; URBMI, Urban Resident Basic Medical Insurance; URRMI, Urban and Rural Resident Medical Insurance.