China’s health system is a critical field of action to address the social determinants of health and the related health inequities. The health system is one of the primary building blocks for system of social protection and social solidarity, and contributes to poverty alleviation. Health system strengthening aims to improve health through tackling the health system constraints.

Increasing life expectancy

China has made many great achievements in improving health status over the past six and a half decades. The life expectancy at birth in China increased from 35 years in 1949 to 75 years in 2012, mainly due to a strengthened health system.

China is facing lots of challenges in health during the demographic and epidemiological transitions including rapid economic growth

China is facing lots of challenges in health during the demographic and epidemiological transitions including rapid economic growth, urbanization and industrialization, population ageing, diseases and risk factors related to lifestyle and environmental pollutions.

From the 1950s to 1970s when China was still a low-income country, investing in basic health infrastructures, training primary health workers, expanding coverage of the basic financial protection mechanisms, and coordinating health-related sectors were the major actions in making a health system function.

China established a three-tier health care delivery system in both rural and urban areas in the 1950s and 1960s. The structure and function of the health delivery system have not been radically changed, even if the structure of health needs has basically transformed.

Health system performance

How the health care delivery system is to be integrated and coordinated for addressing rapid rising of non-communicable diseases and population ageing is currently one of the top priorities

How the health care delivery system is to be integrated and coordinated for addressing rapid rising of non-communicable diseases and population ageing is currently one of the top priorities on the health reform agenda.

However, the country has also experienced a decline in the level of health system performance.

For example, collapse of a rural cooperative medical scheme in the mid 1980s led to an increase in the number of households who incurred catastrophic medical expenditures; financing of public hospitals relying on user fees led to cost escalation of medical care and increasing unmet health needs of the poor; and inappropriate incentives for health providers led to concentration of qualified health workers in urban and tertiary hospital settings.

Since early 2009, China has implemented a new round of health system reform, aiming to achieve universal health coverage by 2020. While the reform has made good progress in expanding population coverage of financial protection mechanisms, challenges of cost escalation, fragmented health delivery system, and inequity in health remain.

Knowledge and evidence on how those challenges are to be addressed through health system strengthening are needed.