JANUARY

CHINA
is not substantially more expensive than usual care for patients. Information on patients’ emergency visits is not
routinely sent to their primary care doctors.
Hospitals: Hospitals can be public or private, nonprofit or for-profit. Most township hospitals and community
hospitals are public, but both public and private secondary and tertiary hospitals exist in urban areas. Rural
township hospitals and urban community hospitals are often regarded as primary care facilities, similar to village
clinics rather than ‘true’ hospitals. In 2013, there were 13,396 public hospitals and 11,313 private hospitals
(excluding township hospitals and community hospitals), of which 17,269 were not-for-profit and 7,440 were
for-profit (National Health and Family Planning Commission, 2014). In 2013, there were 487,802 public primary
care facilities and 427,566 private village clinics (National Health and Family Planning Commission, 2014).
Hospitals are paid through a combination of out-of-pocket payments, health insurance compensation, and,
in the case of public hospitals, government subsidies—the latter representing 13.5 percent of total revenue
in 2013 (National Health and Family Planning Commission, 2014). A significant number of patients pay 100
percent out-of-pocket, because they receive out-of-network services. Although fee-for-service is dominant,
DRGs, capitation, and global budgets are becoming more popular in selected areas. Local health authorities set
fee schedules, and doctor salaries and other payments are included in hospital reimbursement.
Mental health care: Mental health care, including disease diagnosis, treatment, and rehabilitation services, is
provided in special psychiatric hospitals and psychological departments of tertiary hospitals. Patients with mild
illness are often treated at home or in the community; only severe mentally ill patients are treated in psychiatric
hospitals. Both outpatient and inpatient mental health services are covered by insurance, with benefits subject
to lower copayment rates. In 2013, there were 28 million mental health patient visits to special psychiatric
hospitals, and on average one psychiatrist treated 4.6 patients per day (National Health and Family Planning
Commission, 2014). Mental health is not integrated with primary care.
Long-term care and social supports: In accordance with Chinese tradition, long-term care is provided mainly
by family members at home. There are very few formal long-term care providers. Family caregivers are not
entitled to financial support or tax benefits, and long-term care insurance is virtually nonexistent; expenses for
care in long-term care facilities are paid almost entirely out-of-pocket. Government may provide some subsidies
to long-term care facilities. On average, conditions in long-term care facilities are poor, and there are long
waiting lists for enrollment in high-end facilities. Formal long-term care facilities usually provide only
housekeeping, meals, and basic services like transportation, but very few health care services. Some long-term
care facilities may coordinate health care with local township or community hospitals, however. There were 4.94
million beds for aged and disabled people in 2013 (National Bureau of Statistics, 2014). Some hospice care is
available, but it is normally not covered by health insurance (Chen, 2014).
What are the key entities for health system governance?
In 2013, the Ministry of Health and the National Population and Family Planning Commission were merged into
the National Health and Family Planning Commission as the main agency for health controlled by the State
Council (central government). The State Administration of Traditional Chinese Medicine is affiliated with the new
Commission. The National People’s Congress is responsible for health legislation. However, major health
policies and reforms may be initiated by the State Council and the Central Committee of the Communist Party
as well, and these are also regarded as law.
The National Development and Reform Commission, which has been heavily involved in the recent health care
system reform, oversees health infrastructure plans and competition among health care providers. The Ministry
of Finance provides funding to government health subsidies, health insurance contributions, and health system
infrastructure. The Ministry of Human Resource and Social Security runs urban employment-based basic
insurance and urban resident basic insurance. The China Food and Drug Administration is responsible for drug
approvals and licenses, but health technology assessment or cost-effectiveness have not played a significant
role yet. The China Center for Disease Control and Prevention is administrated by the National Health and
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The Commonwealth Fund