China's Grassroots Healthcare Reform Invests Over RMB 90 Billion; Guangdong's Model Highlighted at NHC Press Conference

Since the launch of deepened healthcare reform, the CPC Central Committee and the State Council have consistently attached great importance to primary healthcare. They have integrated the reform and development of primary healthcare into the overall planning of economic and social development, established “prioritizing primary care” and “driving progress through reform and innovation” as the guiding principles for health work in the new era, and consistently upheld strengthening primary care as a fundamental principle of deepened healthcare reform. China has gradually achieved significant phased results in ensuring access to medical services and improving the quality of care at the primary level. Throughout this process, various regions have actively explored and boldly practiced, giving rise to many noteworthy and exemplary approaches.

VCBeat (WeChat ID: vcbeat) has learned that the National Health Commission held a press conference in Guangdong today to highlight achievements in grassroots healthcare reform, with a particular focus on the experiences of comprehensive grassroots medical reforms in Guangdong Province and Guangzhou City.

In terms of comprehensive grassroots reform, localities have deepened county-level comprehensive healthcare reforms in accordance with the guiding principles of “strengthening counties, revitalizing townships, stabilizing villages, integrating upper and lower levels, ensuring information connectivity, and innovating models.” Efforts have been intensified to enhance grassroots service capacity and stimulate the vitality of primary medical and health institutions. The construction of county-level medical communities, particularly tightly integrated medical communities, has been actively promoted. Channels and mechanisms have been established and improved to clarify responsibilities, rights, and interests, and to facilitate the vertical flow of high-quality medical resources. These initiatives aim to foster an integrated and continuous healthcare service model that is health-centered, prevention-oriented, and combines prevention with treatment.

First, prioritizing service accessibility to ensure that residents can access primary care services. From 2012 to 2018, the central government invested over RMB 90 billion in infrastructure construction for primary healthcare institutions, basically achieving full coverage of village clinics and township health centers. The service capacity of county-level hospitals has been significantly improved, with more than 80% of residents able to reach the nearest medical facility within 15 minutes.

Second, with a focus on service capacity, we have promoted the ability of primary care institutions to provide effective diagnosis and treatment. In 2018, the total number of primary healthcare personnel reached 3.965 million, including 1.305 million licensed (assistant) physicians, representing increases of 7.1% and 30%, respectively, compared with 2012. The number of visits to primary healthcare institutions reached 4.429 billion. Since 2016, 17,450 individuals have been recruited and trained under the “3+2” assistant general practitioner program, and 82,877 individuals have obtained qualifications as rural general practice assistant physicians, further strengthening the human resources for healthcare services in rural areas, particularly in economically underdeveloped regions. Meanwhile, through initiatives such as the “Quality Primary Care Campaign” and pilot programs for community hospital development, we have continuously enhanced the service capacity and quality of primary healthcare institutions.

Third, with a focus on improving the quality and efficiency of medical insurance, we ensure that people can afford medical care. The basic medical insurance system has been continuously improved, promoting the integration of urban and rural medical insurance systems. The participation rate in basic medical insurance for both urban and rural residents exceeds 98%, currently covering more than 1.35 billion people. In 2019, fiscal subsidies at all levels across China and individual contributions will reach RMB 520 and RMB 250 per person per year, respectively, making the overall funding level 5.9 times higher than when the system was first established in 2009. The establishment and improvement of the universal medical insurance system have provided financial security for grassroots populations to access medical services.

Fourth, adopting a health-centered approach to promote the public’s well-being by reducing disease incidence and delaying disease onset. Adhering to the principle of prevention first, China has implemented the National Basic Public Health Services Program and major public health service projects. The per capita subsidy standard for basic public health services increased from 15 yuan in 2009 to 69 yuan in 2019, with continuously expanding service coverage and progressively enriched service offerings. Solid progress has been made in promoting family doctor contract services, constantly enriching the content of these contracts to provide the public with integrated services that combine basic medical care, public health, and health management.

Guangdong Province has taken effective measures to stimulate the enthusiasm of grassroots services, enhance grassroots service capabilities, and optimize service models, achieving positive results. In particular, by implementing the “Two Permissibles” at the grassroots level—ensuring fiscal support for primary healthcare institutions as Category I public welfare entities while managing income distribution according to Category II public welfare operational principles—the province has effectively addressed issues such as insufficient motivation and lack of vitality among grassroots healthcare workers. Preliminary statistics show that in the first half of 2019, the hospitalization rate within county-level areas across the province reached 83.2%, representing a one-percentage-point increase compared to the same period last year.

From 2017 to 2019, Guangdong Province invested RMB 50 billion from fiscal funds at all levels to strengthen the service capacity of primary healthcare institutions, comprehensively addressing deficiencies in both hardware and software infrastructure.

First, we strengthened the standardized construction of infrastructure for the three-tier rural medical service network. We implemented upgrade and construction projects for 190 county-level public hospitals across the province and upgraded 47 central township health centers to county hospital status. Building upon the completion of standardized construction for township health centers, we promoted the publicly funded standardized construction of 10,000 village clinics; as of this July, 6,772 village clinics have been completed. Meanwhile, we initiated the development of a county-level emergency medical service system and equipped county people’s hospitals with 76 types of essential equipment.

Second, make every effort to attract and cultivate talent for grassroots healthcare institutions. Implement initiatives such as “Thousand Doctors to Hundred Counties,” “One Hundred Chief Experts to Grassroots Levels,” and “Thousand College Graduates to Grassroots Levels.” Cultivate management cadres, discipline leaders, and technical backbones for county-level hospitals, and annually train 1,400 college students through targeted, contract-based programs. Mandate that 5% of intermediate-level and above health professionals from urban tertiary Grade A hospitals serve at grassroots levels for one year each year. Implement the “Grassroots Health Talent Depression-Filling Plan” to cultivate a cohort of professional management and clinical backbone personnel who are willing to go, able to stay, and effective in their roles. Establish special posts for general practitioners at the grassroots level, with provincial financial subsidies of RMB 60,000 per post annually. Increase the subsidy standard for village doctors to RMB 20,000 per village per year, and raise the position allowance for medical staff in township health centers to RMB 1,000 per person per month. Carry out team-based assistance programs, under which urban tertiary Grade A hospitals dispatch medical teams to provide counterpart support to county-level hospitals.

First, establish a new operational mechanism that integrates guarantees with incentives. Implement the “Two Permissibles” policy by comprehensively rolling out the model of “Category I Public Welfare Fiscal Guarantee and Category II Public Welfare Performance Management” in primary healthcare institutions. Improve the performance-based salary system for these institutions, refine the “Two Permissibles” into the “Six Permissibles,” and further stimulate the enthusiasm of primary healthcare personnel.

Second, implement flexible human resource management policies. Adopt the model of “county-level recruitment and administration with township-level utilization,” encourage the establishment of a “talent pool” system, and enable unified allocation and mobility of staffing quotas and personnel across the entire county. Deepen the reform of the professional title evaluation system: healthcare professionals in scarce specialties who have obtained intermediate professional titles and continuously worked at the grassroots level for 10 years in underdeveloped areas shall be directly recognized as holding senior professional titles (associate senior level). Implement a target-based management responsibility assessment system for directors of grassroots healthcare institutions, granting them authority over personnel appointments, operational decision-making, and resource distribution.

First, a Three-Year Action Plan to Promote the Development of “Internet + Healthcare” was issued. The “Five Ones” Campaign for Information-Based Convenience and Public Benefit was launched and implemented.

Second, we advanced the construction of provincial health information platforms. The management information system for primary healthcare institutions at the provincial level was completed, and the telemedicine platforms for county-level hospitals were fully launched. Information connectivity has been established between 20 provincial telemedicine centers and 56 county-level hospitals, with coverage to be extended to all township health centers and provincially designated impoverished villages by the end of the year. Construction of the Provincial Population Health Information Platform has also been initiated.

Third, we are promoting the application of AI technologies in medicine at the primary care level. Artificial intelligence-powered doctor assistants and medical wearable devices have been deployed in 1,438 poverty-stricken villages across the province, with full coverage of all such villages to be achieved by the end of September. Fourth, we are leveraging big data to facilitate precise healthcare reforms at the county level. The Guangdong Health and Medical Big Data Center has been initially established, aggregating basic information, electronic health records, and electronic medical record data for nearly 100 million permanent residents in Guangdong. This enables precise analysis of patient flow, disease types, and medical expenses among county-level residents, providing robust support for decision-making.

Promote the development of medical alliances in diverse forms tailored to local conditions. In urban areas, primarily disseminate the experience of the Shenzhen Luohu Healthcare Group; in rural areas, mainly advance the integrated development of county, township, and village healthcare services. Facilitate the formation of medical alliances involving 30 high-level hospitals and county-level hospitals. Formulate and issue policy documents on the construction of close-knit county-level medical communities, gradually improve policies related to health insurance payment and service pricing, establish a performance evaluation indicator system, and standardize the development of medical alliances. As of the end of June this year, the province had established a total of 70 urban medical groups, 206 county-level medical communities, 232 specialized alliances, and 78 telemedicine collaboration networks. Hospitals under provincial and ministerial administration have taken the lead in establishing 15 specialized alliances focused on major diseases and scarce medical resources.

The focus of contract-based services is shifting toward improving quality and efficiency, ensuring that each signed contract is fulfilled effectively and substantively. Implement classified, paid, and differentiated contracting models; develop service packages and set fee standards tailored to different population groups and types, thereby meeting residents’ personalized service needs. Establish three-tier training bases at the provincial, municipal, and county levels, and carry out a six-year “snowball” training program for family doctor teams to enhance the service quality of family doctors.

Next, the heads of the Guangzhou Municipal Government, Huadu District Government of Guangzhou City, Yangxi County Government of Yangjiang City, Guangdong Province, and Yingde City Government of Qingyuan City, Guangdong Province, respectively introduced typical experiences related to grassroots healthcare reform.

From 2010 to 2018, Guangzhou’s municipal and district-level fiscal authorities invested a total of over RMB 16 billion in primary healthcare institutions. By formulating and implementing plans for the layout of medical and health facilities, the city has basically established a “15-minute medical service circle” in urban areas and a “30-minute medical service circle” in rural areas. Guangzhou has developed nine community health service centers ranked among the “Top 100 in China,” two township health centers listed among the “Top 100 in China,” and four provincial-level training bases for family doctor team services, successfully earning designation as a municipal-level advanced unit in national primary traditional Chinese medicine work.

By establishing mechanisms, stabilizing the workforce, and enhancing vitality, Huadu District has pioneered a new path characterized by “a strong district, vibrant towns, stable villages, coordinated vertical linkages, and seamless information flow.” This approach has created a favorable situation in which the public reaps tangible benefits, medical personnel are motivated, healthcare institutions achieve development, and the Party and government enhance their public image. In recent years, public satisfaction with healthcare services has remained at a high level, with the local consultation rate reaching 90%.

Yangjiang County established the Yangxi General Hospital by horizontally integrating three county-level hospitals and vertically aligning with eight township health centers, achieving “six unifications” in personnel, clinical operations, pharmaceuticals and medical devices, finance, information systems, and health insurance payment management. Village clinics were incorporated into this unified management framework, realizing a high degree of integration of medical resources across county-township and township-village levels. In 2018, the proportion of consumables per 100 yuan of medical revenue in public hospitals across the county decreased by 42.6% compared to the pre-reform period; average outpatient costs per capita dropped by 12.7% year-on-year, and average inpatient costs per capita declined by 10.1% year-on-year. The volume of outpatient and emergency visits at township health centers across the county increased by 18.0%, while hospital admissions rose by 21.0%. The share of medical service revenue increased to 32.1%, and the proportion of personnel expenditure rose to 45.3%.

Yingde City has comprehensively enhanced the service capacity of primary healthcare institutions in accordance with the strategy of “strengthening county-level facilities, invigorating township-level services, and stabilizing village-level care.” As a result, the primary healthcare sector has demonstrated a favorable trend characterized by “three increases, one decrease, and one control.” Medical service volume has risen significantly; in 2018, the number of outpatient and emergency visits and hospital admissions at the primary level increased by 1.7 times and 93.4%, respectively, compared to the pre-reform period. Primary care outpatient and emergency visits accounted for 67% of the city’s total, indicating a marked return of patients to primary care facilities. The inpatient rate within the county reached 90.7% in the first quarter of 2019, representing a 6.9 percentage point increase from 2015. The income of medical personnel has continued to rise, with the average annual salary of primary healthcare workers reaching RMB 107,000 in 2018, an increase of RMB 66,000 compared to the pre-reform period. Drug costs have declined year by year, with the drug cost ratio at the primary level standing at 26% in 2018, a decrease of 14 percentage points from the pre-reform level.