China's 11 Comprehensive Healthcare Reform Pilot Provinces: Achievements and Innovations in the New Healthcare Reform Era

On the morning of June 26, the National Health Commission held a press conference in Tongling, Anhui Province, to introduce typical experiences from provinces piloting comprehensive healthcare system reforms. In February 2015 and May 2016, the State Council’s Leading Group for Healthcare System Reform successively designated two batches, totaling 11 provinces, as pilot provinces for comprehensive healthcare system reforms.

Since 2009, the deepening of the new healthcare reform has been underway for a full decade. In 2009, the central government proposed the strategic goal of deepening healthcare reform: ensuring that everyone has access to basic medical and health services, with comprehensive implementation planned by 2020. The overall direction is to be health-centered, focusing on addressing the issues of greatest concern to the public. The following is a summary of the main experiences:

Healthcare reform is a global challenge that has received high-level attention from the CPC Central Committee and the State Council. To further enhance the overall, systematic, and coordinated nature of the reforms, in 2015, the Leading Group for Healthcare Reform under the State Council decided to launch comprehensive provincial-level pilot programs. Currently, there are 11 provinces designated as comprehensive healthcare reform pilots.

Over the past few years, the pilot provinces have consistently followed the overall deployment for deepening healthcare reform,Implement “One Concept” and Highlight “Two Priorities”, concentrating efforts on key areas and critical links, implementing targeted policies, and developing a number of noteworthy best practices.

A core principle is to adhere to prevention first.All provinces have integrated the concept of “comprehensive health and holistic well-being” into various policy measures for economic and social development.

First, organize and implement health initiatives. All pilot provinces have issued documents related to their provincial health initiatives, mobilizing the entire society to participate in health promotion, with the aim of preventing diseases among the general public and reducing disease incidence.

Second, improve the public health service system. Shanghai and other regions have issued guidelines for strengthening the construction of disease prevention and control systems, implementing reforms in institutional management, performance evaluation, and support mechanisms to enhance public health security capabilities.

Third, we have implemented public health services in greater depth. All pilot provinces have strengthened the assessment and management of public health service delivery, particularly for basic public health services. Regions such as Chongqing have explored the procurement of services to enhance the targeted nature and effectiveness of these services.

Fourth, standardize the management of chronic diseases. All pilot provinces have used hypertension and diabetes as entry points to explore effective models for the integrated development of prevention, treatment, and management. In Anhui Province, senior nurses were deployed to community settings to strengthen chronic disease management for key populations, raising the hypertension control rate in pilot areas to over 70%.

Two key priorities are to make concerted efforts to address the problems of “difficulty and high cost in accessing medical care.”In addressing the challenge of “difficult access to medical care,” pilot provinces have actively advanced supply-side structural reforms in the healthcare sector, optimized the allocation of medical and health resources, and established an orderly tiered diagnosis and treatment system.

First, promote the decentralization of high-quality medical resources. Regions such as Anhui have leveraged the development of close-knit medical consortia to facilitate the downward flow of high-quality medical resources, effectively enhancing service capacity at the primary care level. Ningxia has established a five-tier telemedicine service system across the entire autonomous region.

Second, implement comprehensive reforms at the county level. Pilot provinces have deepened reforms in personnel management, compensation, and staffing systems in line with the guiding principles of “strengthening counties, revitalizing townships, stabilizing villages, enhancing vertical coordination, ensuring information connectivity, and innovating service models.” These efforts aim to enhance healthcare service capacity at the county level, stimulate vitality, and strive to ensure that patients with serious illnesses can receive treatment within their home counties. Zhejiang has made substantial progress in this area and accumulated valuable experience; Hunan has achieved an inpatient care utilization rate of over 90% within its counties. Third, emphasize both reform implementation and service improvement. All pilot provinces have introduced a series of convenient and beneficial measures for the public, further enhancing people’s sense of gain. Zhejiang has implemented the “At Most One Visit” reform province-wide, greatly facilitating access for the general public.

Fourth, we encourage and support the development of private medical institutions. Pilot provinces have continued to deepen reforms to streamline administration, delegate power, improve regulation, and upgrade services (“Fang Guan Fu” reforms), further simplifying approval procedures and strengthening policy support to effectively meet the public’s diverse and multi-level health needs. Fifth, we fully leverage the advantages of Traditional Chinese Medicine (TCM), which is characterized by its simplicity, convenience, efficacy, and affordability. In Jiangsu and other regions, basic coverage of TCM halls (clinics) at the grassroots level has been largely achieved, garnering widespread public approval.

In addressing the issue of "high medical costs," pilot provinces have used pharmaceutical reform as a breakthrough point to deepen the coordinated development of healthcare, health insurance, and pharmaceuticals.

First, further reduce artificially inflated drug prices. Pilot provinces have actively implemented reform measures such as the National Essential Medicines System and centralized volume-based procurement to eliminate the inflation in drug pricing. Shaanxi Province, together with 14 other provinces, established an inter-provincial procurement alliance for high-value medical consumables.

Second, deepen the comprehensive reform of public hospitals. Pilot provinces are accelerating the establishment of a modern hospital management system, using the formulation of hospital charters as a key lever to promote standardized and refined hospital management. Shanghai employs information technology to conduct dynamic performance assessments of public hospitals.

Third, expand the effectiveness of medical security. All pilot provinces have unified the basic medical insurance systems for urban and rural residents, implemented payment method reforms, and raised the level of coverage. Fujian Province has rolled out province-wide pilot programs for Diagnosis-Related Group (DRG)-based payment and charging, leveraging the incentive and constraint mechanisms of medical insurance payment methods.

Fourth, we will intensify health-focused poverty alleviation efforts. Regions such as Sichuan have substantially strengthened the capacity-building of county-level hospitals, deepened paired assistance programs, and strived to address the shortage of personnel at township and village-level healthcare institutions. In areas such as Qinghai, the reimbursement rate for inpatient expenses under critical illness medical insurance for the impoverished population has been increased to 90%.

Overall, the 11 pilot provinces have implemented robust comprehensive healthcare reform measures and achieved remarkable results, effectively fulfilling their roles as the “vanguard” and “pioneers.”

Deepen the “At Most One Visit” reform in the field of medical and health services.Focusing closely on key yet seemingly minor issues such as “difficulty in accessing medical care” and “cumbersome healthcare experiences” in urban hospitals, ten measures were introduced in 2018, including “reduced queuing for medical visits” and “more convenient payment methods.” These initiatives enabled province-wide unified appointment registration, hospital-wide integrated payment and settlement, and self-service access to in-hospital services, and were selected as one of the Top Ten New Measures in China’s national healthcare reform. In 2019, a new set of ten measures was launched, promoting novel applications such as “cloud-based film images,” “post-treatment payment,” and “facial recognition for medical services,” with 50 counties achieving “one-stop service for newborn-related matters” and ensuring that residents need to “visit government offices at most once.”

Comprehensively Promote the Construction of County-Level Medical Consortia.Medical consortium construction was fully rolled out across 70 counties (cities and districts), where 208 county-level hospitals and 1,063 township health centers were integrated into 161 medical communities. This initiative fused county and township medical and health institutions, facilitated coordinated reforms in medical services, health insurance, and pharmaceuticals, and established new mechanisms for health insurance payment, medical service pricing, personnel compensation, and drug supply. Five major centers, including a human resources center, were established, and six unified management systems, such as asset operation, were implemented. In 2018, the pilot areas saw year-on-year increases of 12% in outpatient and emergency visits and 22.3% in hospital discharges at township health centers. The proportion of patients treated within their respective counties and at primary care facilities rose by 4 percentage points and 6.1 percentage points, respectively.

Deepen coordinated reforms in pharmaceuticals, pricing, and health insurance.Fully implement the system of dean responsibility under the leadership of the Party committee, control the growth rate of total medical expenses in public hospitals at 9%, initiate a new round of adjustments to medical service prices in six prefecture-level cities and 21 counties (cities, districts), and launch price adjustments for provincial-level public hospitals. The Provincial Committee for Comprehensive Deepening Reforms has researched and formulated policies to deepen the reform of health insurance payment methods; the proportion of secondary reimbursement by critical illness insurance on top of basic medical insurance reimbursement shall be no less than 60%. Five cities and counties, including Ningbo, have been recognized by the State Council as localities with notable achievements in pragmatic reform implementation.

Focusing on the issues of “difficulty in accessing medical care,” “high cost of medical care,” and “inconvenience in seeking medical care” among the general public,Took the lead nationwide in fully abolishing markups on pharmaceuticals and high-value medical consumables in public hospitals, comprehensively implementing the “two-invoice system” for drug and consumable procurement, and introducing innovative reforms such as county-level medical consortia, volume-based drug procurement, and a “revolving pool” mechanism for public hospital staffing quotas.. Pilot the “Two-Card System” for basic public health services, vigorously implement health-focused poverty alleviation initiatives, and actively promote the implementation of policies such as “county-level management with township-level deployment” and “township-level recruitment with village-level placement.”

Significant results have been achieved in the ten-year comprehensive healthcare reform. The proportion of personal health expenditure in total health expenditure decreased from 38.6% to 27.9%, and life expectancy per capita increased from 74.8 years to 76.7 years.

Since the beginning of this year, Anhui Province has embarked on a new journey from a fresh starting point. While promoting the pilot experience of Tongling in building close-knit urban medical consortia and rolling out initiatives such as the “Smart Medical Assistant,” the province has focused on enhancing the substantive development of county-level medical communities to establish close-knit county-level medical communities. This approach can be summarized as the “Two Packages, Three Lists, and Six Integrations.”

I. Implement bundled advance payments for medical insurance and public health funding to strengthen the interest linkage in medical-prevention integration

Allocate the basic medical security fund for urban and rural residents and the funding for basic public health services to Medical Communities on a capitated, global prepaid basis, thereby solidifying the Medical Communities’ responsibility for integrating medical care with disease prevention. Surpluses from the prepaid funds shall be retained by the Medical Communities, while reasonable deficits shall be shared. Establish strong ties linking interests and responsibilities, and strengthen the mechanisms for benefit-sharing and joint liability within Medical Communities.

II. Establish Three Management Lists to Clarify the Responsibilities, Rights, and Interests within the Medical Consortium

First, establish a list of governmental responsibilities for operating healthcare institutions. Strengthen the government’s leadership and assurance responsibilities in running healthcare services, and clearly define the government’s roles in the planning, development, construction, subsidization, and debt resolution of public medical and health institutions.

Second, establish an internal operational management checklist for the medical consortium. Strengthen the “Four Clarifications,” namely clarifying that the legal entity status, functional positioning, employee identity, and funding channels of member institutions within the medical consortium remain unchanged. Implement the “Eight Unifications,” namely unified administration, human resources, financial management, medical services, health insurance management, pharmaceutical and medical device management, information systems, and performance evaluation across the medical consortium.

Third, establish a comprehensive regulatory checklist for external governance. Implement the government’s managerial and supervisory responsibilities over medical institutions by developing a comprehensive regulatory checklist that clarifies regulatory content, elements, processes, and other aspects, thereby strengthening the development of professional ethics and conduct.

III. Streamline the Six Key Steps in Public Healthcare Access to Alleviate Difficulties and High Costs in Seeking Medical Care

First, to achieve vertical integration of expert resources. Residents in townships can access medical expert services at the county level.

Second, achieve vertical integration of medical technologies. Diagnosis and treatment of common and frequently occurring diseases, Level I and II surgeries, and traditional Chinese medicine services are to be addressed at the primary care level.

Third, achieve vertical integration of pharmaceutical supply chains. The lead hospital shall establish a central pharmacy for the medical consortium to ensure the effective supply and rational use of medications at township health centers.

Fourth, achieve vertical integration of reimbursement policies. Implement tiered medical insurance reimbursement policies for the hierarchical diagnosis and treatment system, with higher reimbursement rates at township health centers for appropriate conditions.

5. Achieve seamless two-way referral between upper- and lower-level medical institutions. Tertiary hospitals assign dedicated staff to track and manage patients involved in two-way referrals, ensuring more continuous care.

Sixth, achieve vertical integration of public health services. The medical consortium integrates public health resources such as disease control and prevention, maternal and child health care, etc., to improve the quality of primary-level public health services.

This year, Anhui Province is advancing the development of closely integrated county-level medical communities in 37 counties, with a plan to fully achieve their transformation and upgrading by 2020, thereby creating Version 3.0 of county-level medical communities.

In recent years, under the guidance and support of the National Health Commission, Fujian’s healthcare reforms have focused on institutional mechanisms and strengthened the “three-medical linkage,” achieving positive results.

Continue to advance the “Three-Medical Linkage” reform.First, adhering to the principle of high quality and reasonable pricing, we have deepened pharmaceutical reforms. We established a provincial sunshine price-capped procurement platform for pharmaceuticals and medical consumables, a unified drug settlement platform, and a “Two-Invoice System” traceability mechanism, thereby strengthening supervision over drug procurement and usage. We actively implemented the national pilot programs for centralized volume-based procurement and utilization of drugs. Meanwhile, we dynamically adjusted medical service prices through a “vacating the cage to change the bird” strategy; in recent years, medical service prices have been adjusted 21 times across the province, including four adjustments in provincial public hospitals, involving a total amount of RMB 681 million.

Second, deepening healthcare security reforms with a focus on improving the efficiency of healthcare security fund utilization. First, a provincial-level pooling and adjustment system for the basic medical insurance fund for urban employees was established. This year, the provincial adjustment fund was raised at 30% of the actual premiums collected in each locality during the current year. In the first quarter, a total of RMB 2.563 billion was centrally pooled, benefiting seven pooling areas and receiving positive feedback. Reforms to healthcare security payment methods were implemented, with over 700 disease types covered under province-wide diagnosis-related group (DRG)-based payment and charging systems. Among these, Sanming City implemented 796 C-DRG groups, covering 67.24% of discharged patients. A total of 417 medical institutions across the province have been included in the national networked settlement system.

Third, deepening healthcare reform with a core focus on improving medical quality and standards. All public hospitals across the province have initiated reforms of their internal operational mechanisms, using the annual target salary system for hospital directors as an entry point. This year, management measures for total wage bills and chief accountants in provincially administered hospitals were revised and improved. Performance assessments for tertiary public hospitals were advanced, and 44 hospitals were selected to pilot modern hospital management systems. Efforts to achieve “dual high” excellence in medical services and to establish National Medical Centers and Regional Medical Centers were implemented, striving to ensure that patients with complex and critical conditions receive treatment within the province. In conjunction with the implementation of the World Bank’s healthcare reform project, all 41 county-level medical consortia in the province have entered substantive operation. In Youxi County, an early pilot site, outpatient and emergency visits at primary care facilities increased by 34.29% year-on-year in 2018, while referrals outside the county decreased by 35.64% year-on-year. Places such as Zhangzhou City have fully completed the standardized construction of public village clinics, achieving universal health insurance coverage at the village level.

Strengthen the Support Capacity for Healthcare Reform.Strengthening the development of medical and health personnel, particularly at the grassroots level, the province saw an increase of 0.33 licensed (assistant) physicians and 0.52 registered nurses per 1,000 population in 2018 compared with 2014. Advancing national health informatization, Fujian was designated as a national demonstration province for “Internet Plus Medical Health.” Promoting diversified healthcare provision, privately operated hospitals accounted for 20.6% of hospital beds across the province. The comprehensive reform pilot of the Provincial Center for Disease Control and Prevention has been launched to explore deeper reforms in the field of public health.

Through sustained efforts, the results of healthcare reform in Fujian Province have continued to emerge: In 2018, key indicators such as life expectancy, maternal mortality rate, and infant mortality rate remained at relatively high levels nationwide; public satisfaction with public hospitals increased by 1.6 points year-on-year, reflecting an overall satisfactory level. The proportion of medical service revenue rose by 10.52 percentage points compared to the pre-zero-markup period, with this indicator reaching 42.05% in Sanming City. The number of general practitioners per 10,000 people increased by 0.46 year-on-year. Over the past five years, the average annual growth rate of wage income for medical staff in public hospitals across the province was approximately 12.5%. Outpatient and emergency visits at county-level hospitals increased by 4.73%, indicating a positive shift in patient flow.

To address the challenges posed by the coexistence of large cities, vast rural areas, extensive mountainous regions, and major reservoir areas, as well as the uneven distribution of medical resources, we will leverage grassroots informatization to promote the decentralization of high-quality medical resources, thereby enhancing the equity and accessibility of healthcare services.

Build platforms to accelerate information interconnectivity.Established a two-tier population health information platform at the municipal level and across 38 districts and counties. The municipal platform has passed the national Class 3A certification for provincial-level platforms, accumulating over 30 million electronic health records (EHRs) and more than 20 million electronic medical record (EMR) entries. By integrating 13 business systems—including population information, EMRs, and EHRs—a unified “single network” for health information has been formed, enabling cross-regional and cross-institutional interoperability, data sharing, and authorized access.

Promote the decentralization of healthcare resources and vigorously develop telemedicine.To address issues such as the inconvenience for residents in remote areas to access medical care and the shortage of professional technical personnel at the primary level, we should vigorously develop telemedicine using medical consortia as the vehicle, establish a three-tier telemedicine service system comprising city, district/county, and primary levels, and extend the supply chain of healthcare resources.

At the municipal level, a telemedicine collaboration network has been established with tertiary Grade A hospitals in the city as the core, connecting district and county hospitals and selected primary healthcare institutions. Chongqing is home to three affiliated hospitals of the military, which also participate in the development of medical consortia. At the district and county level, regional remote diagnosis and treatment centers are built based on district- and county-level hospitals, implementing a service model of “primary-level examination and higher-level diagnosis.” For example, Nanchuan District leveraged the tertiary Grade A advantages of its District People’s Hospital to establish five major centers: remote electrocardiography, remote imaging, pathological diagnosis, clinical laboratory testing, and sterile supply distribution. Additionally, automated biochemistry analyzers, B-mode ultrasound systems, and DR or CR equipment were provided to primary healthcare institutions, cumulatively serving 200,000 patient visits from grassroots facilities.

Currently, 90% of the districts and counties across the city have implemented telemedicine services, with remote electrocardiogram (ECG) coverage extending to over 70% of these areas. Thirteen districts and counties have established regional imaging centers, facilitating more than one million remote diagnoses annually. This enables residents in remote mountainous regions to access high-quality diagnostic and treatment services from major hospitals without leaving their local communities. The rate of medical visits within county-level jurisdictions has reached 91.2%, basically achieving the goal that patients with serious illnesses can be treated within their own counties.

Enhance Quality and Innovate Informatics-Based Services for Public Convenience and Benefit.Integrate and enhance the functions of regional health information platforms to provide services such as appointment scheduling, online payment, and personal health record inquiries, thereby enabling data to “do the running” so that patients need to make fewer physical visits. Over 80% of hospitals at Level II and above have implemented various appointment-based diagnosis and treatment services, and ten “Smart Hospitals” have been established. A mobile application for family doctor contract services has been launched, facilitating real-time interactions between residents and doctors, including online contracting, health consultations, chronic disease follow-ups, and video calls. This provides comprehensive, full-lifecycle health services to the public. Additionally, by leveraging facial recognition and GPS geolocation systems, the platform enables online transmission of medical service process images, thereby enhancing the authenticity and quality of contracted services.

Strengthen regulatory oversight and enhance the level of informatization management. A municipal-level healthcare reform monitoring information system has been established, involving interface modifications based on existing Hospital Information Systems (HIS) and financial systems in hospitals. All public hospitals within the city (excluding military hospitals) have been fully integrated into the municipal healthcare reform monitoring platform. The system incorporates 116 basic monitoring indicators—such as average cost per visit, medical revenue and expenditure, health insurance reimbursement, and referral patterns between different levels of care—as well as over 40 analytical monitoring indicators. This enables comprehensive, real-time, dynamic monitoring of the entire patient journey from admission to discharge. The monitoring system has been applied to carry out tasks including DRG-based performance evaluation, centralized prescription review, regulation of medical practices, and healthcare reform monitoring, thereby improving the level of informatized and refined management.

Basic Practices.First, establish a unified regulatory platform. In January 2017, Sichuan Province leveraged the National Population Health Information Platform to develop and launch the Medical “Three Supervisions” Platform. This platform connects more than 7,000 medical institutions at various levels and types, integrating data from diagnosis and treatment services, medical record front pages, and direct statistical reporting, thereby achieving real-time, dynamic, and precise end-to-end supervision of medical service behaviors.

Second, scientifically establish regulatory indicators. Six categories comprising 36 specific regulatory indicators have been established, covering practice qualifications, medical proficiency and quality, resource efficiency, appropriate conduct, and cost monitoring. Based on the nature of the indicators and regulatory requirements, tiered supervision and categorized application are implemented. These regulatory indicators are subject to dynamic management and will be revised and adjusted as appropriate based on evolving circumstances.

Third, establish an effective operational mechanism. A total of 18 institutional documents, including the Implementation Guidelines for the “Three Supervisions” in Healthcare, have been successively issued. Six mechanisms have been established, covering data collection, data analysis, verification and rectification, on-site investigation, adjudication, and accountability. Three working groups—focused on data analysis, on-site verification, and adjudication—have been formed. A workflow of “daily collection, weekly analysis, and monthly enforcement” has been implemented, achieving intelligent, paperless, and mobile closed-loop operational management.

Work Effectiveness.First, medical services have become increasingly standardized. Compared with the initial phase of regulatory implementation, both the number of problem clues and verified issues have shown a dual decline: unreasonable problem clues decreased by 83.5%, and verified unreasonable issues dropped by 81.07%. The number of Diagnosis-Related Groups (DRGs) across the province has reached 735, an increase of 23 groups, while the mortality rate in low-risk groups has decreased by 0.19 percentage points compared to the beginning of the system’s implementation. The outpatient antibiotic usage rate has declined by 2.76 percentage points, and the proportion of pharmaceutical costs in total medical expenses has fallen from 33.6% at the start of implementation to the current 27.33%.

Second, a deterrent posture has been largely established. Since the launch of the “Three-Supervision” framework for healthcare, the regulatory platform has screened over 600,000 clues of suspected irregularities, ordered medical institutions to rectify 39,100 instances of non-compliant practices, identified more than 6,000 cases of unreasonable medical conduct, held over 5,700 healthcare professionals accountable, imposed administrative penalties on 29 medical institutions and 14 healthcare professionals, and significantly enhanced healthcare professionals’ awareness of practicing in accordance with laws and regulations.

Third, improved efficiency in industry regulation. A comprehensive regulatory mechanism for the medical services industry has been initially established, integrating resources such as hospital management, supervisory law enforcement, information statistics, and professional industry associations. This has effectively addressed the shortcomings of traditional regulatory approaches—characterized as “static,” “campaign-style,” “blanket,” and “migratory”—which were often extensive yet inefficient, thereby enhancing the capacity and level of industry oversight.

First, regarding the reform of public hospitals:All 10 prefecture-level cities and 83 counties in Shaanxi Province have established Public Hospital Management Committees. The system of director responsibility under the leadership of the Party committee has been actively implemented. More than 30% of secondary public hospitals and 10% of private non-profit hospitals have completed the formulation of their hospital charters. Fifty-four hospitals have undertaken pilot tasks for the modern hospital management system at both the central and provincial levels. Pilot reforms of the compensation system cover more than 40 secondary and tertiary public hospitals across 10 cities. Public hospitals achieving a balance between revenue and expenditure account for 78.99%, which is 11.5 percentage points higher than the national average.

Second, in terms of drug supply and guarantee:Full coverage of the “Two-Invoice System” for pharmaceuticals and medical consumables has been achieved in public hospitals. The pilot program for the Chief Pharmacist system is being steadily advanced, with its scope now covering 51 hospitals across four cities in the province. In Baoji City, the implementation of the Chief Pharmacist system led to an average reduction of approximately 10% in hospital pharmaceutical expenditures, along with significant improvements in prescription compliance and cost-control efforts. Meanwhile, a procurement alliance for pharmaceuticals and medical consumables was established in collaboration with 14 provinces (autonomous regions). The joint procurement prices for imported anticancer drugs decreased by an average of 11.3% compared to the previous listed online prices, resulting in cost savings of nearly RMB 100 million.

Based on national data from 2016, among nearly 200 million discharged patients, fewer than one-quarter were treated at primary care institutions, with the remainder receiving care at urban hospitals. This distribution is highly unreasonable and highlights the weakness of primary healthcare service capacity. In September 2017, Jiangsu Province took the lead in China by launching a community hospital development initiative. The construction of community hospitals does not entail replacing existing community health service centers or township health centers; rather, its core objective is to enhance the medical service capabilities of primary healthcare institutions. A comprehensive strategy is required, with workforce development as the central focus. Efforts should be strengthened in building the primary healthcare workforce, including aspects such as technical accreditation, medication usage, improvement of existing personnel’s competencies, and the decentralization of high-quality medical resources.

In 2018, 26 primary healthcare institutions in Jiangsu Province were established as community hospitals. What are the benefits of community hospitals? They enhance public trust in primary care by providing accessible medical services and truly achieving the integration of clinical care and prevention. Strengthening medical service capacity serves as the best guarantee for this integration. This approach not only builds a solid platform for the development of primary healthcare technical teams but also supports the establishment of a tiered diagnosis and treatment system.

Qinghai Province has established a multi-tiered medical security system,Established a five-tier healthcare security framework, with basic medical insurance as the foundation, critical illness medical insurance as a supplement, and medical assistance, emergency relief, and employee mutual medical aid serving as the safety net., leveraging the synergistic effects of various safeguard policies to establish a healthcare security system that is comprehensive, provides a basic safety net, multi-tiered, and sustainable. In terms of basic medical insurance, coverage levels have been continuously improved: the per capita funding standard for urban and rural resident basic medical insurance across the province has increased from RMB 104 in 2008 to RMB 858 this year; the policy-covered reimbursement rates at tertiary, secondary, and primary hospitals have risen to 70%, 80%, and 90%, respectively; and the enrollment rate has remained stable at over 98%.

In 2013, Qinghai Province took the lead nationwide in integrating the New Rural Cooperative Medical Scheme (NRCMS) with the Urban Resident Basic Medical Insurance, establishing a unified urban-rural resident basic medical insurance system characterized by “six unifications.” This included the consolidation of administrative bodies, policy measures, and medical insurance catalogs, while elevating the pooling level of urban-rural resident medical insurance to the provincial level. Regarding critical illness insurance, Qinghai adhered to a model combining government leadership with market mechanisms, fully leveraging the professional expertise of commercial insurance companies. Based on a comprehensive assessment of fundraising capacity, medical cost levels, and per capita disposable income of urban and rural residents, the province pioneered the implementation of a critical illness medical insurance system covering all urban and rural residents as well as urban employees across the entire province starting in December 2012. This system imposes no restrictions on specific diseases, and the per capita funding standard has been raised to RMB 95 this year.

Patients with major illnesses whose out-of-pocket medical expenses exceed the deductible threshold of RMB 5,000 after basic medical insurance reimbursement are covered by critical illness medical insurance, which provides an additional 80% reimbursement. For recipients of civil affairs assistance, the actual reimbursement rate exceeds 90%. Meanwhile, a critical illness insurance system for urban employees has been established. By the end of 2018, a total of RMB 1.46 billion in critical illness insurance benefits had been disbursed to 278,000 urban and rural residents with major illnesses.

Meanwhile, employee mutual medical assistance programs have been implemented. After urban employees receive benefits from basic medical insurance and critical illness insurance, they are provided with reasonable additional subsidies through the employee mutual medical assistance system, further alleviating the burden of medical expenses. In terms of medical assistance, policies have been continuously improved. Full integration of urban and rural funds, consistent policies, and unified standards have now been achieved, ensuring effective coordination with basic medical insurance and critical illness medical insurance. The coverage of medical assistance has gradually expanded beyond traditional civil affairs recipients to include urban and rural residents’ families impoverished by illness, while the level of assistance and service capacity continue to be enhanced.

Hunan Province has primarily focused on two key areas. First, it has worked to enhance the capacity for treating major diseases, with a particular emphasis on strengthening county-level healthcare services by addressing weaknesses and shoring up deficiencies. In recent years, the service capacity of county-level hospitals in Hunan has improved significantly, with the county-level hospitalization rate reaching 90.92%, marking a solid step toward ensuring that patients with serious illnesses can receive treatment within their counties. Second, regarding treatment, the province has targeted several conditions that pose the greatest threat to the health of its residents. For instance, cardiovascular and cerebrovascular diseases account for 45% of all deaths in Hunan. To address this, the province has strengthened the development of stroke centers and chest pain centers to improve treatment outcomes.

In the management of chronic diseases, such as end-stage renal disease (ESRD), treatment requires continuity, standardization, and long-term commitment, often entailing high costs. How can this condition be effectively managed through a tiered diagnosis and treatment system? Hunan Province has proposed a model characterized by “county-level treatment, township-level management, and village-level visits.” Under this framework, “county-level treatment” involves establishing peritoneal dialysis centers in all counties across the province, providing standardized training to ensure consistent quality of care. “Township-level management” means that all chronic diseases within the county are overseen by township health centers. “Village-level visits” refer to home-based peritoneal dialysis patients being regularly visited by village doctors. Following the implementation of this model, initial diagnoses are conducted by county hospitals. Since peritoneal dialysis is primarily performed at home, village doctors conduct daily visits to provide guidance and ensure the quality of treatment.

Preliminary statistics show that this single item has reduced costs by more than 40%. Secondly, it has made medical care more accessible for the general public. Previously, patients had to travel dozens or even hundreds of miles to county towns for treatment. Now, under the management of township health centers and with specific guidance from village clinics, patients can receive treatment at home. This model is worth promoting in rural areas.

Source: National Health Commission, China.org.cn, etc.; compiled by VCBeat.