The evolution and future trajectory of public hospital reforms with a public-welfare orientation in China

TL;DR

This paper analyzes the history and future of public hospital reforms in China, emphasizing the importance of maintaining a public-welfare focus for successful healthcare transformation.

Contribution

The study integrates historical and policy analysis to provide a novel framework for understanding China's public hospital reforms and their public-welfare orientation.

Findings

Public hospital reforms in China have evolved through four distinct stages shaped by socioeconomic changes.

Restoring and maintaining public-welfare orientation is crucial for successful healthcare reforms.

Collaborative governance and tripartite linkage among medical services, insurance, and pharmaceuticals are recommended to align reforms with public-welfare goals.

Abstract

As a cornerstone of the healthcare system, public hospital reforms in China represent a complex and critical endeavor, shaped by the nation’s evolving socioeconomic landscape. This paper employs a methodological framework of historical and policy analysis to examine the evolution of public hospital reforms in China. It traces the trajectory of these reforms against the backdrop of the country’s socioeconomic development across different periods and identifies four distinct stages: (1) the government-led system foundation stage (1949–1978), (2) the market-oriented phase marked by a gradual weakening of public-welfare nature (1979–2004), (3) the period of reflection and readjustment toward restoring public-welfare orientation (2005–2020), (4) the ongoing stage of deepening reform centered on reinforcing public-welfare nature (2021–present). A key contribution of this study lies in its integration of historical and policy perspectives, addressing a significant gap in the comparative literature on health system reforms. The analysis concludes that upholding public-welfare nature as the core principle is essential for evaluating the success of future reforms. To address existing policy barriers, the study proposes establishing a collaborative governance mechanism and strengthening the “tripartite linkage” among medical services, health insurance, and pharmaceuticals, coupled with a reconstruction of incentive systems to better align with public-welfare objectives. These insights offer valuable lessons for other developing countries pursuing similar health system transformations under complex socioeconomic conditions.