China's healthcare system mainly comprises the healthcare services sector, the healthcare insurance sector, and the drugs and medical equipment sector, which are supervised by three separate government departments. Specifically, the PRC National Health Commission (NHC)2 is responsible for supervising the medical institutions and medical services industry, the Ministry of Human Resources and Social Security is responsible for formulating the basic healthcare insurance system and policy and for managing healthcare insurance funds, and the National Medical Products Administration (NMPA)3 is responsible for drug and medical equipment registration and supervision.
The healthcare economyi General
Healthcare services can be divided into basic healthcare services and special healthcare services, depending on the scope of coverage and the extent of the specific services.Basic healthcare services
Basic healthcare services consist of basic public healthcare services and basic medical care services, which the government provides free of charge. The scope of basic public healthcare services in China has been revised and expanded since the launch of China's healthcare reforms in 2009. The National Basic Public Healthcare Service Standard, promulgated in 2017, stipulates that basic public healthcare services consist of 13 types of services, including residents' health file management, vaccinations, healthcare administration for special groups (children aged under six, pregnant women, the elderly, and patients with hypertension, type 2 diabetes, severe mental disorders and tuberculosis), infectious diseases and public healthcare emergency reporting and treatment. In December 2019, the Law on Promoting Basic Medical and Health Care was promulgated to further the development of medical, hygiene, and healthcare services and ensure citizens' access to basic medical and healthcare services.Special healthcare services
In addition to basic healthcare services, the Chinese healthcare system also includes special healthcare services. Special healthcare services refer to medical services provided by medical institutions to satisfy special medical needs, such as special surgical operations, full nursing care, special wards, specialist outpatient services and medical cosmetic surgery.ii The role of basic medical insurance
China's basic medical insurance system currently consists of basic urban employee medical insurance and basic medical insurance for urban and rural residents. Basic urban employee medical insurance is compulsory for all urban employers and employees. Meanwhile, all urban and rural residents who are not covered by basic urban employee medical insurance may choose to purchase basic medical insurance for urban and rural residents, including personnel under the flexible working hour system who have difficulty participating in basic urban employee medical insurance. By the end of 2020, the number of people participating in the two basic medical insurance schemes reached 1.36 billion, with the coverage stabilising at over 95 per cent of the population of China.4iii Funding and payment for special healthcare services
In addition to basic healthcare services, both public and non-public medical institutions also provide special healthcare services to satisfy non-basic medical needs. However, the amount of special healthcare services provided by a public medical institution cannot exceed 10 per cent of all healthcare services it provides.
Under the current basic medical insurance system in China, the national medical insurance system does not cover the cost of special healthcare services. Such costs are to be directly undertaken by the individuals incurring the costs or reimbursed under commercial health insurance.5
Primary/family medicine, hospitals and social carei China's healthcare service system
China's healthcare service system is developed under a dual structure for urban and rural areas. The rural healthcare system is composed of three levels of medical institutions, which are county hospitals, township hospitals and village clinics. The urban healthcare system is also made up of three levels of medical institutions, which are regional central hospitals, community healthcare service centres, as well as clinics and infirmaries. Densely populated cities also have tertiary hospitals with more advanced technologies and equipment. The entire healthcare service system is known as the 'dual and three grades' system.ii Graded treatment system
In China, patients can freely choose hospitals to receive medical treatment. However, public hospitals have often been overcrowded because they possess better medical resources.6 By contrast, community hospitals are less frequently visited, although they provide more accessible and convenient healthcare services to residents. In response to this issue, the Guiding Opinions on Promoting Graded Medical Treatment System Construction was promulgated in 2015 to alleviate overcrowding and promote the rational allocation of medical resources. The guiding opinions describe the establishment of a graded medical treatment system including initial diagnoses at community medical institutions, two-way referrals, divisions for acute and chronic diseases, and communications between institutions. At present, China is promoting the implementation of such graded medical treatment system by building medical consortiums.7
Meanwhile, China is actively establishing and improving the healthcare services system for the elderly: community healthcare service centres provide continuous health management and medical care; general medical institutions are convenient for the elderly to make appointments with doctors; in addition, elderly care institutions that meet certain conditions may establish geriatric disease hospitals, rehabilitation centres and nursing homes that, if qualified, may be designated as being within the scope of basic healthcare insurance for urban and rural residents.8 Additionally, China supports pension institutions to establish medical institutions and medical institutions to establish pension institutions.9iii Application of electronic medical records
Electronic medical records are an important means to promote healthcare services informatisation and will help to improve the quality and efficiency of medical services. In 2010, the Ministry of Health, a predecessor to the NHC, initiated work on its hospital informatisation construction pilot scheme, focusing on the promotion of electronic medical records.10 Since then, the use of electronic medical records has become more popular across the country. In 2017, the National Health and Family Planning Commission, also a predecessor to the NHC, promulgated the Regulations on the Management of Electronic Medical Records Applications (for Trial Implementation), which stipulate a series of requirements for the content, writing and saving, use and storage of electronic medical records. The regulations, together with a series of supporting national and industry standards for electronic medical record systems, data management and medical terminology, constitute the framework for the management of electronic medical records in China. At present, the NHC continues to promote the nationwide digitisation of medical records in medical institutions, such as by evaluating the levels of electronic medical records management at different medical institutions.iv Personal information protection
China has gradually established and improved its personal information protection system through the promulgation of legislation, judicial interpretations, rules and voluntary national standards, including the Data Security Law, the Cybersecurity Law, the Interpretation of Several Issues concerning the Application of Law in the Handling of Criminal Cases of Infringement of Citizens' Personal Information, the Measures for Determining the Illegal Collection and Use of Personal Information by Apps, and the Information Security Technology – Personal Information Security Specification (GB/T 35273-2020). The PRC Civil Code, which came into force in January 2021, has a specific chapter that provides for the protection of personal information, laying the foundation for the enactment of laws such as the Personal Information Protection Law.
Meanwhile, special attention has been paid to the healthcare sector with respect to personal information protection. The Provisions on Administration of Medical Records in Medical Institutions, promulgated in 2013, require medical institutions and their medical staff to keep strictly confidential personal information contained in patients' medical records and not to disclose personal information for non-medical, teaching or research purposes. The Measures for Administration of National Health and Medical Big Data Standards, Security and Services (for Trial Implementation), promulgated in July 2018, require local storage of health and medical big data. Furthermore, in accordance with the Regulations on Administration of Human Genetic Resources, if the relevant personal information is classified as human genetic resources information, any collection, preservation, utilisation and disclosure thereof shall comply with certain requirements, including ethical reviews, prohibition on purchase and sale, prohibition on collection or preservation by foreign or foreign-controlled organisations, individuals or institutions, and prohibition of cross-border transfers. Additionally, the Information Security Technology – Personal Information Security Specification, a voluntary national standard revised in October 2020, lists personal medical treatment records as personal sensitive information, and recommends additional measures to be taken for the transfer, storage, access control, processing, sharing and transfer of personal sensitive information. The Information Security Technology – Guide for Health Data Security, a voluntary national standard that came into effect in July 2021, provides further guidance for the use and protection of personal health and medical information.