Organization of Healthcare in China and its Reforms

International audienceThe structure of healthcare supply in China is very specific. Indeed, as of 2011, more than 85% of all health personnel worked in public healthcare institutions. In addition, public hospitals provide a very large part of outpatient services on top of their inpatient provision. The goal of this chapter is to explain the reasons behind this very high provision and its consequences. The background presented makes a clear differentiation between rural and urban areas. For each geographical area, a historical and longitudinal reading aims at explaining the current situation. Shortly after the creation of the People’s Republic of China in 1949, a healthcare system organized in three tiers, known as the Community Medical System (CMS), was set up in rural locations. Patients had to enter the system through the first tier and were then funnelled into other tiers for the more severe cases. Patients whose affliction required very specific treatment were transferred to urban areas, into provincial or central hospitals. In urban areas, from 1949 to 1980, healthcare access was organized at company level. If, today, the general organization of the healthcare system remains in rural areas, economic as well as administrative reforms have deeply reshaped access to healthcare in these structures