Deepening Health Reform In China - World Bank

Deepening Health Reform In China

Building High-Quality And Value-Based Service Delivery

Policy Summary

China Joint Study Partnership World Bank Group, World Health Organization, Ministry of Finance, National Health and Family Planning Commission, Ministry of Human Resources and Social Security

2016

Contents

Foreword. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Executive Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Abbreviations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxv Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxvii

Background: Impressive Gains in Health Outcomes,

but Substantial Challenges Ahead

1

Aging, chronic disease, and risk factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Quality of care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Inefficient service delivery: hospital-centrism, fragmentation and Distorted incentives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Risk of low value care: Diminishing gains in health with escalating Health spending . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Spending projections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Part I Service Delivery Levers

17

Shaping tiered health care delivery system in accordance

with People-Centered Integrated Care Model (Lever 1)

19

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Challenges. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

DEEPENING HEALTH REFORM IN CHINA

iii

iv

DEEPENING HEALTH REFORM IN CHINA

Core action areas and corresponding implementation strategies for developing and implementing PCIC-based service delivery model: lessons from international and national experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Improving Quality of Care in Support of People-Centered

Integrated Care (Lever 2)

35

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Challenges to Improving Quality of Care in China. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Recommendations for Improving the Quality of Care . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Engaging Citizens in Support of the People-Centered

Integrated Care Model (Lever 3)

49

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Challenges to engaging citizens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50

Recommendations: Strengthening Citizen Engagement . . . . . . . . . . . . . . . . . . . . . . . . . 51

Reforming Public Hospitals and Improving their Performance

(Lever 4)

65

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65

Challenges and lessons in Public Hospital Governance and Management in China. . . . 66

Recommendations for moving forward with public hospital reform: Lessons from Chinese and international experience. . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Part II Institutional and Financial

Environment Levers

77

Realigning Incentives in Purchasing and Provider

Payment (Lever 5)

79

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Key Challenges in Purchasing Health Services and Paying Providers. . . . . . . . . . . . . . . 80

Recommendations for Realigning Incentives in the Health System in China . . . . . . . . . 82

Strengthening Health Workforce for People-Centered

Integrated Care (Lever 6)

89

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Key Challenges in the Human Resource Management in China. . . . . . . . . . . . . . . . . . . 90

C ontent s

v

Recommendations for Moving Forward with Human Resources Reform: Lessons from Chinese and International Experience. . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Strengthening Private Sector Engagement in Production and

Delivery of Health Services (Lever 7)

97

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Key Challenges. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99

Recommendations for Strengthening Private Sector Engagement in Production and Delivery of Health Services: Lessons from Chinese and International Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102

Modernizing Health Service Planning to Guide Investment

(Lever 8)

107

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107

Key Capital Investment Challenges in the Health Sector in China. . . . . . . . . . . . . . . . . . . . 108

Recommendations for Moving Forward with Service Planning Reform: Lessons from Chinese and International Experience. . . . . . . . . . . . . . . . . . . . . . . . . . . . 110

Part III Moving Forward with Implementation

117

Strengthening Implementation of Service Delivery Reform

119

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Implementation Challenges. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 An Actionable Implementation Framework. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Moving Forward: Spreading Effective and Sustainable Implementation at the Local Level . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Toward a sequential reform implementation plan for reaching full scale in China . . . . . . 132

Annexes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Annex 1 Levers and Recommended Core Actions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Annex 2 Government Policies In Support of the Eight Levers. . . . . . . . . . . . . . . . . . . . . 138 Annex 3 New Policy Guidelines on Tiered Service Delivery (Guo Ban Fa [2015] NO.70) and Recommended Core Actions. . . . . . . . . . . . . 142 Annex 4 Nomenclature and Summaries of 22 PCIC Performance Improvement Initiatives. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Annex 5 Impact Frequency of Studies on PCIC Initiatives (no. of studies). . . . . . . . . . . . 147

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

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