THE ROLE OF PATIENT VALUE AND PATIENT-CENTRED
CARE IN HEALTH SYSTEMSgoals of this reform has been to move the country from a fragmented, hospital-focused healthcare
system with low levels of access to a multi-tiered one based around primary care providing the bulk
of treatment.^62
Patient-centricity has an even longer history in Chinese policy. Since as early as 1997 it has been a major
goal of health policy.^63 Gordon Liu—professor of economics at Peking University National School of
Development, who has advised state officials on aspects of health reform—explains that “when the
healthcare system is being discussed in China, policymakers always talk about how to better serve
patient demands for better access to better quality of care including facilities, devices, prescriptions
and shorter waiting times.”
Healthcare reform efforts have secured some important accomplishments. In 2002, for example, only
10% of the population had access to even basic health insurance, but now that figure is over 95%.^64 In
addition, substantial investment has gone into creating primary care infrastructure. The number of
community health centres in the country, urban primary care facilities, rose from 24,260 in 2008 to
34,238 in 2014.^65 More striking, between 2008 and 2015 annual government subsidies to primary care
institutions overall rose more than sevenfold to US$20.3bn.^66
Despite such improvements, though, the country is far from having patient-centred, or even integrated
care provision. A joint study by the World Bank, WHO and various Chinese government ministries
recently called the country ’s health system “hospital-centric, fragmented and volume driven. Service
delivery has a strong bias toward doing more treatment than improving population health outcomes
and serving more people at hospitals rather than at grassroots levels.”^67
As for patients themselves, the report said that “a much-needed comprehensive, system-wide
approach to engage citizens in health, with well-defined roles for patients and providers, is still missing.
China’s health system needs to become more patient-centred. Concerns about quality of care and
providers not acting in the patient’s interest have eroded citizen trust in the system.”^68
A muffled patient voice
Many reasons help explain the failure of policy since 1997, and the 2009 reforms in particular, to create
the aimed-for integrated health system. One is of particular relevance to this report.
The patients themselves remain noticeably absent from efforts to shape transformation. Patient-
centred care, for example, as understood in Chinese policy at least until 2010, has revolved around
ordering hospitals to provide better service rather than encouraging clinicians to co-create care with
patients.^69
Attempts at change in recent years have been made with evident sympathy for patients: Mr Liu notes
that policymakers take note of media reports and academic research on patient difficulties with the
system, such as families suffering from catastrophic costs. Nevertheless, he explains that there is “a lack
of formal platforms or transparent channels through which people can have their voices feed into the
62 Zhu Chen, “Launch of the health-care
reform plan in China,” Lancet, 2009.
63 Jingqing Yang, “The side-effects of China’s
patient-centred healthcare reform,” Social
Policy Association [UK] conference paper,
2010; Central Committee of the Communist
Party of China, 关于卫生改革与发展
的决定 [Decision on health reform and
development], January 15th 1997.
64 Gordon Liu et al, “China’s Health Reform
Update,” Annual Review of Public Health,
2017.
65 National Bureau of Statistics China,
“Health Care Institutions,” Table 22-1, China
Statistical Yearbook 2015, 2015.
66 Xi Li et al, “The primary health-care system
in China,” Lancet, 2017.
67 Deepening Health Reform In China:
Building High-Quality And Value-Based
Service Delivery, 2016.
68 Ibid.
69 Jingqing Yang, “The side-effects of China’s
patient-centred healthcare reform,” Social
Policy Association [UK] conference paper,
2010.