What does it take to improve nationwide healthcare quality in China?

Despite the great strides that have been made during China’s recent healthcare reform to improve access to healthcare,1 substantial gaps in quality persist.2 In a study of 33 tertiary hospitals in China, Jian and colleagues reported no improvement in most process indicators on healthcare quality for acute myocardial infarction, cerebral ischaemic stroke, chronic obstructive pulmonary disease and bacterial pneumonia, from 2013 to 2018.3This study provides the most contemporary evidence of quality trends during a 5-year period after the launch of China’s healthcare reform. More importantly, it covers a broad set of treatments for four common clinical conditions that are commonly used for assessing healthcare quality.4–9 The poor performance and lack of improvement in Chinese hospitals revealed in this study aligns with prior findings. In a nationally representative study on ST-segment elevation myocardial infarction (STEMI) from 2001 to 2011, no improvement was found in in-hospital mortality outcomes, which may be a result of the continued underuse of reperfusion therapy and other recommended treatments.10 Through comparisons between urban and rural hospitals, the same study also found that despite differences in treatment and the availability of advanced facilities, outcomes for patients admitted to rural hospitals were similar to those of patients who were admitted to urban hospitals, indicating that the additional resources available at urban hospitals did not result in greater benefits to patients.11 Given the tremendous political commitment and financial investment in China’s healthcare reform during the past decade, it is critical to understand how to improve nationwide healthcare quality. An important step toward improvement is to understand the reasons underlying the current quality of care in China. Overall, performance measurements are inadequate.2 The government established a nationwide claims data system—the Hospital …