Health and Healthcare in China: An Editorial Introduction

Health and healthcare sector is a growing part of the national economies worldwide. China is no exception, with a total health expenditure estimated to reach 3 trillion Renminbi (RMB, 1 RMB1⁄4$0.16 as of October 16, 2021) in 2015 (Li & Fu, 2017) and projected to continue growing. The Chinese government announced in August 2016 an ambitious “Healthy China 2030” blueprint to ensure health security for all its 1.4 billion citizens, further highlighting the importance of the healthcare sector in China. Health and healthcare is an intricate system itself, with a multitude of stakeholders that can be summarized into 5Ps, that is, payers, patients (current or prospective), providers, producers (of medical devices and drugs), and policymakers. Since China’s policymakers rolled out the new round of healthcare reform in 2009, payers have played an enlarged role in the healthcare system, with the establishment of three health insurance schemes and, more recently, the creation of the National Healthcare Security Administration. Health insurance coverage has reached about 95% of the population, providing patients basic health security (Yip et al., 2019). An example is the improved coverage of healthcare services among rural residents brought by the New Cooperative Medical Scheme, now merged with the Urban Resident Basic Medical Insurance Scheme (Li et al., 2019). China’s healthcare reform has also strived to address the issues related to providers and the misaligned incentives between providers, producers, and payers. For instance, China’s hospital reform has attempted to reduce bypassing (Li et al., 2021), improve efficiency, and lower the overuse of prescription drugs and devices with improved payment design. The four articles in this special issue of the Chinese Economy have addressed the 5Ps with novel insights and innovative methods. They have examined health services use and expenditures among middle-aged and elderly residents with hypertension, the demand for an integrated healthcare provider system as a result of the comorbidities associated with mental health, health insurance coverage of migrant workers in China, and governance and innovation in China’s pharmaceutical sector. The noncommunicable disease has become the major underlying cause of mortality, accounting for 89.5% of all deaths in China in 2017 (Liu et al., 2020). Among the noncommunicable diseases, hypertension is a chronic condition that can be prevented and prevented from further progression by lifestyle interventions. Xu et al. examine the cost and healthcare service utilization associated with the comorbidities of hypertension (Xu et al., 2022). They use data from the National Health Services Survey to estimate the association between disease status and health services use by using a generalized estimating equations method. They find that rural residents with hypertension comorbidities are more likely to use healthcare services than their urban counterparts after controlling age, sex, and other confounders. The authors call for more efforts in promoting secondary prevention and integrated care for comorbidities among patients with hypertension, and provide payer, provider, and policymakers evidence for such interventions.