A healthcare worker checks a boy’s ear health in a kindergarten in Chuzhou City, Anhui Province in March, 2022. Photo: CFP

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Good health is an essential prerequisite for a person’s all-round development. The health of the people is the foundation to a developing society, a prosperous country, and the great rejuvenation of the Chinese nation. The Resolution of the Central Committee of the Communist Party of China (CPC) on the Major Achievements and Historical Experience of the Party over the Past Century, adopted at the Sixth Plenary Session of the 19th Central Committee of the Communist Party of China on November 11, 2021, explicitly said that “we have advanced the Healthy China initiative across the board.” The 20th CPC National Congress continued to elevate the Healthy China initiative and the people’s health as a strategic priority for the country’s development going forward. 

New concept for health 

As times change, people’s understandings and perceptions of disease and health differ accordingly. Our comprehension of health directly influences our value orientation regarding health and what we are willing to do—or sacrifice—for the sake of health preservation, which consequently impacts resource allocation. 

Over a long period of time, human society’s perception of health evolved from “bodily health” to “a sound condition of body, mind, and society.” Accordingly, modern medicine also developed from treating illnesses of the body to treating physical, mental, and psychiatric conditions. Under the influence of these values, human society has been protecting health mainly by trying to understand diseases and developing diagnosis and treatment methods. However, this also reveals the intrinsic dilemma inherent in modern medicine—a focus on the disease instead of the patient. 

Against this historical backdrop, which is accompanied by accelerated population aging, the spectrum of disease has expanded significantly, with chronic diseases now normalized among elderly people. Living with chronic diseases for decades has become a universal phenomenon worldwide. Thus, it is necessary to change the way we look at health by establishing new values, while redefining health from an integrated and systematic perspective: healthy means being able to adapt and manage ourselves when our body, mind, society, or social interactions are challenged by the environment and being able to integrate our body and soul while establishing a harmonious, organized state between man and environment. 

The new health concept puts people first, builds and develops integrated health, and supports the ability to adapt to society. It highlights that health is not the opposite of illness, and the core of protecting health lies in exhibiting a person’s inner values and personal responsibility. It is also why the “Outline of the Program for Healthy China 2030” highlighted “jointly build good health for all.” Only when individuals take care of themselves can the goal of good health for all finally be achieved. 

Under the new health concept, three things need to be reconstructed within China’s health system. First, it is necessary to reconstruct individuals and communities’ systematic perspective on health, so that they pursue harmony of the body and mind, and harmony with the environment. Second, China needs to reconstruct the supply system for its healthcare service and shift its focus to maintaining health. Third, it is important to reconstruct the mechanism for health care resource allocation and center it around “disease prevention and boosting functionality,” while promoting preventive care, diagnosis, treatment, and health care services in an integrated way, to make full use of the limited resources of the health care system. 

Better resource allocation 

The “Outline of the Program for Health in China 2030” is the first national-level medium- and long-term strategic plan proposed since the establishment of the PRC. It has become the action plan for advancing the Healthy China initiative across the board, which requires active optimization of the resource allocation pattern. 

The prerequisites for ensuring that health is prioritized include optimizing the allocation structure for health-related resources, growing the entire society’s medical and health costs in an orderly manner, promoting sound interactions between health and economic development. “Putting health first” means that it is important to prioritize public health when allocating resources and governing the socioeconomic system. From the perspective of health investment and functional production, maintaining and promoting public health requires an input of corresponding resources. 

Theoretically, two kinds of effects exist between investing in the resources for public health and economic growth. For one thing, improving public health not only helps enhance labor productivity and promotes the accumulation of human capital, but also helps drive high-quality economic growth by promoting healthcare consumption, investment, and positive externality. Furthermore, resource inputs, used for improving and protecting public health, are a part of the limited resources for the larger economic and social system, the unreasonable growth of which will squeeze out the resources originally available for economic growth, and consequently have a negative impact on economic growth. 

In addition, economic growth and rising income levels can, improve public health thanks to improved diets and consumption of more nutritious food. Whether it’s the positive or the negative effects that health has bigger impact on economic growth is determined by both the total health input (cost) under a certain developmental phase and the resource allocation structure. To be specific, this refers to the balanced allocation of resources (human, material, and financial resources) between urban and rural areas, different regions, public health and medical systems, and different tiers of diagnosis and treatment system (first, second, and third tier medical institutions, as well as treatments among different groups of people). As the total health cost grows, China urgently needs to optimize its resource allocation structure in the health sector. The key to resolving the challenge of unaffordable health care in China is to adjust the structural imbalances in resource allocation, and boost the efficiency of medical resource allocation, both of which are the material basis for implementing the Healthy China initiative as the country enters a new development stage. 

As China’s economy enters a new development phase and starts to advance the Healthy China initiative across the board, it is necessary to solve the problem of expensive medical bills, optimize health care’s resource allocation structure, and improve the efficacy of allocating limited resources, to make sure that people’s health is protected at an affordable cost. 

Effective supply and demand 

On the one hand, we need to build a high-quality and efficient integrated health service model as the starting point to promote the supply-side reform of China’s medical and health service system. A quality and efficient integrated health service model places human health needs at the core, combines disease prevention, health management, disease treatment, care and rehabilitation services, and provides the public with specialized, smoothly connected, comprehensive and full life-cycle integrated health services. The integrated health service model highlights the fundamental position of disease prevention and the primary care medical system in maintaining health, which is the key to solving the problem of “difficult and expensive access to health care” and optimizing the allocation of health care resources to improve the overall efficiency of the health system. 

Taking into account international experience and the specific situation of China’s current fragmented healthcare services, we should empower each local community to explore unique models of vertical integration within the medical service system and horizontal integration with the disease prevention and rehabilitation system, according to local conditions. We need to explore and study the strategic relationships among various shareholders, such as different types of health service providers, the public, and health insurance authorities under different integration models, and seek win-win solutions for all parties. Because of the sharp economic and cultural differences among regions in China, each region has different capacities to bear the burdens and costs associated with the reform of the local health system. We need to explore and summarize health service integration models that are suitable for economic and social management and the cultural characteristics of different regions, and prudently implement them in similar regions. 

At the same time, we should strengthen talent training and cultivation systems and doctors’ career development at the primary healthcare level, and consolidate the status of the primary health care system as the “gatekeeper of health.” We will improve the training system for general practitioners, standardize training programs, improve the remuneration system and career development system for primary care doctors, and enhance the attractiveness of the primary health care system to outstanding health professionals, to fundamentally support the cultivation of talent and the development of systems for the primary health care system. 

Also, we should explore new models to guide the public’s reasonable demand for health services. Human society’s demand for medical and health services comes from the need for health, so the demand for health services is the “surface” and the need for health is the “root.” For a long time, China’s health care system has been backlogged with unreasonable treatment demands for mild diseases which is not only a subjective result of people’s distrust of primary care doctors, their professionalism, and their lack of knowledge about diseases and health, but also an objective factor linked to the difficulty of retaining good doctors at the grassroots level. The current demand-side management in China basically relies on financial incentives provided by higher medical insurance reimbursement rates to guide people to primary level medical institutions, which is often not effective as people’s living standards improve and their medical affordability increases. In such a context, China can explore a gradual reform. Based on the current “primary care bonus” approach, for a certain period of time, a primary care bonus can be given to people who follow a hierarchical principle for medical treatment. That means compensating people in need of medical care with superior input. In doing so, people can vote with their feet to choose the grassroots institutions with good service. This will, on the one hand, change people’s medical behaviors and motivate them to go to primary care physicians, and on the other hand, select the institutions with strong grassroots service capabilities by engaging with theses service providers. At the same time, the primary health care system no longer takes two lines of income and expenditure, but collects a “head fee” for patients. In addition, provinces and municipalities should combine medical data to establish a public credit system for medical care. 

Whether due to the implementation of the new concept of health, or the supply-side structural reform of healthcare services and demand management, all healthcare needs a series of institutional reforms and top-level design at the national level, local provincial, and municipal levels. We need to change China’s current “treatment rather than prevention” health service model, build a people-oriented, health-centered health system, and explore a government-led, socially concerted policy synergy system in the new development stage, in order to better achieve the goal of building a healthy China. 

Pang Ruizhi is a professor from the College of Economic and Social Development at Nankai University. 

 

 

Edited by WENG RONG