REVIEW article
Front. Public Health
Sec. Public Health Policy
Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1606842
This article is part of the Research TopicHealth Policy Approaches to Chronic Disease ManagementView all 7 articles
A Scoping Review of National Policies for Hierarchical Medical System in China Since the 2009 Health Reform
Provisionally accepted
- Schools of Medicine and Nursing Sciences, Huzhou University, Huzhou, China
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AbstractBackground Universal health coverage (UHC) is driving the global health agenda. In 2009, the Chinese government launched a new round of healthcare reform towards UHC, and made remarkable progress in UHC through the establishment of a hierarchical medical system (HMS). We aim to summarize and review the evolution of China's hierarchical medical system policy.Methods Eligible policies were identified between March 7, 2009 and December 31, 2022, by searching the official websites of the PKULAW Database, the Chinese State Council, and related ministries. Policy screening and data extraction were conducted by two researchers independently and discrepancies were resolved by consensus. Policy maker, policy initiatives, policy instrument, policy structure and evolution were visually analyzed. The people-centered integrated care model was used as the framework for analysis. Results 150 policy documents were included, most of which were issued in the 13th Five-Year Plan. There were 14 ministries involved in policy making, and they cooperated with each other, led by the State Council, with the National Health Commission and the National Administration of Traditional Chinese Medicine as the core. The pattern of policy making was top-down and bottom-up. Several areas showed to have strong policy support, including reforming the healthcare service delivery system, strengthening the primary health care workforce, reforming the health insurance system, and digitizing the health care system. Supply-side and environmental policy instruments were used the most while demand-side policy instruments were used the least.Conclusions Over the past decade, China continues to demonstrate its policy commitment and completed the transformation from local pilot to national promotion. Based on the results of the study, we propose the following recommendations: (1) a unified policy framework is necessary to coordinate the development and regulation of hierarchical medical system and facilitate multi-sectoral cooperation, (2) in-depth reforms in the key regions in hierarchical medical system, such as public hospital reform, medical insurance payment, (3) balance the use of various policy instruments, giving full consideration to the characteristics of hierarchical medical system at different stages.
Keywords: China, Health reform, hierarchical medical system, policy review, policy
Received: 06 Apr 2025; Accepted: 30 Jun 2025.
Copyright: © 2025 Cai, Hua, Fang, Xia, Shen and Lou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Jiantong Shen, Schools of Medicine and Nursing Sciences, Huzhou University, Huzhou, China
Jianlin Lou, Schools of Medicine and Nursing Sciences, Huzhou University, Huzhou, China
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