Chinese health care system and clinical epidemiology

Abstract

China has gone through a comprehensive health care insurance reform since 2003 and achieved universal health insurance coverage in 2011. The new health care insurance system provides China with a huge opportunity for the development of health care and medical research when its rich medical resources are fully unfolded. In this study, we review the Chinese health care system and its implication for medical research, especially within clinical epidemiology. First, we briefly review the population register system, the distribution of the urban and rural population in China, and the development of the Chinese health care system after 1949. In the following sections, we describe the current Chinese health care delivery system and the current health insurance system. We then focus on the construction of the Chinese health information system as well as several existing registers and research projects on health data. Finally, we discuss the opportunities and challenges of the health care system in regard to clinical epidemiology research. China now has three main insurance schemes. The Urban Employee Basic Medical Insurance (UEBMI) covers urban employees and retired employees. The Urban Residence Basic Medical Insurance (URBMI) covers urban residents, including children, students, elderly people without previous employment, and unemployed people. The New Rural Cooperative Medical Scheme (NRCMS) covers rural residents. The Chinese Government has made efforts to build up health information data, including electronic medical records. The establishment of universal health care insurance with linkage to medical records will provide potentially huge research opportunities in the future. However, constructing a complete register system at a nationwide level is challenging. In the future, China will demand increased capacity of researchers and data managers, in particular within clinical epidemiology, to explore the rich resources.

Keywords: China; clinical epidemiology; health care; insurance; registry.

Figure 1

Chinese health care system. Notes: ^aThe numbers provided in the figure are from China Statistical Yearbook – 2015 for year 2014. Urban subdistrict and village residents committee/community residents committee are not government organizations. ^bA total of 31 provincial governments including four municipalities, five autonomous regions, and 22 provinces (Taiwan, Hong Kong, and Macau are not included). ^cThe following types of health institutions are not listed: health inspection institutions, specialized disease prevention and treatment, health education institutions, first aid centers, blood gathering and supplying institutions, health supervision and inspection agencies, sanatoriums, clinical laboratory centers, medical scientific research institutions, on-job training institutions, medical examination centers. Abbreviations: CDC, Centers for Disease Control and Prevention; HFPC, Health and Family Planning Commission; MCH, Maternal and Child Health Institutions.