Quality of primary health care in China: challenges and recommendations

Research output: Contribution to journalArticle


  • Li Xi
  • Harlan M Krumholz
  • Winnie Yip
  • Jan De Maeseneer
  • Qingyue Meng
  • Elias A Mossialos
  • Chuang Li
  • Jiapeng Lu
  • Meng Sun
  • Qiuli Zhang
  • Dong Roman
  • Liming Li
  • Sharon-Lise T Normand
  • Richard Peto
  • Jing Li
  • Zhengwu Wang
  • Hongbing Yan
  • Runlin Gao
  • Somsak Chunharas
  • Xin Gao
  • Raniero Guerra
  • Huijie Ji
  • Yang Ke
  • Zhigang Pan
  • Xianping Wu
  • Shuiyuan Xiao
  • Xinying Xie
  • Yujuan Zhang
  • Jun Zhu

Colleges, School and Institutes


As part of its health care reform in the past decade, China has significantly increased financial investment and introduced favourable policies for primary health care. However, widespread gaps in the quality still exist, which has contributed to missed opportunities to promote population health. In this review, we aim to identify the causes for poor quality, and provide policy recommendations for improvement. These gaps include suboptimal screening, diagnosis, and treatment of diseases, which compromise health outcomes. System challenges include: suboptimal education and training of primary health care practitioners; a fee-for-service payment system that incentivizes testing and treatments over prevention; fragmentation of clinical care and public health service; insufficient continuity of care throughout the entire health care system. Now is an opportune time for China to strengthen the quality of its primary health care as the government is shifting its reform attention to ‘improving quality and enhancing efficiency ( ti zhi zeng xiao , 提质增效)’. The following recommendations merit consideration: enhancement of the quality of training for primary health care physicians and tailor continuing professional development for the current workforce; establishment of performance accountability to incentivize high-quality and high-value care; integration of clinical care with the basic public health services; and strengthening of the coordination between primary health care institutions and hospitals. Additionally, China should consider modernizing its PHC system through the establishment of a learning health system built on digital data and innovative technologies that can combine tools for accountability, efficiency, and improvement. Lessons from these strategies could serve as a model to other countries facing similar challenges.


Original languageEnglish
JournalThe Lancet
Publication statusAccepted/In press - 15 Jan 2020