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