With the continuous increases in residents' health needs and the urgent need to solve the problems of medical treatment, medical reform in China has become a key measure to promote the construction of Health China and improve national governance capabilities. It is of academic and practical significance to systematically sort out the logical framework and practical results of healthcare reform in China. In this study, a logical pipeline of "Tao, Principle and Tactics" was centered on to comprehensively and systematically analyze the strategic choices, system design and implementation mechanism of healthcare reform in China. Briefly, the "Tao" anchored the core concept of health-centered guidance by the Healthy China strategy and the health priority development strategy. The "Principle" promoted the construction of an integrated health system, graded diagnosis and treatment, and public health system by implementing strategies for the coordinated development and governance of the three medical institutions, social governance, medical prevention collaboration, and medical prevention integration. The "Tactics" implemented specific measures like reforming the operation mechanism of public hospitals, strengthening grassroots, cultivating and utilizing talents, and empowering information technology. Healthcare reform in China has made positive progress in financing and payment mechanisms, governance systems and capabilities, service models and efficiency, equity and accessibility. A Chinese plan has been formulated to be a reference for global health governance.
Over the fifteen years since the deepening of medical and healthcare system reform in China (hereinafter referred to as deepening healthcare reform in China), a series of policies have been intensively introduced by the central government to promote the development of the general practitioner system. With strong government support and guidance, general practice in China has made positive progress in discipline construction, training and education, and workforce development. The proportion of medical schools with general practice teaching institutions increased from 21.1% in 2010 to 85.7% in 2019, showing an increase of 64.6 percentage points. Meanwhile, the proportion of medical schools offering general practice courses increased from 46.1% to 81.1%, showing an increase of 35.0 percentage points. The number of general practitioners trained through various pathways increased from 109 800 in 2012 to 561 800 in 2023, with an average annual growth rate of 16.00%, far exceeding the growth of licensed (assistant) physicians nationwide (5.64%). The proportion of general practitioners in the total number of physicians increased from 4.20% to 11.75%, showing an increase of 7.55 percentage points. During 2010-2024, the actual enrollment of rural order-oriented medical students reached 89 000, displaying increased number of general practitioners and improved educational qualifications in rural areas of central and western China. General practice beds increased from 307 900 in 2009 to 487 800 in 2023, with an average annual growth rate of 3.34%. General practice outpatient and emergency visits increased from 431 million in 2009 to 848 million in 2023, maintaining approximately 13.00% of the national total outpatient and emergency visits. Among them, the proportion of primary-level general practice outpatient and emergency visits to total primary-level outpatient and emergency visits increased from 26.32% to 33.07%. General practice inpatient admissions increased from 11.275 2 million to 12.247 9 million. The proportion of national total discharges decreased from 8.47% to 4.07%, while the proportion has increased in the past two years by 0.39%. Compared with other secondary clinical disciplines, general practice still has a room for continuous improvement, including weak quantity and quality of general practitioners, limited research capacity, unbalanced distribution of general practitioners at the national level, insufficient numbers of high-quality general practitioners, and inadequate attractiveness of general practitioner positions. Moreover, increased health demands brought by the overlapping effects of population aging and chronic disease prevalence are great challenges to be solved. Based on in-depth analysis, this paper proposed targeted recommendations.
