Since the launch of the National Essential Public Health Services Program in 2009, China's primary public health system has undergone a structural transformation from a focus on "building foundations and ensuring equitable access" to one centered on "improving quality and promoting population health". From the perspectives of policy evolution and public governance, this study systematically reviewed the fifteen-year development of the program (2009-2024), with a focus on its policy trajectory, institutional development, implementation outcomes, and future directions. The results showed that, over the past fifteen years, China had progressively established an institutional framework characterized by strong government leadership, stable fiscal support, and implementation through primary health care institutions. Notable progress had been made in the formalization of the system, sustained growth in public financing, expansion of service packages, transformation of primary care delivery models, and strengthening of digital governance capacity. These developments had collectively contributed to the establishment of a primary public health service network that covered the entire population across the life course. At the implementation level, key services—including electronic health records, chronic disease management, maternal and child health services, elderly health management, and the national immunization program—had been continuously strengthened. Service coverage and the level of standardized management had improved substantially, contributing to enhanced equity, strengthened primary care capacity, and improved public experience and perceived benefits of health services. Despite these achievements, several challenges remained, including regional disparities, shortages in the primary health workforce, performance evaluation systems that continue to emphasize process indicators, and limited interoperability among health information systems. Looking ahead, it is essential to further strengthen fiscal investment and performance-based incentive mechanisms, refine the design of service packages, promote integration between medical care and public health, and advance digital governance. These efforts will help improve the quality of primary public health services and strengthen health governance capacity, thereby providing institutional support for the Healthy China strategy and the achievement of universal health coverage.
After nearly fifteen years of evolution, China's family doctor contractual service has progressed from initial pilot trials to a phase of rapid expansion, achieving system creation "from scratch", optimizing institutional structures, and swiftly extending coverage to the target population. It has now entered a stage of high quality development, focusing on thorough and refined implementation. The rollout of this initiative has contributed positively to raising residents' health literacy, effectively managing the incidence and progression of chronic diseases, improving overall public health, and advancing health equity. Nevertheless, practical challenges remain, including workforce shortages, insufficient operational dynamism, constrained service offerings, and less than ideal user experience. To address these issues, this paper puts forward a blueprint described as "one core, two boosters, three mechanisms, and four outcomes". Specifically, it proposes consolidating the central role of contractual services, strengthening the dual pillars of capability and motivation, reinforcing the three mechanisms of training, collaboration, and incentives, and enhancing the four outcome dimensions: health status, cost containment, sense of benefit, and public recognition. This framework offers a decision making reference for advancing the construction of family doctor contractual services in the context of high quality development.
