Social values and health priority
setting in China
Mary Docherty
King’s College London, London, UK
Qi Cao and Hufeng Wang
School of Public Administration and Policy, Renmin University, Beijing, China
Abstract
Purpose – The purpose of this paper is to provide an overview of the organisational and procedural
arrangements for healthcare reform in China, and describe the role of social values in the relevant
decision-making process.
Design/methodology/approach – An analysis of recent developments aimed at achieving
universal coverage in China was undertaken in the context of describing the influence of
underlying social values.
Findings – The key underlying social value was found to be social solidarity. Other values were
implicit rather than explicitly stated, and were subservient to the overall aim of comprehensive
coverage.
Originality/value – The paper shows that China is embarking on the largest-scale health reforms in
the world. There is an eagerness to share experiences with other countries in an attempt to ensure the
success of the reforms. There is an increasing understanding of the need to make the values
underpinning the reforms more explicit and, in particular, those concerned with efficiency and
appropriateness.
Keywords China, Health care, Social values, Government policy, Health carereform, Universal coverage,
Social solidarity
Paper type Case study
1. Introduction
The primary objective of current healthcare reforms in China is to deliver universal
coverage of essential health services with better provision than was ever achieved
during the era of the planned economy. The introduction of market forces to the health
care system in the 1980s led to escalating costs through over-use and increasing health
inequalities, rather than the improvement in quality and efficiency which a
market-based system was expected to bring. During this period, social discontent at
unaffordable care and social inequalities became more prevalent. In 2002 China’s
politburo re-emphasised social solidarity as the central value underpinning health
policy. Subsequent increases in government health expenditure followed, signifying a
departure from a market-based approach and a sustained effort to involve the whole
population in a social health insurance system.
A comprehensive healthcare reform programme for China’s 1.3 billion population
was implemented in 2009. The size and cost of these reforms has been unprecedented,
with an additional $125 billion being injected into health care expenditure. Government
targets include social healthcare insurance for 90 per cent of the population by 2011,
rising to 100 per cent by 2020. In order to contain this rising expenditure and meet the
goal of universal health coverage, health care priority setting is required. Priority
The current issue and full text archive of this journal is available at
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Health priority
setting in China
351
Journal of Health Organization and
Management
Vol. 26 No. 3, 2012
pp. 351-362
q Emerald Group Publishing Limited
1477-7266
DOI 10.1108/14777261211238990