China's Healthcare Systems - A Status Update from the 2009 Major Health Care Reform

China's healthcare has undergone several transformations. For the past 15 years, China has tried to expand insurance and improve access to appropriate pharmaceuticals. These efforts; however, have been undermined by inadequate funding and decentralization of responsibility to the provinces, leading to uneven implementation of reform throughout the country. In this article, we present a brief history of the Chinese health system and then present findings from a systematic literature review focused on the implementation of the 2009 reform. Within this review, we explore the impact of reform on access and use of health care services, changes to the health care workforce, the quality of health care, the expansion of insurance coverage, drug regulations, health care financing, efforts to improve the efficiency of the system, and public opinions on the reform effort. We conclude that, while reforms have noticeably improved China's health system, several problems persist. In 2009, after years of debate, China adopted a major reform of its health system. The goals of reform included expanding health insurance, reducing health care disparities, increasing the use of primary care, improving the use of pharmaceuticals, and strengthening the public health workforce (Wang et al. 2011). The government's aim was to reduce inequities in the use of health care and strengthen access to essential services by 2020. In this paper we assess the implementation of health reform in China based on findings from a systematic review of the English language literature. We find that China has succeeded in expanding insurance and reducing regional variation in the use of health care. Efforts to strengthen the primary care system, increase the size of the workforce, and regulate pharmaceuticals, however, have been less successful. To achieve the health reform goals articulated more than a decade ago, China must make additional investments in primary care and its public health infrastructure. In the next section of the paper, we provide a brief overview of the Chinese health system and its evolution since 1949. Next, we describe how we conducted our literature review and summarize its findings. We conclude with some reflections on the status of health reform in China