Innovations Under the China Health Reform Program-for-Results : A Case Study Series

Since 2009, China has been undertaking an ambitious program of health system reforms. Comprehensive reforms were defined in five priority areas: basic health insurance, health service delivery at grassroots level, essential public health service, an essential drugs program, and public hospital reform. After more than a decade of implementation, these reforms have led to notable achievements; however, challenges remain. The government of China tackled these health system challenges in its Thirteenth Five-Year Plan, the implementation of which was supported by a USD 600 million China Health Program-for-Results between 2018 and 2022. This was one of the first Program-for-Results financed by the World Bank in China and globally. Program-for-Results finances a subset of activities in a broader government program and uniquely links disbursement of funds directly to the achievement of specific program results rather than inputs as in traditional investment projects. In this Program-for-Results, there were three key results areas, aligned to the objectives of the government health reform program: (a) drawing on the reform model in successful pilots to deepen and mainstream comprehensive public hospital reforms; (b) strengthening primary health care services through establishing patient-centered integrated care; (c) addressing cross-cutting dimensions of the policy, institutional, and financial environment, such as information technology, to support the health reforms. This report showcases four case studies of innovations that summarize key lessons and experiences in the implementation of reforms under the Program-for-Results in the two provinces. The selected innovations are drawn across the three results areas of the Program-for-Results and shed light on tackling common health system challenges. The complexity of the health system in China and ambitious nature of its health system reforms combine to set the tone for the case studies, which provide opportunities for in-depth, multifaceted explorations of complex issues in the real-life health care settings