How China strengthens health care support at the grassroots level

Editor's note:

China has built the world's largest health-care system, covering more than 95 percent of the population with basic medical insurance. Over the past five years, the country has introduced a series of measures to bring higher-quality medical services closer to people's doorsteps.

Since August 2022, 64-year-old Hu Detian has received hemodialysis at the central hospital of Yanzihe Town, Jinzhai County, Lu'an City, east China's Anhui Province. According to Hu, being treated at the facility in his hometown has saved him substantial medical costs over the past three years.

Before that, he had to travel to the much farther hospital in Lu'an for treatment. Not only were reimbursement rates lower there, but years of rent and transportation expenses added up to a considerable sum.

A few years ago, the hospital in his hometown could not handle hemodialysis or even basic outpatient surgery. Locals either endured minor illnesses at home or trekked to municipal- or provincial-level hospitals for anything serious. Roughly one-third of county residents sought care elsewhere.

Building county-level medical consortia

Change began in 2019, when China launched pilot reforms for developing closely integrated medical and health consortia at the county level. Jinzhai County was selected as a national pilot for county-level medical consortia.

The initiative aims to establish a triage system led by county-level hospitals and improve the capacity of medical and health institutions at the township and village levels. The final goal is to ensure that common diseases are treated at the city or county level, while routine health concerns are managed at the grassroots level, according to the National Health Commission (NHC).

Within Jinzhai County, personnel, funds, and equipment were reorganized around patient needs into seven upgraded township "sub-centers," each headed by a leadership member from the county hospital.

A tiered referral system was introduced. To ensure these sub-centers could retain patients, the county hospital dispatched expert teams – three associate chief physicians and one head nurse – to each site.

Since the reform, two-way referrals have reduced outpatient and inpatient volumes at the county hospital by more than 10 percent, while primary-level visits have risen by over 20 percent.

China now has 2,188 counties and districts piloting county-level medical consortia, the NHC said. About 80 percent of these counties have set up resource-sharing hubs, and 90 percent of township health clinics and community health service centers can now provide pediatric care.

The Chinese government aims to achieve full coverage of medical consortia in all county-level regions by the end of 2027. Residents are expected to reach the nearest medical institution within 15 minutes by then.

More national efforts necessary

Launched in 2009, the latest round of health-care reform has, over 15 years, increased the number of primary-level medical institutions from 882,000 to 1.04 million – up 17.9 percent, according to data from the NHC.

Yet growth in facilities has not translated into proportional use. Data also shows that primary-level facilities' share of total visits fell from 61.8 percent in 2009 to 51.7 percent in 2024 – a 10-percent drop.

Experts attribute the decline to shortages of qualified staff and outdated equipment at some grassroots sites, as well as insurance policies that favor inpatient reimbursement while offering limited coverage for outpatient services at the primary level.

"People don't choose nearby community services mainly because they don't trust them; they think the capability is weak," Professor Liu Yuanli of Peking Union Medical College told China Media Group (CMG).

Broader national efforts are needed to complement local reforms. In April 2025, 13 central ministries jointly issued a guideline on optimizing primary-care infrastructure, with the core goal of strengthening both hardware and software at grassroots facilities.

According to the guideline, by 2030, the layout of primary-level medical and health institutions will be more balanced and accessible. Meanwhile, telemedicine and intelligent services will be more widely used.

Hu Tongyu, head of the Operation Evaluation Section at the NHC Primary Health Department, told CMG that the commission and partner agencies have focused on plugging gaps and shoring up weak links in grassroots medical services.

To bolster emergency care capacity, Renshou County in southwest China's Sichuan Province has accelerated construction of five emergency centers – for chest pain, stroke, trauma, critical maternal care and critical pediatric/neonatal care.

In 2024, the county government invested 196 million yuan (about $27.44 million) in infrastructure and equipment, including MRI and CT scanners, as well as angiography machines for cardiocerebral interventions.

Renshou's five centers now provide seamless care, from pre-hospital emergency services and grassroots referrals to in-hospital multidisciplinary consultations. The mortality rate for acute myocardial infarction has fallen from 10 percent to 3.1 percent.