How China enhances grassroots health care services

For the past three years, 64-year-old Hu Detian has received life-saving hemodialysis at his local hospital in Yanzihe Town, Jinzhai County, Lu'an City, east China's Anhui Province. This accessible care has saved him a substantial amount of money, he said. 

Previously, Hu had to travel to a distant city hospital where lower reimbursement rates, combined with years of travel and rent costs, created a significant financial burden.

This local option didn't always exist. A few years ago, the town's hospital couldn't perform hemodialysis or even basic surgeries. Residents often treated minor ailments at home, while more serious conditions required a long journey to city or provincial hospitals.

Building county-level medical consortia

Change began in 2019, when China launched pilot reforms to establish closely integrated county-level medical and health consortia. Jinzhai County was among the first national pilots.

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.

China aims to achieve full coverage of medical consortia in all county-level regions by the end of 2027, with residents able to reach the nearest medical institution within 15 minutes.

More national efforts

Since the latest round of health-care reform in 2009, the number of primary-level medical institutions in China has risen from 882,000 to 1.04 million – an increase of 17.9 percent, NHC data shows.

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.

By 2030, the layout of primary-level medical and health institutions is expected to be more balanced and accessible, with telemedicine and intelligent services widely available.

Hu Tongyu, head of the Operation Evaluation Section at the NHC Primary Health Department, told China Media Group that the commission and partner agencies have focused on addressing gaps and strengthening weak areas 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.