After three decades of breathtaking economic growth in which its gross domestic product (GDP) grew by 10 percent annually (World Bank, undated-a), China has become the world’s second largest economy. Its growing wealth has lifted 680 million people out of poverty, accounting for 94 percent of the decline in poverty in developing countries (Tuck, 2013). Its life expectancy at birth increased from 44 years in 1961 to 73 years in 2011 (World Bank, undated-b). But rapid industrialization has had profound implications for the health care needs of the population. The confluence of urbanization, changes in lifestyle (including diet and physical...

China’s current five-year plan calls for a transition from an economy focused on labor and natural resources to one that is knowledge-based; that is, an economy for which the creation and use of knowledge are central to economic development (Nolte et al., 2012). China’s rapid development over the past three decades has transformed the country, lifting huge swaths of the population out of poverty. Now, the central government has seized on the opportunity to develop high-value modern industries with advanced technologies and large employment capacity. Recent data on the contribution of the manufacturing and service sectors to China’s GDP (see...

Many experts have noted the mismatch between the health care needs of 21st-century societies and the way health care is organized, financed, and delivered in mature economies, which we refer to in this report as the “Western-style” model of health care. This model evolved in an era dominated by conditions that required acute care for conditions such as infections, injuries, and childbirth. The health care delivery systems, multilevel infrastructure for financing care, and even the predominant paradigm for innovation were shaped by that historical context. Thus, if one imagines the demand for health care as a pyramid, with the top...

In countries with Western-style health care systems, concern is growing about the health outcomes and financial sustainability of these systems, leading to calls for fundamental reform. However, reform efforts are often thwarted by what political scientists callpath dependence; i.e., situations in which policymakers’ options are constrained by history and existing institutional structures. Established health care systems tend to have many entrenched stakeholders who are familiar with and benefit from the status quo and who resist change unless fully compensated. As a consequence, policymakers are often unable to reform policies—even if they realize the current system does not achieve...

In the wake of the miraculous economic growth that China experienced during the past several decades, the forces of rapid modernization and development combined with the accelerating aging of the population have dramatically increased its burden of chronic disease. Our analysis points to a substantial gap between China’s current health care infrastructure and workforce and the demand for care, and suggests that the gaps will continue to widen. The speed at which the burden of chronic disease is growing, combined with China’s vast population, imply that scaling up the existing health care system and bolstering its workforce through training or...

China’s economic and social progress over the past 50 years has outpaced the development of its health care system. The health of China’s population is being influenced simultaneously by its rapid rate of aging, growing wealth, and migration from rural to urban living, as well as by greater reliance on food of low nutritional value and decreased physical activity. The result is an expanding burden of chronic disease and disability, even as mortality due to acute illness wanes. To handle the new challenge, the Chinese health care system must undergo a transformation.

The current system is handicapped by a severe...