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Overcoming the legacy of marketisation: China’s response to COVID-19 and the fast-forward of healthcare reorganisation

Liu, Z., Kirkpatrick, I., Chen, Y. ORCID: 0000-0003-2549-8880 & Mei, J. (2020). Overcoming the legacy of marketisation: China’s response to COVID-19 and the fast-forward of healthcare reorganisation. BMJ Leader, 5(1), pp. 42-45. doi: 10.1136/leader-2020-000294


This Commentary looks at the recent experience of China’s healthcare system in dealing with the Covid-19 outbreak. Focusing on events in the city of Wuhan between Dec 2019 and April 2002 it shows how, initially, the response to the pandemic was impaired by a legacy of past reforms that had required public health organizations such as hospitals and community healthcare centers to operate as mini businesses. By increasing service fragmentation, this legacy left China’s healthcare system badly prepared for the recent crisis. Specifically, it resulted in poor intelligence and patients bypassing primary care to access larger tertiary hospitals, with consequences for overcrowding and spiraling infection rates. However, China’s experience also points to the role of the City administration in overcoming these obstacles, using the established hierarchy to adopt a system wide perspective and quickly re-organize services. This involved formalizing the role of GPs in the gatekeeping and triage of patients with Covid-19 symptoms and in the process, helping to fast-forward earlier reforms aimed at improving service integration. This policy highlights the advantages of public ownership and control over healthcare in the Chinese case with implications not just for policy makers, but also managers and clinical leaders locally who must enact these changes.

Publication Type: Article
Additional Information: This article has been accepted for publication in BMJ Leader, 2020 following peer review, and the Version of Record can be accessed online at © BMJ Publishing Group Ltd (2020) Reuse of this manuscript version (excluding any databases, tables, diagrams, photographs and other images or illustrative material included where a another copyright owner is identified) is permitted strictly pursuant to the terms of the Creative Commons Attribution-Non Commercial 4.0 International (CC-BY-NC 4.0)
Publisher Keywords: Covid-19; healthcare; primary care; integration
Subjects: H Social Sciences > HD Industries. Land use. Labor > HD28 Management. Industrial Management
J Political Science > JQ Political institutions Asia
Q Science > QR Microbiology > QR355 Virology
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Departments: Bayes Business School > Management
SWORD Depositor:
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