Xiao, Y, Husain, L and Bloom, G (2018) Evaluation and learning in complex, rapidly changing health systems, Globalization and Health, 14:112, DOI: 10.1186/s12992-018-0429-7

Healthcare systems are increasingly recognised as complex, in which a range of non-linear and emergent behaviours occur. China’s healthcare system is no exception. The hugeness of China, and the variation in conditions in different jurisdictions present very substantial challenges to reformers, and militate against adopting one-size-fits-all policy solutions. As a consequence, approaches to change management in China have frequently emphasised the importance of sub-national experimentation, innovation, and learning. Multiple mechanisms exist within the government structure to allow and encourage flexible implementation of policies, and tailoring of reforms to context. These limit the risk of large-scale policy failures and play a role in exploring new reform directions and potentially systemically-useful practices. They have helped in managing the huge transition that China has undergone from the 1970s onwards. China has historically made use of a number of mechanisms to encourage learning from innovative and emergent policy practices. Policy evaluation is increasingly becoming a tool used to probe emergent practices and inform iterative policy making/refining. This paper examines the case of a central policy research institute whose mandate includes evaluating reforms and providing feedback to the health ministry. Evaluation approaches being used are evolving as Chinese research agencies become increasingly professionalised, and in response to the increasing complexity of reforms. The paper argues that learning from widespread innovation and experimentation is challenging, but necessary for stewardship of large, and rapidly-changing systems.

Liu T, Hao X and Zhang Z (2016) Identifying community healthcare supports for the elderly and the factors affecting their aging care model preference: evidence from three districts of Beijing, BMC Health Services Research, 16:1863, DOI: 10.1186/s12913-016-1863-y

The Chinese tradition of filial piety, which prioritized family-based care for the elderly, is transitioning and elders can no longer necessarily rely on their children. The purpose of this study was to identify community support for the elderly, and analyze the factors that affect which model of old-age care elderly people dwelling in communities prefer.

This paper analyses the main policy documents of Urban Employee Basic Medical Insurance System (UEBMIS) over the past two decades and the institutional environment, experiences, and problems in the process of reform. The authors state that in the future, UEBMIS should proceed according to the guideline of ensuring basic demands, establishing a multi-level security system, and ensuring sustainability. It should also proceed according to the guideline of gradual advancement and piloting first. Top-level design and linkage reform should be improved, national data should be unified, and a data-evaluation system should be established.

Through summarizing the new situation and new problems since the pilot implementation development of urban and rural medical insurance for catastrophic diseases in China, this article analyzes the nature of medical insurance for catastrophic diseases and the relationship among New Rural Cooperative Medical System and Basic Medical Insurance for urban residents, puts forward the main difficulties and the faced challenges in the development of medical insurance for catastrophic diseases.

Establishment of medical security and assistance mechanisms for catastrophic diseases is the focus of health care reform to tackle the large medical expense burden. Based on sorting out the stage of the development of China's severe illness security policy, point out the cotent and difficulties of the connection of medical assistance and medical insurance for catastrophic diseases, analyse the main problems of medical assistance for catastrophic diseases and give appropriate policy recommendations.