Implications for the Global South: China’s Integrated Health Care Delivery System as a Public Good With Institutional Strengths

Abstract

Uneven public service provision is a key constraint to political development in the global South. Resource shortages, institutional weaknesses, and external dependencies are intertwined into systemic crises that directly generate livelihood grievances and regime risks. Human health is regarded as a core element in promoting the overall progress and development of society, and SDG3 Good Health and Well-being focuses on the holistic strengthening of health systems and the prevention and management of health risks. The integrated healthcare model, as a strategy to promote continuity and coordination of healthcare services, has been widely advocated and practiced globally, however, the implementation results are often unsatisfactory at the rural level, reflecting a disconnect between policy and practice, as well as deep-rooted structural barriers, and the challenge of uneven development triggered by unequal distribution of resources is intensifying. The investigator of this paper, a provincial-level reform practitioner promoting integrated healthcare services, in observing the process of integrated healthcare service reform changes, argue that the effective vertical integration of public-sector-led healthcare resources is key to improving healthcare access for populations in impoverished areas. This research study took 3 years to conduct, and visited the Health and Health Bureau of District X, District Z, and District Y in Hangzhou, Zhejiang Province several times to get a comprehensive understanding of the face-to-face advancement of the five MEDCs (Medical Communities) in District X, the four MEDCs in District Y, and the four MEDCs in District Z. Research indicates that to address the imbalance in urban-rural resource development, holistic governance, guided by an institutional integration logic across four dimensions, policy, organization, institutions, and the public, can activate the autonomy of actors at all levels. However, it is necessary to ensure consistency among the goals and interests of the implementer, which will further enhance the active participation of diverse stakeholders in the redistribution of resources. In developing Southern countries, this system has established effective practices in addressing imbalances in public resource development and fostering effective multi-stakeholder interactions across hierarchical levels. This paper aims at reshaping the academic debate on the integration of health systems in developing countries, challenge the neoliberal “market-first” reform paradigm, and argue for the effectiveness of state-led vertical integration in addressing fragmentation issues.