The health system and health impacts of primary healthcare reform in China: A systematic review

Abstract Background China has undergone a comprehensive primary healthcare(PHC) reform since 2009 aiming to deliver accessible, higher-quality, and equitable healthcare. However, there is limited understanding of the effectiveness this reform. This systematic review synthesizes evidence on health system impacts Methods We searched 13 international databases three Chinese for quantitative studies assessing published between January March 2020. in English or Mandarin. Eligible study designs were RCTs, quasi-experimental controlled before-after studies. included that: assessed PHC policies 2009; had geographical, temporal population comparators; any outcome measures expenditures, service utilisation, quality care outcomes. Study was using ROBINS-I, results synthesized narratively. PROSPERO: CRD42021239991. Results Of 35,480 titles, 37 (27 ten Mandarin). Eight considered at low risk bias. The covered all major 2009, but mostly focused essential medicine (N = 15) financing 10). quantity delivery policies(e.g., family physician services), low(N 3,with moderate serious bias). 17 found that reforms promoted utilisation. Its improvement appear people with chronic diseases(N 11). Evidence costs OOPs not clear. Some showed pro-equity benefits accrued disadvantaged regions groups. Conclusions Comprehensive can some related utilisation high-risk vulnerable populations. Policymakers should continue prioritize achieve Universal Health Coverage. Key messages • finding suggests large-scale healthcare Future research include more robust seek better understand impact care, outcomes equity.