Tabea Bork-Hueffer, National University of Singapore, Singapore

Presentation Title: Governance challenges in China's urban health care system: Effects for the domestic and international migrant population



This presentation contributed a deeper understanding of challenges in China's health system governance by contrasting levels of influence and the roles of different stakeholders in the health system including government bodies, public, private and illegal health care providers, patients (here with a focus on domestic and international migrants) and their social networks, paying institutions, medical goods and equipment producers, social organizations and civil society. It shed light on the effects of health governance on domestic and international migrants' access to health care. Misdirected and uncoordinated reforms of the health care system, persistent informal modes of power negotiation, lack of regulation and control, coeval post-reform diversification of types of health care providers and an increasingly self-assertive as well as economically-oriented group of providers have led to an increasing imbalance in stakeholder power within the governance network. Countervailing these imbalances is a prerequisite to achieving the central goals of a health system - improved health, enhanced responsiveness and increased fairness in financial contribution.

Key Lessons Learned

  • Governance only works if all stakeholders across the health system are involved.
  • Imbalances in the roles and influences of stakeholders currently aggravate the improvement of migrants’ access to health care.
  • Administrative units are responsible for regulation and control at the same time, but they are often understaffed and corrupt.
  • Health care providers are having more and more influence on aspects of health care regulation.
  • There is a lack of third party independent supervision to intervene in this stakeholder relationship, e.g., insurance companies often take this role in health care systems within social insurance systems.
  • Migrants often rely on social networks for medical help or assistance with medical bills. 

Policy/Practice Implications of Research

  • Health-related return migration needs further study.
  • Reforms have been made to improve health care, but some neglected elements include:
    • The lack of third party supervision and monitoring;
    • Extension of regulation to the  private sector;
    • Overall reforms of administrative structure including the integration of government ministries and other units;
    • Corruption;
    • Institutionalization of relationships between the administrative units;
    • The responsiveness of health care providers;
    • Government funding to achieve these goals;
    • Patient organizations and the work of social organizations should be strengthened (in particular for migrants); and,
    • Increasing of awareness and options for migrants and establishing targeted health services for migrants which can be easily achieved through already existing structures.

Knowledge Gaps and Needs

  • How well were the health care reforms implemented?
  • What is the role of mobile unregistered health practitioners?
  • How do other international migrant groups accept the social insurance system?
  • More research on highly skilled international / domestic migrants, in addition to low- / middle-skilled migrants.