iv DEEPENING HEALTH REFORM IN CHINA Challenges.............................................................23 Core action areas and corresponding implementation strategies for developing and implementing PCIC-based service delivery model: lessons from international and national experience............................ 24 Improving Quality of Care in Support of People-Centered Integrated Care (Lever 2) 35 Introduction.................. 35 Challenges to Improving Quality of Care in China.................. 36 Recommendations for Improving the Quality of Care................. 40 Engaging Citizens in Support of the People-Centered Integrated Care Model (Lever 3) 49 Introduction… 49 Challenges to engaging citizens............................................ 50 Recommendations:Strengthening Citizen Engagement.........................51 Reforming Public Hospitals and Improving their Performance (Lever 4) 65 Introduction..........................................................65 Challenges and lessons in Public Hospital Governance and Management in China....66 Recommendations for moving forward with public hospital reform: Lessons from Chinese and international experience............................70 Part ll Institutional and Financial Environment Levers 77 Realigning Incentives in Purchasing and Provider Payment (Lever 5) 79 Introduction 79 Key Challenges in Purchasing Health Services and Paying Providers...............80 Recommendations for Realigning Incentives in the Health System in China.........82 Strengthening Health Workforce for People-Centered Integrated Care (Lever 6) 89 Introduction ................. 89iv DEEPENING HEALTH REFORM IN CHINA Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Core action areas and corresponding implementation strategies for developing and implementing PCIC-based service delivery model: lessons from international and national experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Improving Quality of Care in Support of People-Centered Integrated Care (Lever 2) 35 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Challenges to Improving Quality of Care in China . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Recommendations for Improving the Quality of Care . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Engaging Citizens in Support of the People-Centered Integrated Care Model (Lever 3) 49 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Challenges to engaging citizens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Recommendations: Strengthening Citizen Engagement . . . . . . . . . . . . . . . . . . . . . . . . . 51 Reforming Public Hospitals and Improving their Performance (Lever 4) 65 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Challenges and lessons in Public Hospital Governance and Management in China . . . . 66 Recommendations for moving forward with public hospital reform: Lessons from Chinese and international experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Part II Institutional and Financial Environment Levers 77 Realigning Incentives in Purchasing and Provider Payment (Lever 5) 79 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Key Challenges in Purchasing Health Services and Paying Providers . . . . . . . . . . . . . . . 80 Recommendations for Realigning Incentives in the Health System in China . . . . . . . . . 82 Strengthening Health Workforce for People-Centered Integrated Care (Lever 6) 89 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89