China Health Reform Program

Abstract*

The objective of the Health Reform Program-for-Results Project for China is to improve the quality of healthcare services and the efficiency of the healthcare delivery systems in Anhui and Fujian provinces. China has made impressive gains in improving overall health outcomes in past decades, along with its rapid economic development. In 2009, China unveiled an ambitious national health care reform program with the goal of providing affordable, equitable... Show More

Development Objective

To improve the quality of healthcare services and the efficiency of the healthcare delivery systems in Anhui and Fujian provinces.

Key Details

Project Details

Project ID
P154984
Status
Closed
Team Leader
Kate Mandeville , Wei Han
Borrower 2
National Health Commission

Country
China
Disclosure Date
June 10, 2016
Approval Date
(as of board presentation)
May 9, 2017
Effective Date
September 11, 2017

Total Project Cost 1
US$ 600.00 million
Implementing Agency
Anhui Provincial Health Commission,Fujian Provincial Health Commission
Region
East Asia and Pacific
Fiscal Year 3
2017

Commitment Amount
US$ 600.00 million
Environmental Category
N/A
Last Update Date
October 16, 2023
Closing Date
December 31, 2021

Last Stage Reached
BANK APPROVED

Notes
1. Total project cost includes funding from World Bank and non-bank sources in US$ millions. Active and Closed projects show current commitments. Proposed (pipeline) and dropped projects show the forecast amount. The commitment amount for projects in the pipeline is indicative and may be modified during the project preparation.
2. Borrower refers to the Borrower of a Loan or Recipient of a Grant.
3. ”Fiscal Year” is the fiscal year in which the project was approved (or dropped if the status is dropped). The World Bank's fiscal year is from July 1 - June 30. For example, a fiscal year of 1996 corresponds to July 1, 1995 - June 30, 1996.

Sectors

Themes

FY17 - Human Development and Gender

FY17 - Disease Control15%
- FY17 - Non-communicable diseases15%
FY17 - Health Systems and Policies85%
- FY17 - Health Finance28%
- FY17 - Health Service Delivery38%
- FY17 - Health System Strengthening18%

Project Map

Interactive Map

Finances

Financing Plan (US$ Millions)

Financier	Commitments
International Bank for Reconstruction and Development	600.00

Total Project Financing (US$ Millions)

Product Line	IBRD/IDA
IBRD Commitment	600.00
IDA Commitment	N/A
IBRD + IDA Commitment	600.00

Lending Instrument
Grant Amount	N/A
Total Project Cost**	600.00

Summary Status of World Bank Financing (US$ Millions) as of February 28, 2025

No data available.

Detailed Financial Activity as of February 28, 2025

Download:

Period	Financier	Transaction Type	Amount (US$)
Oct 1, 2019	IBRD-87440	Int Charges	3,350,013.50
Mar 16, 2020	IBRD-87440	Loan Disb	36,700,000.00
Sep 11, 2017	IBRD-87440	Loan Disb	1,500,000.00
Sep 11, 2017	IBRD-87440	Fee Charges	1,500,000.00
Apr 1, 2018	IBRD-87440	Int Charges	135,410.95
Apr 1, 2018	IBRD-87440	Int Charges	1,975.00
Apr 1, 2018	IBRD-87440	Int Charges	745,792.80
Apr 1, 2018	IBRD-87440	Int Charges	18,730.85
Feb 27, 2018	IBRD-87440	Loan Disb	1,250,000.00
Jun 29, 2018	IBRD-87440	Loan Disb	40,000,000.00
Oct 1, 2018	IBRD-87440	Int Charges	282.53
Oct 1, 2018	IBRD-87440	Int Charges	2,547.67
Oct 1, 2018	IBRD-87440	Int Charges	722,854.44
Oct 1, 2018	IBRD-87440	Int Charges	403,824.50
Oct 25, 2018	IBRD-87440	Loan Disb	1,500,000.00
Oct 25, 2018	IBRD-87440	Loan Disb	15,000,000.00
May 9, 2017	IBRD-87440	Loan Commitment	600,000,000.00
Oct 1, 2023	IBRD-87440	Int Charges	-1,171.24
Oct 1, 2023	IBRD-87440	Int Charges	1,171.24
Oct 1, 2023	IBRD-87440	Int Charges	341,468.16
Oct 1, 2023	IBRD-87440	Int Charges	18,175,416.00
Oct 1, 2023	IBRD-87440	Loan Repay	10,286,349.00
Apr 1, 2024	IBRD-87440	Int Charges	19,598,054.00
Apr 1, 2024	IBRD-87440	Int Charges	302,063.20
Apr 1, 2024	IBRD-87440	Loan Repay	10,286,349.00
Aug 16, 2022	IBRD-87440	Loan Cancel	1,914,958.40
Aug 16, 2022	IBRD-87440	Loan Disb	-1,164,958.40
Apr 1, 2023	IBRD-87440	Loan Repay	10,307,100.00
Apr 1, 2023	IBRD-87440	Int Charges	14,993,892.00
Oct 1, 2022	IBRD-87440	Int Charges	940.08
Oct 1, 2022	IBRD-87440	Int Charges	8,348,161.50
Oct 1, 2022	IBRD-87440	Loan Repay	10,307,100.00
Apr 1, 2023	IBRD-87440	Int Charges	781,062.30
Apr 1, 2023	IBRD-87440	Int Charges	934.95
Apr 1, 2022	IBRD-87440	Int Charges	3,497,028.20
Apr 1, 2022	IBRD-87440	Int Charges	23,339.39
Oct 1, 2021	IBRD-87440	Int Charges	1,984.31
Oct 1, 2021	IBRD-87440	Int Charges	281,706.20
Oct 1, 2020	IBRD-87440	Int Charges	45,737.96
Oct 1, 2020	IBRD-87440	Int Charges	424,708.34
Oct 1, 2020	IBRD-87440	Int Charges	2,751,224.50
Jul 13, 2020	IBRD-87440	Loan Disb	39,600,000.00
May 21, 2019	IBRD-87440	Loan Disb	61,255,104.00
Jun 24, 2019	IBRD-87440	Loan Disb	15,047,500.00
Apr 1, 2019	IBRD-87440	Int Charges	1,035,864.56
Mar 26, 2019	IBRD-87440	Loan Disb	69,140,000.00
Apr 1, 2019	IBRD-87440	Int Charges	673,956.56
Sep 17, 2019	IBRD-87440	Loan Disb	1,500,000.00
Oct 1, 2019	IBRD-87440	Int Charges	2,841.37
Oct 1, 2019	IBRD-87440	Int Charges	38,527.40
Oct 1, 2019	IBRD-87440	Int Charges	524,979.44
Oct 1, 2021	IBRD-87440	Int Charges	2,365,331.00
Oct 1, 2021	IBRD-87440	Int Charges	478.08
Oct 20, 2021	IBRD-87440	Loan Disb	106,450,000.00
Oct 12, 2021	IBRD-87440	Loan Disb	113,500,000.00
Mar 30, 2021	IBRD-87440	Loan Disb	34,900,000.00
Apr 13, 2021	IBRD-87440	Loan Disb	61,750,000.00
Apr 1, 2021	IBRD-87440	Int Charges	272.65
Apr 1, 2021	IBRD-87440	Int Charges	394,576.22
Apr 1, 2021	IBRD-87440	Int Charges	1,814,770.00
Apr 1, 2021	IBRD-87440	Int Charges	36.55
Apr 1, 2020	IBRD-87440	Int Charges	1,979.50
Apr 1, 2020	IBRD-87440	Int Charges	488,926.34
Apr 1, 2020	IBRD-87440	Int Charges	3,196,844.50
Apr 1, 2020	IBRD-87440	Int Charges	143.84
Aug 28, 2020	IBRD-87440	Loan Disb	157,395.00
Oct 1, 2020	IBRD-87440	Int Charges	4,010.93

Footnotes

Ratings

IMPLEMENTATION RATINGS

Name	Review	Date
Overall Implementation Progress (IP)	Satisfactory	2021-07-30
Progress towards achievement of PDO	Satisfactory	2021-07-30
Monitoring and Evaluation	Satisfactory	2021-07-30

COMPLETION RATINGS

INDICATOR	IMPLEMENTATION COMPLETION & RESULTS REPORT: 04-28-2022
Outcomes	Substantial
Risk to Development Outcome
Bank Performance	Substantial
Borrower Performance
Government Performance
Implementing Agency

INDEPENDENT EVALUATION RATINGS

INDICATOR	ICR REVIEW:	PROJECT PERFORMANCE ASSESSMENT REPORT:
Outcome Rating	Satisfactory	N/a
Risk To Development Outcome		N/a
Bank Performance	Moderately Satisfactory	N/a
Borrower Performance		N/a
Government Performance	Not Rated	N/a
Implementing Agency		N/a
Icr Quality	High	N/a
M&e Quality	Substantial	N/a

Results Framework

PROJECT DEVELOPMENT OBJECTIVE INDICATORS

INDICATOR		BASELINE	CURRENT	TARGET

Proportion of hospital discharges paid through case-based payment for all county-level public general hospitals and TCM hospitals Value AH: 12 FJ: 3 AH: 32 FJ: 50
Date May 9, 2017 December 31, 2021
Comment
Proportion of inpatients to be treated through standardized clinical pathways at county level public general hospitals Value AH: 4 FJ:0 AH: 50 FJ:50
Date May 9, 2017 December 31, 2021
Comment
Proportion of outpatient care delivered by primary care facilities Value AH: 61 FJ: 51 AH: 61.8 FJ: 55
Date May 9, 2017 December 31, 2021
Comment

Number of prefectures that manage Type II diabetes patients using the integrated NCD service package (Threshold value for a prefecture to qualify as using the integrated service package is 25% of tota	Value	0	AH: 6 FJ: 4
	Date	May 9, 2017	December 31, 2021
	Comment

INTERMEDIATE RESULTS INDICATORS

INDICATOR		BASELINE	CURRENT	TARGET

Average length-of-stay for county level public hospitals Value AH: 8.82 FJ: 7.41 AH: 8 FJ: 7.37
Date May 9, 2017 December 31, 2021
Comment

Number of counties that have public disclosure of quality report (e.g. ALOS, drug revenue as a proportion of hospital revenue, expenditure per visit for outpatient, expenditure per admission for inpat	Value	AH: 55FJ:10	AH: 61 FJ: 68
	Date	May 9, 2017	December 31, 2021
	Comment

Proportion of labor based service revenue in total service revenue for all public hospitals in the province Value AH: 25FJ: 24.58 AH: 30.00 FJ: 30.00
Date May 9, 2017 December 31, 2021
Comment
Out-of-pocket payment as portion of the total inpatient services expenditure Value AH: 42FJ: 50.83 AH: 37 FJ: 48.83
Date May 9, 2017 December 31, 2021
Comment
Proportion of patients hospitalized within county Value AH: 69; FJ: 63 AH: 73 FJ: 80
Date May 9, 2017 December 31, 2021
Comment
Proportion of total Registered Physicians (assistant physician) and Registered Nurses practicing at the primary care facilities Value AH: 26.80 FJ:29.09 Increase
Date May 9, 2017 December 31, 2021
Comment
Number of hypertension patients that are under standardized management Value AH: 4500 000FJ: 1250 000 AH: 4700 000 FJ: 1300 000
Date May 9, 2017 December 31, 2021
Comment
Number of counties that have established a county-township-village population health information system [Anhui] Value 0 20
Date May 9, 2017 December 31, 2021
Comment
Number of THCs / CHCs that have established primary care health information systems [Fujian] Value 0 500
Date May 9, 2017 December 31, 2021
Comment

Number of prefectures achieving integration (at least of the management) of the health insurance schemes, thereby allowing unified payment arrangement for all providers	Value	AH: 0; FJ: 2	AH: 12 FJ: 9
	Date	May 9, 2017	December 31, 2021
	Comment

Program experience sharing and dissemination Value NA NA
Date May 9, 2017 December 31, 2021
Comment
The county IDS system has been scaled up to at least 50 counties/districts in Anhui Value NA Annual targets
Date May 9, 2017 December 31, 2021
Comment
The integration of the management of the three health insurance schemes at the provincial level in Fujian is undertaken Value NA NA
Date May 9, 2017 December 31, 2021
Comment
Growth rate of medical service revenue of public hospitals in the entire province Value AH: 8%FJ: 8.88% <10%
Date May 9, 2017 December 31, 2021
Comment

Proportion of hospital discharges paid through case-based payment for all county-level public general hospitals and TCM hospitals	Value	AH: 12 FJ: 3	AH: 32 FJ: 50
	Date	May 9, 2017	December 31, 2021
	Comment

Proportion of inpatients to be treated through standardized clinical pathways at county level public general hospitals	Value	AH: 4 FJ:0	AH: 50 FJ:50
	Date	May 9, 2017	December 31, 2021
	Comment

Proportion of outpatient care delivered by primary care facilities	Value	AH: 61 FJ: 51	AH: 61.8 FJ: 55
	Date	May 9, 2017	December 31, 2021
	Comment

Average length-of-stay for county level public hospitals	Value	AH: 8.82 FJ: 7.41	AH: 8 FJ: 7.37
	Date	May 9, 2017	December 31, 2021
	Comment

Proportion of labor based service revenue in total service revenue for all public hospitals in the province	Value	AH: 25FJ: 24.58	AH: 30.00 FJ: 30.00
	Date	May 9, 2017	December 31, 2021
	Comment

Out-of-pocket payment as portion of the total inpatient services expenditure	Value	AH: 42FJ: 50.83	AH: 37 FJ: 48.83
	Date	May 9, 2017	December 31, 2021
	Comment

Proportion of patients hospitalized within county	Value	AH: 69; FJ: 63	AH: 73 FJ: 80
	Date	May 9, 2017	December 31, 2021
	Comment

Proportion of total Registered Physicians (assistant physician) and Registered Nurses practicing at the primary care facilities	Value	AH: 26.80 FJ:29.09	Increase
	Date	May 9, 2017	December 31, 2021
	Comment

Number of hypertension patients that are under standardized management	Value	AH: 4500 000FJ: 1250 000	AH: 4700 000 FJ: 1300 000
	Date	May 9, 2017	December 31, 2021
	Comment

The county IDS system has been scaled up to at least 50 counties/districts in Anhui	Value	NA	Annual targets
	Date	May 9, 2017	December 31, 2021
	Comment

Growth rate of medical service revenue of public hospitals in the entire province	Value	AH: 8%FJ: 8.88%	<10%
	Date	May 9, 2017	December 31, 2021
	Comment