For international patients and global partners, understanding a nation’s healthcare quality governance is paramount. China has established a comprehensive, multi-dimensional healthcare quality management system. Through tiered governance, rigorous evaluation, and progressive alignment with international standards, the country is driving continuous improvement in patient safety and clinical quality, thereby enhancing the international competitiveness of its medical services.
China’s healthcare quality management system is the core institutional framework guiding the nation’s transition from “quantity and scale” to “quality and performance.” This system employs multi-dimensional mechanisms—including regulatory policies, quality standards, performance evaluations, and digital governance—to ensure the safety, effectiveness, and equity of medical services.
1. Main Pillars of China’s Healthcare Quality Management System
China’s quality management is built on a framework of tiered responsibility and multi-stakeholder collaboration, involving government bodies, medical institutions, and professional associations.
National and Provincial Governance
At the apex of this system is the National Health Commission (NHC), which holds overall responsibility for formulating and implementing national health policies, including those related to medical quality and safety. The NHC, in coordination with bodies like the State Administration of Traditional Chinese Medicine, leads nationwide initiatives to enhance healthcare quality. The recently issued “Action Plan for the Comprehensive Improvement of Healthcare Quality (2023-2025)” focuses on strengthening quality and safety management across all hospital departments, with a particular emphasis on surgical fields.
Provincial health authorities are responsible for executing national directives within their jurisdictions, creating a top-down accountability structure. This is complemented by a network of national and provincial Medical Quality Control Centers covering a wide range of clinical specialties. These centers are tasked with developing specialized quality control plans, analyzing data, and providing technical guidance to healthcare institutions.
Hospital-Level Quality Management
Within hospitals, a two-tier “hospital-department” management system is implemented. The hospital’s Medical Quality Management Committee, typically chaired by the hospital president, oversees the institution-wide quality and safety framework. Each clinical department has its own quality management group, ensuring that national standards are implemented at the grassroots level of patient care. This internal structure is designed to monitor and improve a set of 18 Core Systems for Healthcare Quality and Safety that guide clinical practice nationwide.
Four-Tier Quality Governance Network
| Level | Functional Role | Representative Bodies |
|---|---|---|
| National | Policy & standard formulation, national monitoring | NHC, National Quality Control Centers |
| Provincial | Organizing evaluations & data analysis | Provincial Health Commissions & Quality Control Centers |
| Municipal | Promoting standardization & training | Municipal Health Authorities |
| Hospital | Implementing internal quality management & self-assessment | Hospital Quality Control Committees |
2. Key Regulatory Mechanisms and Evaluation Standards
China employs a robust set of regulatory tools to monitor and enhance the quality of its medical services.
Hospital Accreditation and Tiering System
A cornerstone of quality control in China is its hospital accreditation and tiering system. Hospitals are classified into three tiers (Primary, Secondary, and Tertiary), with Tertiary hospitals representing the highest level of medical care, research, and education. These tiers are further subdivided into grades (A, B, C), with Tertiary Grade A Hospital signifying excellence across all aspects of healthcare delivery. This classification is not static; hospitals must undergo regular and stringent evaluations to maintain their status.
The accreditation standards are continuously updated, with the latest “Accreditation Standards for Tertiary Hospitals (2022 Edition)” emphasizing patient-centered care and continuous quality improvement.
Public Hospital Performance Evaluation
In 2019, China introduced a national performance evaluation for Tertiary public hospitals, commonly referred to as the “Guokao.” This comprehensive assessment evaluates hospitals based on 55 indicators across four dimensions:
- Medical Quality: Focusing on clinical outcomes and patient safety.
- Operational Efficiency: Measuring the effective use of resources.
- Sustainable Development: Assessing the long-term viability and growth of the institution.
- Patient Satisfaction: Gauging the patient experience.
The results of the “Guokao” are publicly released and directly impact a hospital’s reputation and government support, creating a powerful incentive for continuous improvement.
Multi-pronged Supervision Methods
In addition to these structured assessments, the Chinese government utilizes a range of supervisory methods. These include “flight inspections”—unannounced, on-site checks to ensure compliance with regulations and standards. Routine monitoring of daily medical activities is also a key feature of the system. Furthermore, social supervision is encouraged through public feedback channels and patient satisfaction surveys, ensuring that the patient’s voice is an integral part of quality oversight.
Adopting International Experience
While absorbing international experience, China’s healthcare quality governance has forged its own localized path:
| Source of International Experience | Adopted Mechanism | Implementation in China |
|---|---|---|
| WHO Patient Safety Solutions | Standardized incident reporting and correction systems | National nosocomial infection surveillance network covers 100% of Tertiary hospitals. |
| OECD Quality Indicators | Calculating amenable mortality based on disease burden | Publication of the “National Disease Burden Monitoring Report.” |
| UK NHS Quality Improvement Model | Establishing in-hospital PDCA cycles for continuous improvement | Hospitals establish dedicated “Quality Improvement Offices.” |
| US DRG-based Payment System | Shifting from volume-based to value-based payment | Nationwide rollout of DRG/DIP case-based payment reforms. |
3. Global Standing of China’s Healthcare Quality
International rankings and indices consistently show that the quality and accessibility of China’s healthcare system have made significant strides.
The Lancet’s Healthcare Access and Quality (HAQ) Index
The Healthcare Access and Quality (HAQ) Index, published by the medical journal The Lancet, measures national healthcare levels by assessing mortality rates from various causes that should not be fatal in the presence of effective medical care. Although the latest Global Burden of Disease (GBD) study analyzes data up to 2019, it highlights China’s dramatic progress over the past decades, with a particularly rapid pace of improvement since 2000. However, the study also points to significant regional disparities within the country, with central cities like Beijing and Shanghai performing on par with many high-income nations.
Numbeo Health Care Index
The Numbeo Health Care Index, which is based on user-contributed data, provides a comparative overview of global healthcare systems. In its mid-2025 rankings, China’s healthcare system is positioned among the top globally, ranking 32nd with a score of 68.7. The index considers factors such as the skills of medical staff, equipment, and cost. For comparison, the United States scored 67.8, Germany 71.9, and Singapore 71.8. This user-perception-based ranking positions China’s healthcare system as competitive and highly regarded by its users.
4. Integration with International Standards and Global Recognition
Recognizing the importance of aligning with global best practices, many Chinese hospitals actively seek international accreditation.
Application and Evolution of JCI and Other International Accreditations
Accreditation by the Joint Commission International (JCI) is widely considered the gold standard in healthcare globally. A significant number of hospitals in China have successfully obtained JCI accreditation, demonstrating their commitment to the highest standards of patient care and safety.
The number of Chinese hospitals pursuing JCI accreditation grew rapidly in the 2010s, reaching a peak around 2018. Starting in 2019, authorities began to discourage public hospitals from participating in third-party overseas accreditations, leading many to shift their focus to domestic performance and quality improvement. In 2023, JCI closed its business operations in China. Nevertheless, socially-run and high-end private hospitals still view international accreditation as a tool for brand endorsement and for facilitating direct billing with international insurers.
ISO and Specialized Accreditation
Beyond JCI, many leading hospitals have adopted the ISO 9001 Quality Management System to optimize processes and enhance efficiency, thereby further improving service quality.
China has adopted ISO 15189 to establish a quality system for medical laboratories, which are accredited by the China National Accreditation Service for Conformity Assessment (CNAS). Since the launch of accreditation for ISO 15189:2022 in December 2023, 248 medical laboratories had been accredited to the new standard by CNAS (as of December 6, 2024).
Developing Homegrown International Standards
To integrate global standards while retaining local characteristics, China is also developing its own internationally recognized accreditation system. The “International Accreditation Standards for Hospitals (2021 Edition),” developed by the Shenzhen Hospital Accreditation Research Centre, has been accredited by the International Society for Quality in Health Care External Evaluation Association (ISQua EEA). This initiative aims to create a framework that aligns with international best practices while being directly applicable to the Chinese healthcare context, which can facilitate recognition by international insurance companies.
China’s healthcare quality management system is a dynamic and evolving framework that is increasingly aligning with the highest international standards. For patients seeking high-quality, cost-effective, and innovative medical services, China presents a highly attractive and credible option.
