ArticleFrontiers in public health2026
The impact of national comprehensive medical reform on healthcare quality: evidence from China.
Article in Frontiers in public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Healthcare quality is an important dimension of health system performance and a key criterion for evaluating the effectiveness of China's deepening healthcare system reform. This study treats the National Comprehensive Medical Reform pilot as a quasi-natural experiment to examine its impact on healthcare quality and further analyzes the potential mechanism of pharmaceutical pricing reform. Methods: Based on panel data from 31 provinces in China from 2012 to 2020, combined with data on medical malpractice liability disputes from China Judgments Online, this study employs a multi-period difference-in-differences model to identify the policy effect of the National Comprehensive Medical Reform pilot. Healthcare quality is measured by the incidence of medical malpractice liability disputes and inpatient mortality, and the mechanism of pharmaceutical pricing reform is analyzed through changes in the structure of medical expenditures. Results: The study finds that the National Comprehensive Medical Reform pilot significantly reduced the incidence of medical malpractice liability disputes and inpatient mortality, indicating that the reform helped improve healthcare quality. Mechanism analysis shows that the reform significantly reduced drug expenditure per outpatient visit and per inpatient admission, lowered the share of drug expenditure, and increased the share of medical service fees. These findings suggest that the National Comprehensive Medical Reform may have improved healthcare quality by reducing hospitals' dependence on drug-related revenue, increasing the relative importance of service-based income, and reshaping hospital revenue structures and provider incentive mechanisms. However, the share of examination fees increased significantly, indicating the possible presence of substitute revenue-seeking incentives and associated quality risks during the reform process. Discussion: The National Comprehensive Medical Reform pilot had a positive effect on improving healthcare quality, and its mechanism may be related to hospital revenue restructuring and the optimization of healthcare service incentives induced by pharmaceutical pricing reform. Future reforms should further strengthen coordination among medical care, medical insurance, and pharmaceuticals, continue to optimize medical service pricing and compensation mechanisms, and curb substitute revenue-seeking behavior, so as to provide a more stable and sustainable institutional foundation for the continuous improvement of healthcare quality.
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