The Rise of Hospital Dominance in China: Distribution of Resources and Activities Between Hospitals and Primary Care Facilities (1949–2018)

China is often seen as a pioneer in primary care development. However, primary care facilities have struggled to obtain sufficient funding and human resources, while county and higher-level hospitals have attracted the major share of health system resources. This chapter measures and compares the long-term trends of the levels of activities and resources between hospitals and primary care facilities from 1949 to 2018. The hospital centrism in China’s contemporary health system is rooted in a continuous history after 1949 that saw primary care facilities initially growing into a tier of care that provided substantial inpatient and ambulatory services like hospitals, but which was unstable, low-cost and de-professionalized relative to hospitals. This long-term perspective offers important insights that complement contemporary studies on primary care strengthening.