Establishing Equitable and Efficient Systems for Education and Healthcare

Education and healthcare are central to successfully sharing the fruits of economic development and promoting social equity. Both can contribute to human capital accumulation, labor productivity promotion, and economic growth. Improvements in education and health also help to close the gap between human capital and income, promoting social equity. They can also be mutually reinforcing. Achieving the development goal of “common prosperity” requires the establishment of equitable and efficient nationwide systems for education and healthcare. Insufficient funding and incomplete institutional systems are two long-term constraints hindering China’s approach to achieving a high-quality education system. On the one hand, public funding for education in China is insufficient and unevenly distributed. Public funding for early childhood education (for ages 0–3) and vocational education is relatively insufficient in China, with significant regional disparities. Guidance and supervision of the education system is insufficient, particularly in public childcare services, the integration between vocational education and general education, participation of enterprises, and autonomy of universities. Insufficient funding and incomplete institutional systems have led to unequally distributed resources in education, thereby weakening the role of education in promoting economic growth and social equity. The limited financial protection provided by health insurance and the uneven allocation of medical resources are the primary reasons for “kan-bing-nan” (seeking care is difficult) and “kan-bing-gui” (seeking care is expensive) in China. “Seeking care is expensive” is manifested as a heavy burden for patients, which can easily result in catastrophic medical expenditure, and even push them into poverty due to illness. “Seeking care is difficult” results from insufficient high-quality medical resources. Patients often struggle to find good doctors when faced with serious illnesses, and the number of physicians in rural areas is relatively low compared with urban areas. “Seeking care is expensive” in China reveals that there is still a long way to go before the country develops a fully comprehensive healthcare security system, and significant disparities persist between urban and rural areas. “Seeking care is difficult” in China reflects the unbalanced allocation of medical resources, with an excessive concentration of high-quality resources and large differences in clinical quality across different levels of medical institutions. The limited financial protection and unbalanced allocation of medical resources undermine the ability of healthcare to promote economic growth and social equity. To establish an equitable and efficient education system, China needs to increase fiscal investment in education and improve the overall environment for the development of young teachers. China should also clarify the focus of its education policies based on the unique characteristics of each stage of education. The government needs to commit more resources to inclusive childcare services in early childhood, expand the supply of in-school resources for basic education, diversify the assessment system, and modernize the vocational education system. To promote equity in basic medical services, China needs boost its financial resources, improve the efficiency of healthcare spending, and encourage innovation in commercial insurance. China should also develop an integrated, people-centered healthcare system with primary care at the core. This includes strengthening the capacity of community-level healthcare institutions, integrating healthcare and social care services at the community level, and promoting the training and development of healthcare professionals.