🎧 Here on The ChinaHealthPulse Podcast, I chat in depth with the real experts who have dedicated years to working in and with China’s health - across policy, industry, academia and well beyond. Our candid conversations aim to provide you with real insight into how care is delivered, how decisions are made, and why it all matters, far beyond China’s borders. Watch or listen here on Substack or Youtube, and/or subscribe on Spotify & Apple Podcasts. These newsletter posts provide all links, plus a full text transcript of each episode. This past month, China’s role in global Health was more visible than ever. The 79th World Health Assembly was held in Geneva last week, bringing governments into the annual forum where health policy financing, technical cooperation on health and diplomacy collide. For countries all around the world, the WHA is much more a health meeting; it’s also a test of how nations can present themselves inside the multilateral institutional platform and how they handle sovereignty questions, how they talk about development and how much global health leadership each nation is aiming for. And for China, certainly, it was a really important platform. The week prior, in mid-May, President Trump visited Beijing for a high-profile summit with President Xi Jinping. And though health may not have been the headline issue, it is a topic that underlies so many of the difficult questions within U.S.-China relations today, whether that’s drug supply chains, biotech competition, health data and disease surveillance, or tariffs or aid or trust. And if we go back a little further, to March earlier this year, and the Two Sessions, China’s annual plenary. This year, China’s 15th Five Year Plan was delivered, and it showed how much pressure China’s domestic health system is under, whether that’s hospital reforms, ageing, long-term care, rising chronic disease burdens. These health policy challenges are part of much larger domestic themes around how China aims to govern healthcare, cost, technology, and social stability at the same time. This episode is a chance for us to step back from all of those headlines and events and ask: what does Beijing actually want from healthcare now? i.e. the policy logic underneath both China’s domestic and international health strategy. To help make sense of this, our guest Professor Yanzhong Huang is one of the leading scholars of China’s health politics and governance, global health security and US-China relations. He looks at China’s health policy through institutions, incentives, state capacity, trust, bureaucracy, international relations and security, connecting all of these dots across both the domestic and the international in a way that many health discussions on China miss. Professor Huang is a Senior Fellow for Global Health at the Council on Foreign Relations, where he directs the Global Health Governance Roundtable Series. He is Professor on Global Health at Schwarzman College at Tsinghua University, and also Professor and Director of Global Health Studies at Seton Hall University’s School of Diplomacy and International Relations, where he developed the first academic concentration among US professional international affairs schools focused specifically on the security and foreign policy dimensions of health. Professor Huang has testified before US congressional committees multiple times and is regularly consulted by media, government, industry, and NGOs on global health in China. He is the author of several major works, including Governing Health in Contemporary China, Toxic Politics: China’s Environmental Health Crisis and its Challenge to the Chinese State, and The COVID Pandemic and China’s Global Health Leadership. He is also Founding Editor of Global Health Governance, the scholarly journal for the new health security paradigm. Watch/listen/read on Substack, on Youtube, or subscribe to the audio podcast on Spotify and Apple: Read our Conversation: (Audio transcript adjusted for clarity and flow) 1. China’s Health Ambitions & Challenges Ruby: Let’s start with the big picture first. When we look at China’s health system in 2026, what do you think does the state want from healthcare now? Is it being treated as a public service, a social stability issue, an innovation engine, a fiscal challenge, a governance test? Or is the challenge that it is all of these things at once? Professor Yanzhong Huang: Well I think if you want to single the most important tension and challenge for China’s healthcare system, in 2026, it all boils down to this challenge, that is: China wants a developer ward health system at a developing country price. But rather than to significantly invest in its healthcare system, for example, it makes its hospitals earn their own cap. So once you see that one choice, (it leads to) almost everything else that people worry about: the inequality, the corruption, the over-treatment, the stunted private sector, all if it starts to look like a consequence of that. Certainly, the government ambition is enormous, Healthy China 2030 aims to raise China’s average life expectancy to around 80 years old by 2030, to cut claims coverage above 95 per cent, pushing to lead in biopharma and AI. But if you look at how much China has spent, it is only around 5 per cent of GDP on health. That is well below what countries with those ambitions usually spend. How do you square that? Not by writing big checks to hospitals, but by telling hospitals to go find the money themselves. A couple of weeks ago I was in my hometown, meeting with the director of the county hospital. I was told that the direct government funding was about 1 per cent of the total revenue, which was roughly 600 million yuan. What is that institution really? A public hospital that behaves like a business, or a money-making machine, if you will. Remember in China, public hospitals provide roughly 80 to 90 per cent of the hospital services, China has imported the incentive of the market, to chase revenue, chase volume, chase the demand, into a system that is still publicly owned but without the discipline a real market imposes. So you get the incentives of the market without its accountability and the ownership of the state without its funding. That is like the worst of both worlds, right? I think that is the major challenge. Just to give an example of the potential consequences. A relative of mine had cerebral haemorrhage last month and needed emergency surgery. The bill was about 100,000 RMB. She is covered, she is insured, but after reimbursement, she was still left paying close to an entire year’s average raw income out of pocket. So the gap between covered and protected - it’s enormous. There’s still a threshold beyond which ordinary families simply fall through. You might call this China’s key line. 2. China’s 15th Five Year Plan Ruby: Bearing in mind China’s persisting challenges, gaps in access, cost inequalities. The Two Sessions in March gave us the 15th five-year plan, the forward-looking five-year blueprint vision of what China wants to achieve across all sectors, including on health care and social welfare. From those health signals, which priorities do you think outside observers should take seriously? And which ones might feel more like repeated policy language that might be harder to translate into real change with time? Do you think we’re seeing a new phase of health reform or continuing unresolved persisting problems as the fiscal demographic and pressures that you mentioned, continue? Yanzhong Huang: Honestly, I think most of what gets announced at the two sessions on health is continuity, or you might call it a gradual approach - essentially, the same '‘Healthy China” language year after year. So the useful question isn’t “what did they say”, it’s “what actually it signalled”, and this year, there are two (areas) that I believe are worth taken seriously. The government is admitting that the basic public health insurer, the health insurance, has hit a ceiling, so it’s doing two things: building rails for private money to share the load, and concentrating the scale of public money on the demographic emergency. The first one, the outside observers tend to most underrate, because it sounds technical, but it isn’t. For the first time, commercial health insurance showed up in the government work report. Premier Li Qiang said that the government would move faster to develop it. In January, China launched its first ever commercial health insurance drug list, the so-called “Category C” list, sitting deliberately outside the basic health insurance catalog, and designed to capture the expensive, highly innovative drugs the public fund can’t afford. So it is simultaneously a confession and an invitation: the confession because the basic insurance can no longer pay for everything, the invitation, to the private sector, here is the official reimbursement pathway for premium medicine, so go and build a market. So for pharma and insurers, that’s the most consequential thing from the Two Sessions. And the second signal is the demographic pivot. That’s where the real money is moving. The government announced that measures to improve total fertility rate to a national child care subsidy 3600 RMB a year per child aged under three. That is around 90 billion RMB of central government money, reaching over 20 million families. They also announced a goal of making basic childbirth essentially free, and even more interesting, assisted reproduction. In-Vitro Fertilisation, IVF, now is covered by insurance in all 31 provincial regions - that was unthinkable, a few years ago. These are some very interesting signals, but cash baby bonuses have a weak track record everywhere, because fertility essentially doesn’t respond much to a few thousand RMB when the real cost we know is more about housing, education, and career
