Health and health care in Chinese government manifestos: a content analysis of the Report on the Work of the Government from 1954 to 2016.

BACKGROUND: The Report on the Work of the Government, an important manifesto of the Chinese administration, provides a fundamental and comprehensive outline for public policy-making annually. For health policy researchers, the report provides unique insights that cannot be found in documents within the health-care sector, since the report addresses health issues together with other social concerns. This study uses government work reports to analyse how health issues have been framed and associated with other crucial agendas within the Chinese Government.

METHODS: A descriptive content analysis was done to examine the classifications, characteristics, frequency, and distribution of health issues elaborated in the 48 government work reports published during 1954-2016. Health issues were identified by extracting texts containing one or more of the following keywords: medicine, hygiene, health, drug, disease, and family planning. Network analysis was applied to investigate what issues are most likely associated with health issues, and how subtopics are connected under the concept of health care and hygiene.

FINDINGS: Although the words hygiene, health care, or medicine appeared in all 48 reports, health issues were explicitly addressed in 42 reports, ten of which only briefly mentioned the subject (<100 words). Health issues received much more attention in recent decades: as a proportion of total word count, text on health issues in the reports rose from an average of 1·72% (SD 1·29) during 1954-77, to 1·87% (1·02) during 1978-87, to 2·62% (0·84) during 1988-2003, and to 5·40% (1·35%) during 2004-16. Some issues were often mentioned before or after health, including education, culture, and sports. Other issues closely relevant to health care, such as family planning and elderly care, were frequently discussed together. The variation of subtopics through time shows how the government shifts focus in the health care sector. For example, health reform appeared first in the 1983 report, but it was not until 1993 that health reform became a focus and remained in all reports afterwards.

INTERPRETATION: This historical overview helps understanding of how the development of the Chinese health system has been propelled by government commitments.

FUNDING: Peking University Medical College Junior Researcher Development Program.