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Overcoming the legacy of marketisation: China’s response to COVID-19 and the fast-forward of healthcare reorganisation
  1. Zhiyong Liu1,
  2. Ian Kirkpatrick2,
  3. Yaru Chen3,
  4. Jixia Mei4
  1. 1School of Medicine and Health, Huazhong University of Science and Technology, Wuhan, Hubei, China
  2. 2The York Management School, University of York, Sheffield, North Yorkshire, UK
  3. 3Cass Business School, City University of London, London, UK
  4. 4School of Public Administration, Zhongnan University of Economics and Law, Wuhan, Hubei, China
  1. Correspondence to Dr Jixia Mei, School of Public Administration, Zhongnan University of Economics and Law, Wuhan 430073, China; meijixia{at}

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Having a healthcare system that’s a public strategic asset rather than a business run for profit allows for a degree of coordination and optimal use of resources.1

This remark by David Fisman, an epidemiologist at the University of Toronto, reflects the views of many policy makers and clinical professionals globally about the relative merits of different organisational models of healthcare for managing the COVID-19 pandemic. COVID-19 emerged in China in November 2019 and was declared a pandemic by the WHO on 11 March. At the time of writing, on 27 July 2020, more than 16.11 million cases of the virus have been reported globally, resulting in more than 64 6641 deaths. Without doubt, responding to this crisis has placed an unprecedented demands on the expertise of public managers, notably those associated with healthcare. But as the opening quotation implies, it may be that these demands are far greater in systems where healthcare services are substantially commercialised and where the emphasis is on competition and fragmentation rather than integration. If this is the case, then how have policy makers and managers dealt with this organisational challenge and what can we learn from their initial responses?

The challenge of how to overcome fragmentation in health services and adopt a system-wide perspective has been one of the most significant wicked problems facing policy makers, managers and clinical leaders around the world. In any healthcare system, rising costs and resource constraints linked to more complex patient needs (associated with population gaining) demand effective collaboration between different parts of a healthcare value chain: public health, primary/community care and specialist hospital services. Ideally this would involve a ‘continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation and palliative care services’ (p10).2

But while this change is urgently needed (perhaps now more than …

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  • Contributors All authors participated in the design and coordination of the study. ZL and IK led the writing and data analysis within the manuscript. YC and JM supported the data analysis and helped draft the manuscript. All authors read and approved the final manuscript.

  • Funding Funding was received from the National Natural Science Foundation of China (grant number: 71874059).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.