Post-acute care in China: development, challenges, and future prospects
Authors: Hu Linlin , Geng Fangli , Liu Winnie , Zhi Mengjia , Yan Runnan 
Published: January 2024

Introduction: Post-acute care has been proved to be a crucial component of the health care system which promotes autonomous living functions, reduce unnecessary hospitalization, prevent unnecessary placement in a long-term care facility, and coordinate care between different levels of care.Different countries have built various forms of a PAC systems for decades. In light of the ongoing payment reform and population aging, PAC is becoming increasingly important as a part of the integrated health system in China. Based on comprehensive literature review, this paper summarizes Chinese health policies and progress that addressed PAC system in recent decades and provides outlook for future development.

Methods: We based our review on published work and grey literature, including reports (international and domestic) and government policy documents. We searched PubMed, Google Scholar, EconLit, MEDLINE, Social Science Research Network, Wiley Online Library, and China Knowledge Resource Integrated Database for relevant research published since January 2009, until June 2022. We restricted our search to works published in English or Chinese and used the search terms “post-acute care”, “rehabilitation”, “nursing care”, “intermediate/transitional care”, “continuous medical/healthcare”, AND “China”, and combinations of these terms.

Results: In the past decade, China has released various policies to support and regulate the development of rehabilitative and nursing facilities, in order to meet the increasing demand for PAC, including the building of rehabilitation and nursing facilities, strengthening PAC at the primary care level, constructing a tiered rehabilitative network, and experimenting innovative payment methods. However, the challenges and gaps remain. China lacks clinical consensus for PAC delivery and continues to face a severe shortage of PAC resources, both in terms of facilities and professionals. Moreover, quality of PAC at the primary level health facilities needs improvement for the hierarchical care system to function well. The development of a sound financing and payment mechanism for PAC services is still at the initial stage.

Conclusions: This is the first paper comprehensively examining the current development progress of PAC as a whole, and point direction for future PAC system development in China.In its overall health system design, although the name of PAC is not explicitly stated in domestic policy documents, it is considered as an integral part towards a more continuous system, and a preliminary framework of the PAC system has been established through various efforts. To promote the further development of China’s PAC system, attention should be given to setting up of official definition and clinical guidelines, development of sound financing and payment models, increasing public and private investment in PAC infrastructures, establishing health provider requirements, strengthening the training and retaining of professionals and development of unified information system for PAC based on functional assessment.