Who Actually Runs Health in China? A Map of Policy and Power

Your foundational explainer to China’s health governance, and how the many pieces fit together to direct care, cost and access.

🩺 This Vital Signs post at China Health Pulse provides an overview of China’s current health ministries: who does what, where the power sits, and why it’s not as simple as a single authority.

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A System Without a Centre

In China’s health system, governance truly matters more than anything else. The shape of policy architecture doesn’t just influence the public system; it defines the rules, boundaries and incentives of the private market too. Even in sectors where the pace of digital innovation or biotech R&D can move quickly towards commercialisation, alignment matters more than data or product, and survival (let alone success) is fully dependent upon reading policy signals and navigating institutional relationships.

Understanding health governance in China is essential. But it’s complex and distinctive.

Governance fragmentation is not unique to China. The US splits power across CMS, FDA, CDC and NIH among others. The UK separates policy from provision, devolves power across four nations, and maintains agencies for licensing, pricing and regulation. The same goes for every country in Europe, and really, around the world.

What is unique to China’s strategic jigsaw, however, is is how flat the hierarchy runs. Reporting lines are diffuse, and power flows not only from the State Council but through Party commissions, local Party secretaries and long-standing institutional momentum.

There’s also deliberate decoupling: where top-down policy drive is combined with bottom-up decentralised execution to produce regional variations in access, outcomes and speed of reform. National agencies set frameworks and launch pilots, but they cannot directly enforce uniform execution. Implementation on the ground depends on local finances, reform incentives and provincial leadership (I’ve written about this before). This means that what happens in clinics and hospitals (and hence, what patients actually experience) varies dramatically across geography.

Understanding who does what and why requires tracing both the architecture and the incentives.

This post provides a starter map, setting out the ecosystem as it stands in 2025: who the major players are, what they’re responsible for, and how they interact. In future Real Diagnosis posts, I’ll go deeper into key ministries to explain their history and trajectory - as well as anecdotes from my time working with them.

Here’s my exclusive and comprehensive stakeholder map of the major bodies governing China’s health: