In 2021, General Office of the State Council issued the 14th Five-Year Plan for Universal Healthcare Security, and in 2026, the National Healthcare Security Administration released the 15th Five-Year Plan for Universal Healthcare Security—marking the two systematic strategic blueprints in the history of China's healthcare security system to be formulated as dedicated five-year sectoral plans. Drawing on institutional change theory, this paper conducts a systematic comparative analysis of the two five-year planning documents to reveal the underlying logic of China's healthcare security system as it evolves from "scale coverage" to "institutional maturity" and from "institutional construction" to "governance modernization". The study identifies three major transition trends across the two plans: the goal system evolves from the establishment of the "Five Healthcare Security Priorities" framework to the systematic deepening of the "Six Healthcare Security Priorities"; the governance logic shifts from "healthcare-security-department-led" unidirectional control to "coordinated development and regulation of medical insurance, medical services, and pharmaceuticals" with systemic integration; and the policy focus moves from "basic coverage" under the system to "quality and sustainability" with enhanced effectiveness. Underlying these transitions is a deeper logic: China's healthcare security system is undergoing a fundamental governance paradigm shift—from "having or not having" to "good or not good", from "whether the system exists" to "whether the system works"—with its core proposition being a paradigm shift from "universal healthcare security" to "universal health". The Healthy China strategy provides the fundamental rationale and institutional environment for the triple transitions above; five-year plans represent concrete practices to advance the modernization of healthcare security governance within the framework of the Healthy China strategy. Looking ahead, China's healthcare security system should continue to intensify efforts along three dimensions—further optimized and more sustainable institutions, collaborative governance, and performance enhancement—to advance healthcare security from "institutional full coverage" to "governance with high quality".
Key words
Healthy China /
healthcare security /
five-year plan /
institutional evolution /
governance transformation
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