The Structural Imbalance and Trajectory of Chinese National Policies on Medical-Preventive Integration: A...

The global health landscape is currently confronted with dual challenges from both infectious diseases and chronic conditions. Medical-preventive integration has emerged as a pivotal strategy to address these issues, aiming to create a comprehensive, closed-loop framework that spans disease prevention, treatment, rehabilitation, and healthcare, ultimately improving population health outcomes. In the Chinese context, existing policies remain fragmented, scattered across various healthcare-related regulations, and lack systematic and comprehensive analysis. This policy fragmentation may impede the creation of synergistic effects essential for the effective implementation of integrated healthcare strategies.

This study adopted a mixed-methods approach to analyze 85 national policies: a three-stage coding process identified 1088 policy nodes, and a three-dimensional framework (policy instruments (X) × full-cycle health service (Y) × integration stages (Z)) was applied to uncover systemic imbalances. Social network analysis and Latent Dirichlet Allocation (LDA) topic modeling were utilized to map interagency collaboration patterns and thematic shifts, which were visualized using Gephi and Sankey.

The analysis revealed that policy instruments are predominantly supply-side (45.04%) and environmental-side (40.35%), with demand-side instruments (14.61%) being notably underutilized, particularly in health financing. Rehabilitation services, representing just 8.27% of the policy focus, were identified as a significant gap in the comprehensive health service cycle. While 44.58% of the instruments facilitated collaboration of medical and preventive services, integration of medical-preventive management stagnated at 25.28%, reflecting institutional inertia that impedes the redistribution of cross-sector resources. Agency collaboration evolved from a siloed approach (2015-2018) to a networked structure (2019-2021) and transitioned to centralized governance post-2022. Thematic shifts in policy discourse moved from a "Healthy China" focus toward pandemic-driven disease surveillance, culminating in the recent development of smart health ecosystems.

China's policies for medical-preventive integration demonstrate notable structural imbalances, particularly in the economic instruments related to health financing and the private-sector participation in healthcare. These imbalances may impede the effective allocation of healthcare resources and hinder the seamless transition toward integrated care. Future policy efforts should focus on optimizing the structure of policy instruments, addressing gaps in the full lifecycle of health services, advancing integration reforms, and promoting the transformation of the healthcare system through enhanced collaborative governance among key stakeholders.