Impact of new health care reform on enabling environment for children's health in China: An interrupted time-series study

Background Creating an enabling environment (EE) can help foster the development and health of children. The Chinese government implemented a new health care reform (NHR) in 2009 in a move to promote an EE for health. The purpose of this study was to evaluate the impact of the NHR on EE for children's health. Methods An interrupted time-series analysis was used to evaluate the changes in the EE before and after 2009 in China. This study analysed the EE through five quantitative indicators, including policy element coverage rate (PECR), service meeting with children's needs rate (SMCNR), multisector participation rate (MPR), and accountability mechanism clarity rate (AMCR), based on the content analysis of available public policy documents (updated as of 2019) from 31 provinces in mainland China, and the number of health care personnel of maternity and child care centres per 10 000 population (HP per 10000 population), based on the 2002-2019 China Health Statistical Yearbook and China Statistical Yearbook. Results The average values of PECR, SMCNR, and MPR increased rapidly to 90.96%, 82.46%, and 81.31%, respectively, in 2019, representing a higher value compared to the AMCR (7.38%). The NHR promoted the EE, in which HP per 10000 population showed the fastest increase (beta(1) =0.03, P< 0.01; beta(3) =0.10, P<0.01), followed by SMCNR (beta(1) =0.94, P<0.01; beta(3) =1.83, P<0.01), AMCR (beta(1) =0.13, P<0.01; beta(3) =0.24, P=0.14), MPR (beta(1) =1.35, P<0.01; beta(3) =2.47, P<0.01) and PECR (beta(1) =1.43, P<0.01; beta(3) =1.47, P<0.01). Conclusions The NHR has a positive impact on the EE, especially on the human resources and service provision for children. Efforts should be intensified to improve the clarity of the accountability mechanism of the health-related sectors.