Unveiling the 35-year evolution of palliative care in mainland China: An in-depth policy analysis.

Abstract

Global aging and rising severe illnesses prevalence have increased demand for palliative care, widening service gaps. Policy support is vital for advancing high-value services. To unveil the 35-year evolution of palliative care policy in mainland China. An in-depth analysis of the external and internal characteristics of palliative care policy documents. Developmental periods were delineated using core characteristics, key events, and annual releases. Network analysis mapped intersectoral collaboration in palliative care policy-making. Text mining techniques, including burst words and word frequency analysis, identified policy priorities and inclinations. Policy instruments were classified using Rothwell and Zegveld's framework to analyze the policy landscape and its evolution. Palliative care policies, the research subject of this study, were retrieved from Chinese legal databases and government websites. Policy evolution spanned five periods: germination (1991-2002), exploration (2003-2010), expansion (2011-2015), rapid development (2016-2019), and stable development (2020-2023). Intersectoral collaboration among policymakers evolved from single-department regulation to multi-sectoral governance, with the National Health Commission serving as the pivotal entity. Policy priorities and inclinations reflected the unification of policy terminology, the establishment of an institution-community-home continuum, and the active incorporation of local elements. Policy instruments transitioned from imbalance to greater balance over time, although several sub-instruments remained underutilized. Mainland China has established a comprehensive palliative care policy framework with distinctive features, with development particularly accelerating after 2016. Nonetheless, gaps persist in dedicated legislation or planning, financially sustainable funding strategies, integration into health professional education, and supportive digital infrastructure. Future efforts should prioritize the transition from framework-building to ensuring equitable access.