{
  "abstract": "Background Hospital-centred operational governance has been a persistent feature of China’s health system. While this model has supported administrative control, rapid service expansion and organisational standardisation, it has also contributed to the continued concentration of resources in hospitals, constrained local flexibility and the relative marginalisation of primary healthcare. This study examines, from the perspective of path dependence, how this governance model gradually emerged and persisted from 1835 to the present.Methods Drawing on historical studies, policy documents, institutional historical data, official materials and comparative global health literature, the study identifies seven phases in the historical evolution of hospital-centred operational governance in China: missionary introduction and early administrative formation; early institutional formation; nationalist integration and public function expansion; wartime adaptation and emergency coordination; socialist consolidation and planned administration; market transition and managerial modernisation and optimisation, digitalisation and performance governance.Results Across these stages, four self-reinforcing mechanisms collectively stabilised this pattern: institutional steering, functional expansion, managerial standardisation and market-oriented transformation. The evidence indicates that hospitals became dominant not simply because they appeared earlier but because they repeatedly accumulated administrative visibility, professional authority, technical capacity, fiscal channels and reform implementation functions.Conclusions For health system reform, the findings suggest that strengthening primary healthcare and improving equity require technical management reforms to proceed in parallel with changes in governance power, financing incentives, resource allocation, workforce status and data infrastructure. The global health implication is that countries pursuing universal health coverage should avoid allowing hospitals to become the default centre of finance, information, professional prestige and policy implementation.",
  "authors": [
    {
      "affiliations": [
        "Curtin University Malaysia Faculty of Business, Miri, Sarawak, Malaysia",
        "Banan Hospital Affiliated to Chongqing Medical University, Chongqing, China"
      ],
      "name": "Jackie Zhanbiao Li"
    },
    {
      "affiliations": [
        "Fourth Medical Center of the Chinese PLA General Hospital Department of Nephrology, Beijing, China"
      ],
      "name": "Duo Wang"
    },
    {
      "affiliations": [
        "Curtin University Malaysia Faculty of Business, Miri, Sarawak, Malaysia"
      ],
      "name": "Xin Li"
    },
    {
      "affiliations": [
        "Department of Ophthalmology and Otolaryngology, Unit 32265 of the People’s Liberation Army, Guangzhou, China"
      ],
      "name": "Menglan Zhu"
    },
    {
      "affiliations": [
        "Curtin University Malaysia Faculty of Business, Miri, Sarawak, Malaysia"
      ],
      "name": "Yingying Tiong"
    },
    {
      "affiliations": [
        "The First Affiliated Hospital of Guilin Medical University, Guilin, Guangxi, China"
      ],
      "name": "Yingqian Lao"
    }
  ],
  "title": "Historical roots of hospital-centred operational governance in China: a path dependence analysis and its implications for global health system reform",
  "uid": "74835492-7d65-5c37-892b-c02f1d96637f"
}