China needs to make a strategic shift in its health care reform to avoid ballooning costs as its population greys and its economy slows, according to a report by the World Bank, the World Health Organization (WHO) and several ministries. Without significant changes, annual expenditure could rise from CNY3.5 trillion in 2014 to CNY15.8 trillion by 2035, an increase of 8.4% a year, the report said. Health spending would account for more than 9% of gross domestic product (GDP) in 2035, up from 5.6% in 2014, with more than 60% of the increase coming from in-patient services. China had a “critically important opportunity” to avoid the high costs of health systems seen in many member countries of the Organization for Economic Cooperation and Development (OECD), the report said. The country could achieve that goal with the help of “deeper reform in the health care system to deliver high-quality care at a reasonable cost,” World Bank Group President Jim Yong Kim said. The report also warned that Beijing was at risk of making the same mistakes many higher-income countries had. As China’s economy loses steam, increasing spending on health care might be difficult to sustain, the South China Morning Post reports.