Objective To assess the carbon footprint of China's healthcare system, identify the main drivers, and provide a scientific basis for the development of practical emission reduction strategies.

Methods Environmental extended input-output analysis and structural path analysis were used to assess the carbon footprint (greenhouse gas emissions) of China's healthcare system.

Results The total expenditure of China's healthcare system reached 4 615 billion yuan in 2017, resulting in 396 MtCO₂e emissions, accounting for 3.7% of the total domestic greenhouse gas emissions. In terms of health expenditure categories, public hospitals were the largest contributor to the carbon footprint, with emissions of 187 MtCO₂e, accounting for 47% of the total emissions from the healthcare system. This was followed by non-hospital purchases of pharmaceuticals (88 MtCO₂e, 22%). In terms of emission sources, the electricity and heat sectors were the largest contributor to the carbon footprint with emissions of 179 MtCO₂e, accounting for 45% of the total healthcare system emissions. This was followed by the agriculture sector (51 MtCO₂e, 13%). When broken down by the healthcare organization sector, indirect emissions along the supply chain due to purchased goods and services (Scope 3) were the most significant contributor, accounting for 87% of the total emissions from the healthcare organization sector.

Conclusion The study showed that public hospitals, electricity and heat sectors, and procurement activities are the main drivers of greenhouse gas emissions from the healthcare system in China. These findings provide a scientific basis for the development of effective emission reduction strategies and the realization of a low-carbon sustainable healthcare system.