public health care

China’s economic and administrative reforms since the late 1970s have led to important changes in the system of public health care. In the countryside, township (former commune) health centres assume a larger share of administrative and financial responsibilities. At the village (former brigade) level, the cooperative medical system has generally disintegrated, and some village clinics are run as fee-for-service businesses. While the state health care system at the provincial, municipal and county levels remains essentially unchanged—each still maintains its functional public health departments and hospitals (including hospitals of Chinese medicine) and other specialized care institutions—the trend has been to encourage wider use of enterprise hospitals by the public and the cooperation of medical institutions from different administrative units. Other developments include a rise in private practice, an increase in fees for treatment and drugs, as well as the growth of specific patient-requested services, such as special hospital rooms or enhanced nursing care. The government maintains and funds organized public health activities, including immunization programmes and maternal and child care, while anti-epidemic stations at the provincial, municipal and county levels work to prevent and control communicable diseases through environmental and food sanitation monitoring. The decentralization of the health system and the reduction of public subsidies to lower-level agencies have aggravated the uneven distribution of resources between the urban and rural sectors, and the rising cost of health care, especially with the expansion of private practice, has increased the burden on low-income families.

See also: hospitals; medical doctors; medical insurance; mental health

Further reading

Huang, S. (1988). ‘Transforming China’s Collective Health Care System’. Social Science and Medicine 27:879–88.

Liu, X. and Wang, J. (1991). ‘An Introduction to China’s Health Care System’. Journal of Public Health Policy 12:104–15.

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