Category: Health Care and Medicine

By A. Nichols

Over the past sixty years China has gone through many major changes. China has made the transition from a strict communist regime under the rule of Mao to a more open society and marketized economy. It is undoubtable that perceptions of China have transformed dramatically as a consequence of these changes. One perception is that since the economic reforms of the 1980s, everything in China has improved. To explore this perception, I looked closely at one aspect of China: health care. The driving question I had was how health care during Mao’s era compared to that in the Reform era.

The Chinese Communist Party, led by Mao Zedong, came into power in 1949 and drastically improved health care in China. The newly implemented health care system was entirely government-controlled and the large majority of Chinese citizens had access to health care. [1] As the book Reforming China’s Rural Health System states, the success of health care during that time was “widely ascribed to its broad deployment of grass root health workers.” [2] This is a reference to barefoot doctors, which were not fully trained doctors but had schooling for approximately two years. [3] The health care system during Mao’s era had huge success. Nearly everyone had access to care and all care was almost fully government funded.

Soon after Mao died in 1976, the Reform era began, marking the beginning of dramatic changes in health care. The Reform era started in 1978 and continues on today. During this time China “opened themselves” to the world. As a consequence, the government’s economy became more capitalistic. Now, instead of just focusing on how to get care to everyone, emphasis was put on making a profit. For example, research has shown that sixty percent of hospital revenues are reliant on pharmaceuticals[4] and that “China had one of the world’s most highest shares of pharmaceutical expenditure relative to health expenditure.” [5] Many doctors will overdiagnose, prescribing drugs that are not needed and even giving surgeries that are not necessary because they are more concerned in making a profit. [6] Health care also became much less government-funded and much more dependent on the individual or local governments to fund themselves. As a consequence, poor areas cannot support themselves while rich urban areas can afford the care that they need. Overall, health care in the Reform era is extremely flawed.

When comparing the health care system during Mao’s era to the present day health care system, it does not even compare in respect to the access that people had to medical attention. During Mao’s era, nearly all citizens had access to health care that was controlled and funded by the government. Now, however, there are millions of people without access to health care. Many people have the preconception that everything in China is better now, however, as we saw with health care, not everything has improved. Despite recent reforms, the health care system during Mao’s era was more effective.

[1] Kaye, Jeffrey, China Struggles With Health Care Reform Amid Growing Demand. (April 14, 2011. PBS News Hour.) News Film.

[2] Adam Wagstaff, Magnus Lindelow, Shiyong Wang, and Shuo Zhang. Reforming China’s Rural Health System. (Washington D.C.: The World Bank, 2009), p.24

[3] LaFraniere, Sharon. “Chinese Hospitals Are Battlegrounds of Discontent.” The New York Times. Accessed October 28, 2012. http://www.nytimes.com/2010/08/12/world/asia/12hospital.html?_r=0

[4] Dr. Yang Hong. The Health Care System in China: Can Ongoing Reforms Meet the Emergent Challenges? (2011, College Station, TX, Texas A&M Architecture for Health Lecture Series)

[5] Adam Wagstaff, Magnus Lindelow, Shiyong Wang, and Shuo Zhang. Reforming China’s Rural Health System. (Washington D.C.: The World Bank, 2009), p.3.

[6] Barefoot Doctors of Rural China. 1975. U.S. Agency for International Development. Documentary Film.