Akademik

Chinese hospitals are the pillars of the urban health care system and an important but not always accessible resource for rural residents with serious illnesses. Most of China’s 16,732 hospitals were built after 1949 in accordance with Chinese Communist Party (CCP) health policies: to provide health care for all; to emphasize preventative care over curative care; and to unify Chinese medicine and biomedicine. The transition to a market economy in the reform era, however, has introduced new challenges to China’s vast network of hospitals and clinics and pushed them away from the egalitarian principles of the Maoist era.

At the founding of the People’s Republic, China was confronted with dire public health conditions. One of the great achievements of Maoist-era health policy was to overcome this crisis by developing the infrastructure to bring basic health care services to both rural and urban areas. Rural health care delivery was structured around a three-tier network of institutions—village clinics, township health centres and county hospitals—whose services ranged from treating simple ailments at village clinics to providing a full spectrum of outpatient and inpatient services at the county hospital. In urban areas, a similar but more professionalized hierarchy of health care institutions was established—primary care street hospitals; secondary care district hospitals; and tertiary care municipal, provincial, and central ministry hospitals.

Reform era policies have raised the quality of health care but sacrificed accessibility. The government has made health care institutions responsible for their own profits and losses and at the same time tried to curtail skyrocketing medical insurance costs.

Under these conditions, only the top-tier hospitals of the rural and urban systems possess the financial resources to compete aggressively for patients and grow hospital revenue. Hospital administrators have realized that cutting-edge medical equipment and the top drugs from the world’s leading pharmaceutical producers bring both the highest marginal returns and the greatest number of patients. As a result, large hospitals are flourishing while lower-tier health institutions languish. At the same time, rural residents and uninsured urban residents are increasingly unable to defray ballooning medical costs. Thus, while health care delivery to remote rural areas has stagnated or even regressed in the reform era, some urban areas have CT and MRI densities per hospital bed that exceed those of the USA or Europe. Although policy-makers are implementing major reforms of the health insurance system and eager to reinvigorate the lower tiers of the urban and rural health care system, the current trend towards uneven resource distribution is not likely to abate soon.

Another important achievement of the Maoist era was the development of a health care infrastructure for Chinese medicine. Since 1949, China has built over 2,500 hospitals of Chinese medicine, accounting for about 15 per cent of all hospitals. Chinese medicine hospitals also offer a wide range of biomedical diagnostic and therapeutic procedures. China’s general hospitals, although dedicated to biomedicine practice, also have designated departments of Chinese medicine.

Hsiao, William et al. (1997). Financing Health Care: Issues and Options for China. Washington, DC: World Bank.