Akademik

Categories of medical doctors include senior Western medicine doctors, assistant doctors and village doctors, as well as doctors of Chinese medicine, and a new official classification for doctors who practiced ‘integrated Chinese and Western medicine’. The training of physicians in China had suffered from the suspension of enrolment during the early years of the Cultural Revolution and the shortening of the curriculum to three years in the first half of the 1970s. After 1978, the length of study has been generally five or six years for medical colleges, and three years for secondary medical schools. Colleges of Chinese medicine also offer five- or six-year courses, but graduates can study for postgraduate degrees in Western medicine (and vice versa), and with appropriate training they can practise whatever type of medicine they choose and prescribe Western drugs. Since the 1980s, higher medical education has increasingly emphasized postgraduate studies and research. Secondary medical schools, which recruit junior middle school graduates, train intermediate medical personnel, offering specialisms in Western and Chinese medicine. Many of the village doctors are former barefoot doctors who have passed certifying examinations instituted since the late 1970s and early 1980s, giving them qualifications equivalent to graduates of secondary medical schools.

The number of medical doctors has increased steadily in the post-Mao period. In 1975, there were 649,100 Western medicine doctors (both senior and assistant) in official health institutions, and the number had risen to 1,582,700 by 1996. The rate of growth for doctors of Chinese medicine has been slower, increasing from 228,600 to 347,800 in the same period. The contingent of intermediate medical doctors, which include assistant doctors and village doctors, has also grown; in 1989, there were 320,671 assistant doctors, 95,097 secondary doctors of Chinese medicine, and 753,686 village doctors. The distribution of doctors, however, reveals the urban-rural disparity as most of them, especially the senior Western medicine doctors, practise in urban areas. The increased professionalization of medicine, the specialization of services and the renewed emphasis on medical technology have also affected the availability of, and access to, physician care. These changes, as well as post-Mao modernization policies, have enabled medical doctors to move into leadership positions in the organization and management of medical practice.

The government’s decision to permit for-profit medicine in the mid 1980s led to the emergence of ‘individual household doctors’ who set up their own clinics or hospitals.

Such private practice takes many forms and appears at every level of the health system, ranging from small village clinics to storefront medical offices in towns and cities. By the end of 1994, there were seventy-four private hospitals. The privatization and commodification of care assumes greater significance as economic changes open up new entrepreneurial opportunities and the state continues to scale back the national health care system.

See also: hospitals; medical insurance; public health care

Chen, H. (ed.) (1984). Modern Chinese Medicine v.3: Chinese Health Care. Lancaster: MTP Press.

Farquhar, J. (1996). ‘Market Magic: Getting Rich and Getting Personal in Medicine after Mao’. American Ethnologist 23:239–57.

Henderson, G., Akin, J., Zhiming, L., Shuigao, J., Haijiang, M. and Keyou, G. (1994). ‘Equity and the Utilization of Health Services: Report of an Eight Province Survey in China’. Social Science and Medicine 39:687–700.

White, S. (1998). ‘From “Barefoot Doctor” to “Village Doctor” in Tiger Spring Village: A Case Study of Health Care Transformation in Socialist China’. Human Organization 57:480–90.