Health Reform in China: An Analysis of Rural Health Care Delivery

Abstract

In its move to a socialist market economy, the Peoples Republic of China (PRC) has transformed its economy and society. Moreover, the Chinese health system has also undergone dramatic changes since 1980. These changes have had far reaching implications for the delivery of health care services in China, with marked contrasts between the developed areas in eastern and urban China and the nationally designated poverty areas in western and north western China. These poverty areas have been particularly affected by reduced state financing, decentralisation of public health services, lack of co-ordination and co-operation between 'vertical' health services, greater freedom for health facilities in managing health service delivery, and the much more emphasis on individuals meeting the costs of their own health care. At the same time, the process of reform in breaking up the agricultural communes weakened the 'social capital' in communities and the co-operative medical system (CMS) arrangements which had supported access of farmers to health care services. Since 1995, central government strategies have established the principles to improve rural health services, but have provided little in the way of tangible incentives to give effect to improving access to, and the quality of, such services. The Central Committee's Decision (19 October, 2002) on "Further Strengthening Rural Health" emphasises earlier principles and provides funding support for the development of a new type of rural co-operative medical system to assist the rural poor to access more effective and efficient health services. This paper that argues that a more systematic approach is required if the new strategic approach is to be successful.