Abstract
This discussion of changes in Chinas health care system over the past 30 years exemplifies some fundamental lessons about the importance of delivery of medical and health care. China was applauded in the past by the World Health Organization and the UN Childrens Fund for its rural health care system based on communes. China in a short time period established a three-tiered system for its 800 million population: 1) a basic brigade health station staffed by barefoot doctors midwives and health aides; 2) better-equipped commune facilities with full-time physicians and nurses; and 3) county hospitals staffed by primary care physicians and specialists. The health status of the rural population improved dramatically under this system. However in the late 1970s and 1980s ideological changes destroyed the commune system and replaced it with trickle down economics and the entrepreneurial spirit. The aim was socioeconomic and quality of life improvement. Instead doctors who now owned the clinics alienated clients by charging high fees for services and the cooperative medical system disappeared. Reports circulated about corruption among medical suppliers and health personnel and about factories recycling hypodermic needles in unsanitary ways. In order to obtain routine care physicians and technicians were bribed. Ultrasound examinations of pregnant women were conducted to ascertain the sex of the fetus which allowed for abortion of unwanted female fetuses and led to a sex ratio of 118.5 for every 100 females. Clayton et al. documented overuse of parenteral injections inadequate sterilization of syringes and acupuncture needles and low levels of immunization against hepatitis B. Although the Maoist era was a period of extreme political repression the commitment to improving the quality of rural life led to valuable development of equitable rural health services. The current unrestrained free market economy combined with political repression has resulted in the decline of the economic and social base for equitable rural health services.
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