Intended for healthcare professionals

Education And Debate

Health in China: The healthcare market

BMJ 1997; 314 doi: (Published 31 May 1997) Cite this as: BMJ 1997;314:1616
  1. Therese Hesketh, research fellowa,
  2. Wei Xing Zhu, programme manager, East Asiab
  1. a Centre for International Child Health, London WC1 N1EH
  2. b Health Unlimited, London SE1 9NT
  1. Correspondence to: Dr Hesketh


    It is now about 15 years since the introduction of the market into health care in China. This produced fundamental changes in the way that health care is financed and resulted in the disappearance of universal free basic health care. Responsibility for provision of health services has been devolved to the provincial and county governments, and healthcare providers have been given considerable financial independence. A fee for service system has been introduced, and several different payment mechanisms are now in operation. The new financing and pricing structures are responsible for greater inequity of access to services and more inefficient use of resources. These problems are widely acknowledged, and a range of solutions is being developed and tested. Since the introduction of the reforms the measurable health status of the population has not declined, probably as a result of overall improved socioeconomic conditions and a continued emphasis on prevention.

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