Ning Lu, PhD, MPH¹, Michael E. Samuels, DrPH², Kuo-Cherh Huang, DrPH, MBA³, and Tracey Young, EdD, MS¹. (1) Department of Public Health, Western Kentucky University, 1 Big Red Way, Bowling Green, KY 42101-3576, 270-745-5260, ning.lu@wku.edu, (2) Rural Health Policy, College of Medicine, University of Kentucky, MN-150 Chandler Medical Center, 800 Rose Street, Lexington, KY 40536-0298, (3) School of Health Care Administration, Taipei Medical University, 250 Wu-hsing St., Taipei, Taiwan

Since the reforms of the past two decades, China’s medical and health care system has shifted from a highly bureaucratic controlled system to a market-based system. The question is what do the changes mean and how they may impact access to health care for the Chinese people? The purpose of this study is to examine the changes in the Chinese health system using informal interviews of Chinese medical staff, governmental officials, and patients conducted in Summer 2002 and 2003 in Beijing, P.R. China. The interviews were loosely structured with questions focused on study subjects' experience with and opinions on changes in China's health system.

The major findings suggest that China is undergoing two major changes: 1) the organization and financing of health care is moving away from government controlled and funded systems to privatized medical practice and a market-based system; 2) the focus and resources of health care is being steered away from low-cost prevention to expensive high-tech equipment and medical procedures.

The impact: In rural areas, where 70% Chinese live and most are poor, basic medical care becomes an expensive commercial product that is beyond the reach of many. In urban areas, the high-tech and advanced medical procedures are almost exclusively utilized by the wealthy and the big urban hospitals. The high-tech medical equipment and procedures come with escalated medical costs that prevent more people from entering the system. These changes have further contributed to the raise of infectious diseases, such as hepatitis, TB, sexually transmitted diseases, and SARS.

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