yn
t
ock
and 1990s.
managed with `economic means,'" a euphe
mism for rationing by price. But the process
didn't really gain steam until 1985. Medical
institutions were transformed into indepen
dently funded, selfgoverning entities, and re
sponsibility for their supervision transferred
to local governments. Clinics and hospitals
still received subsidies: typically, expenditures
were part of local government budgets. But as
economic change swept China, health care
other interests. Hence the quality of local care
from 39 percent to 16 percent. Hospitals and
clinics were largely left to cover their own
costs, which they managed by charging higher
fees to everybody and providing premium
care for premium prices. Drug sales become a
key revenue stream. Indeed, by year 2000,
only a handful of essential drugs remained
under the control of government agencies.
who could afford to pay for it.