background image
93
Second Quarter 2010
reu
te
rs/ki
n
ch
eu
ng
the challenges will be formidable.
In modern China, doctors have never been
paid adequately in comparison to other pro
fessionals (for example, engineers). Thus, it
should not be surprising that once the central
government shed its responsibility for health
care in the 1980s, hospitals and physicians ad
justed by charging whatever the market
would bear. The problem now is how to
change what amounts to an anythinggoes
souk into a disciplined system that can guar
antee decent care for the indigent.
One option is to create a twotier system,
letting private clinics provide premium care
for the affluent while maintaining state
owned hospitals for others. Doctors could be
encouraged to open their own clinics, but as
a condition could be required to devote a
minimum number of hours to service in pub
lic hospitals at very modest salaries.
There is some precedent for this. Private
clinics have sprung up to meet unmet de
mand for medical care in rural areas, and
have apparently delivered services fairly effi
ciently. The question now is whether the gov
ernment can adequately serve the vast major
ity of rural and urban dwellers who can't
afford private medicine.
To manage that, the government will have
to invest hundreds of billions of dollars in fa
cilities and equipment, and it will have to
coax medical workers to move from the cities.
In Mao's day, doctors could be lured to the
communes by ideology or simply ordered to
move by the government. Now they have to
be paid well for their trouble. Indeed, the long