How Health Workers Earn a Living in China

During the period of the command economy government health workers were paid the same salary throughout China. Over the past twenty years the government has managed a gradual liberalization of the labour market, as part of the transition to a ‘socialist market economy’. This paper explores this process in the health sector. Government has found it impossible to maintain uniform pay levels, particularly in the face of a radical devolution of its own financial management. Health workers have increasingly resorted to informal methods of earning an income. Doctors quite commonly accept cash gifts from patients. The government considers this to be unprofessional behavior and has used a combination of moral pressure and loss of professional privileges to discourage it. There is evidence that some doctors also accept kickbacks from drug suppliers or facilities seeking referral patients. The paper concludes that the government will need to establish a new regulatory framework that permits health workers to earn a reasonable income, whilst encouraging them to provide effective and affordable health services. It suggests that the relationships between health workers, governments, and civil society organizations are likely to change considerably in China and other low and middle-income countries during the next few years. [Summary from author]