lthough many observers have proposed using the health care systems of Ger- many, Canada, and Great Britain as models for a restructured U.S. health care system, few would seriously propose China (officially known as the People’s Re- public of China) as a viable model. China’s culture differs greatly from that of the United States, so its citizenry has distinctly different values regarding what constitutes an acceptable health care system. In addition, China’s GNI per capita of only $15,50 severely limits its options, and the remaining communistic underpinnings of its economy make a different set of health care options feasible there than in the United States. (These data and this discussion don’t include Hong Kong, which only became part of China in 1997 and operates under a separate political structure.) That said, China’s story suggests how less developed nations can protect their citizens’ health if they make a long- term commitment to primary care and public health.
China’s health care system reflects its unique history and situation. When the Communist Party in 1949 won control of mainland China after many years of civil war, it found itself in charge of a vast, poverty-stricken, largely agricultural, and densely populated nation. Most people lived in abject misery while a small percentage enjoyed great wealth. Malnutrition and famine occurred periodically, life expectancies for both men and women were low, and infant and maternal mortality were shockingly high. In urban areas, only the elite typically could afford medical care. In rural areas, where most of the population lived, Western medical care barely existed.
Structure of the Health Care System In 1950, one year after winning control of mainland China, the Communist government announced four basic princi- ples for the new nation’s health care system. First, the primary goal of the health care system would be to improve the health of the masses rather than of the elite. Second, the health care system would emphasize prevention rather than cure. Third, the health care system would integrate Western medicine with traditional Chinese medicine. And fourth, to attain health for all in a country with few doctors and widespread poverty, China decided to rely heavily on “physician extenders” and mass campaigns.