Market Mindset Mars Medical Care in China

China is a socialist country governed by a communist party. It has declared its commitment to achieve universal health coverage (UHC) well before the 2030 target set by the United Nations Sustainable Development Goals (SDGs). Yet, increasing commercialisation of its medical care system runs counter to the country’s professed ideology and proclaimed commitment to UHC. The rise of “market socialism” in China, since the time of Deng Xiaoping, has transformed the nature of the Chinese economy and, along with it, the structure and style of its healthcare system. What were the domestic political forces that swept the country on to that path and what have been the consequences? Which are the international entities that are participating in and propelling that transformation?

In a meticulously researched critique, Rama Baru and Madhurima Nundy dissect the policy shifts that have radically altered the character of the Chinese healthcare system. The authors repeatedly refer to the continuing ideological battle between the pro-market group (“neo-liberals”) and the pro-government group (“social democrats”) in defining the role of the public and private sectors. It appears that behind the monolithic facade of the Chinese Communist Party, these struggles have continued since the 1990s with the balance of decision-shaping power shifting over time to the neo-liberals and healthcare moving inexorably towards the pro-market model. Even in the preface, the authors offer the reader their assessment of how this shift to market socialism “had negative consequences for public health institutions, healthcare outcomes and the management of infectious diseases” (p xiii). The last is a reference to the rise of tuberculosis, which embarrassed policymakers and, along with demonstrations of public discontent against poor services and rising healthcare costs, compelled the party leadership to undertake publicly financed healthcare reforms. However, despite this attempt to strengthen the health system and improve the coverage of health insurance, private sector prominence and inequities in healthcare continued to become the increasingly visible hallmarks of a commercialised healthcare system.