Recent trends in the commercialization of medical care in China.
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Date
2014-11
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Abstract
Commercialization of healthcare is a global trend and many
healthcare systems all over the world are affected by it.
Privatization, marketization and liberalization are generally
distinguished from commercialization in that while the former
indicate a shift from state-led provisioning to market-led
provisioning or the transfer of state-owned assets to private hands,
the latter also takes into account the behaviour of public-owned
institutions.1
Commercialization of health services has mainly
occurred when low levels of public investment have created a
space for private interests to grow. It has also arisen from a
generalized crisis due to the rising costs of medical care. These
trends have coincided with the rise of neo-liberalism that argues
that government-funding of social services is inefficient and
called for an enhanced role for the market. Much of the scholarly
writing on the roles of the market and the State during the post-
1970s has tended to look upon these two spheres as discrete.
However, Mackintosh and Koivusalo1
have argued that this kind
of analysis does not capture the interrelatedness of the two sectors
and the underlying processes which drive them. They define
commercialization as the ‘increasing provision of healthcare
services through market relationships to those able to pay; the
associated investment in and production of those services for the
purpose of cash income or profit; and an increase in the extent to
which healthcare finance is derived from payment systems based
in individual payment or private insurance.’1
For over three decades there has been an increasing trend
towards the commercialization of health services in China. There
are discernible phases in this shift, which began with the
commercialization of public hospitals and has led to the more
recent growth of private for-profit hospitals in the major cities.
The Chinese commercialized their health sector fairly rapidly
from the mid-1980s. The rationale given by the government was
the inability of the State to meet the rising costs of healthcare.
Various measures were taken to garner resources for the ailing
hospital sector. These ranged from the introduction of user fees to
the setting up of State-owned enterprises (SOEs)1
which brought
in organizational reforms, finally leading to the autonomization
of hospitals. An SOE is a legal entity created by the government.
It is partially or wholly owned by the government but is able to
participate in commercial activities. Autonomization is a complex
process aimed at financial autonomy and autonomy in governance.
It has created a distinct separation between administrative
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Citation
Baru Rama , Nundy Madhurima. Recent trends in the commercialization of medical care in China. National Medical Journal of India. 2014 Nov-Dec; 27(6): 332-333.