From Barefoot Doctor to Village Doctor in Rural China

The organization, delivery and financing of rural health care at the village level have been de facto privatized with the implicit approval of the Government. Privatization is defined here as the transfer of the financial risk and of service responsibility from the public payor to the private payor. Using data from a nationwide Chinese sample survey, the demographic characteristics, income, working patterns, general education, and professional training, and training preferences of the current village doctors are presented. Two key issues in rural health care in China are discussed: quality of health services and their financial sustainability. The paper suggests alternative ways to train village doctors in order to improve their technical competence and alternative ways to pay for their services. The policy implications of the ongoing privatization of rural health care and policy choices are discussed, a redefinition of the role and functions of the village doctor is recommended, and a networking strategy for integrating rural health services functionally and financially is suggested.