End of Barefoot Doctors in China
Two-thirds of the village doctors currently practicing in rural China began their training as barefoot doctors. This includes Chen Zhu, China’s current Minister of Health, who practiced as a barefoot doctor for five years before going on to receive additional training.
The barefoot doctor system was abolished in 1981 with the end of the commune system of agricultural cooperatives. The new economic policy in China promoted a shift from collectivism to individual production by the family unit. This shift caused a privatization of the medical system, which could not sustain the barefoot doctors. The barefoot doctors were given the option to take a national exam, if they passed they became village doctors, if not they would be village health aides. Village doctors began charging patients for their services, and because of the new economic incentives, they began to shift their focus to treatment of chronic conditions rather than preventative care.
By 1984, village RCMS coverage had dropped from 90% to 4.8%. In 1989 the Chinese government tried to restore a cooperative health care system in the rural provinces by launching a nationwide primary health care program. This effort increased coverage up to 10% by 1993. In 1994 the government established “The Program”, which was an effort to reestablish primary health care coverage for the rural population.
In 2003 the Chinese government proposed a new cooperative medical system that is operated and funded by the government. This program is run more like an insurance program. It pays 10 Renminbi per year for each person covered by the program, and by ensuring coverage for serious diseases. This new program relies heavily on lessons learned from the times of the barefoot doctors, but faces many challenges in providing sufficient, cost-effective care for China’s rural populations.
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