The privatisation of professional knowledge in the public health care sector in China.

ABSTRACT

This paper begins with a review of the Chinese government's reforms on the personnel system in the public health care sector since 1978. These policies were designed to give greater economic autonomy to the public health facilities and public doctors in order to stimulate productivity, but failed to satisfy the medical workers. As public employees whose professional knowledge and skills have long been considered as public property, Chinese doctors have been engaged in 'unofficial conduct' to increase income. This 'conduct'--which includes taking 'red packets', 'drug kickbacks' and 'moonlighting'--is argued to be an unofficial form of the privatisation of professional knowledge and skills.

KEY WORDS

professional knowledge; privatisation; Chinese doctors; health care sector; sociology

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The wave of privatisation in China since 1978 has been a focus of scholarly interest. However, attention has been paid mostly to the privatisation of property. Another trend in privatisation has been largely ignored: the privatisation of professions. The privatisation of professions in China has occurred on two levels: one is the institutional level and the other the individual level. The former is marked by the privatisation of previously state-owned institutions like hospitals, universities and colleges, and the emergence of private clinics/hospitals and universities. The latter features individual professionals using their professional knowledge and skills in private practice to generate an income outside the state salary system. Some professionals such as lawyers, who to a great degree are involved in mainly entrepreneurial business and control their economic terms and work conditions to a great degree, privatise their professional knowledge legally. Other professionals such as doctors, the majority of whom remain state employees, privatise their professional knowledge and skills largely through officially prohibited means and increase their incomes through unofficial sources, although the state has allowed limited legal space for privatisation in medicine.

Scholars have acknowledged the privatisation of medicine at the institutional level. The study by Gordon Liu, Xingzhu Liu and Qingyue Meng (1994) divides the historical development of the private medical market in China since 1949, when the Communist Party rose to power, into three stages. In the first stage (from 1949 to 1966), the private market shrank remarkably. During the second stage (from 1966 to 1978), the private medical practice was completely eradicated. In the third stage (since 1978), a private medical market has been gradually restored (Liu et al 1994). However, private medical providers, who have become more prevalent in the past decade, are yet to form a mature market for medical services. The dominance of the public sector continues, although public health providers have been forced to operate increasingly under market conditions.