Abstract
This chapter explores the reconfiguration of health care responsibilities, needs and rights in contemporary China. Health care in the Chinese official discourses is expressed as both rights and needs that should be secured by the state. However, since the market reform, China has seen the individualisation of health care responsibility that people are required to take responsibility for their own care. The private responsibility of health care in the post-reform era is not simply due to the withdrawal of state and collective protection, instigated by the penetration of the market. For many locals, it is also a remaking of the Confucian self-cultivation and collective self-reliance. Meanwhile, market reforms do add a new layer of requirement on individual patients, who are required to become active consumers in the market.
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- 1.
The authority and laws do not specify what type of health care people are entitled to as a basic human right, but in the new health reform agenda, there are very specific plans about what health care services should be universally provided to people free of charge (for example, public health services like vaccinations to children under age of 5). The list is increasing over the years, and has the tendency to change from selective primary health services to comprehensive health services.
- 2.
A basic health and health promotion law is drafted and under review (see http://health.people.com.cn/n1/2017/1223/c14739-29724759.html, retrieved 31 March, 2018).
- 3.
When writing this part about needs and rights, I have got inspiration from reading ‘Exit, or Evict: Re-grounding Rights in Needs in China’s Urban Housing Demolition’ by Ho (2013) and from discussion with the author.
- 4.
There are rising numbers of NGOs, charities, and religious groups in the post-reform era, which are regarded as a necessary supplement to the work of the state. However, there are few social organisations serving in the health care sector, except some targeting particular illnesses such as HIV-AIDS and tuberculosis, but their impacts are limited (see Duckett 2008).
- 5.
Based on the Confucian virtue of filial piety, elderly parents should have a right (although the term of ‘rights’ was not used) to receive care from their adult children, which has also been incorporated into the civil law of both the Republic of China (since 1911) and the People’s Republic of China (since 1949) (from Fan 2010: 59–60). Since 1996, the government has further put the duties of adult children to take care of their elderly parents into the law—‘Law of the People’s Republic of China on Protection of the Rights and Interests of Elderly People’ (CPG 2005).
- 6.
Besides the many accounts by the people in my field site, the media have also reported stories about elderly people who could not get sufficient health care when their family was unable to shoulder health care responsibility. Also see Wu (2010) research about suicide in China which recorded cases of sick elders committing suicide due to the absence of state and family support.
- 7.
In the late Qing and early Republican era, the health of the nation was largely the responsibility of the citizen, instead of the responsibility of the government, although some new discourses that relate population health with the strength of the nation-state began to emerge with the introduction of ‘hygienic modernity’ (see Rogaski 2004).
- 8.
The number of 450 was obtained from a local government official. But there is no accurate number of the people who died in the cholera after the flood, although the local elderly estimated that there were tens of thousands of deaths.
- 9.
- 10.
Hwang notes the ‘ensembled individualism’ of the Oriental tradition includes ‘physical self’, which is dependent upon others, and a ‘social self’ embedded in a stable social network. The physical self is usually named as ‘small self’ while the social self is termed as ‘great self’. In many cases, the ‘small self’ has to make compromise in front of the ‘great self’.
- 11.
That is why in recent new healthcare reforms the authorities began to reemphasize the public welfare nature of health care.
- 12.
Such as the code of conduct for health professionals requires health professionals to ‘respect patients’ right of being saved, treat patients equally regardless their ethnicity, religion, place of origin, financial condition, status, disability, illness, etc.’, from Article 2 of the ‘Code of Conduct for Medical Institution Professionals’ released by the Ministry of Health (MOH 2012).
- 13.
Such as the well-known case in 2009 about a migrant worker, Zhang Haichao, who took thoracotomy lung examination to prove he got pneumoconiosis in order to defend his right for compensation (see Xinhua Net 2009).
- 14.
Even in the 1990s and early 2000s, the broken body entitles the disabled people to claim certain benefits from the government, such as free body check, the subsidy for taking out medical insurance, and the exemption of taxes when doing business.
- 15.
Generated from many interviews and conversations with local people when asking them to compare health care in the past and that now.
- 16.
An article ‘Deepening Health System Reform’ (Li 2013) written by an official of the NHFPC at the end of 2013 admits that the total medical resources were still insufficient to meet health care needs. It notes that the future healthcare reform aims to reach more fairness and justice by prioritising basic health care, putting major investment in the rural areas, communities at the bottom, difficult localities, and the middle and western regions of China. Also see ‘Chinese government to raise health insurance subsidies’ (CPG 2012a).
- 17.
Han (2012) shows that disadvantaged groups feel more satisfied than privileged ones in China. She explains that it results from the complex interactions of a host of socio-economic, experiential and social cognitive factors, and suggests that life satisfaction is influenced more powerfully by dynamic life experiences and subjective evaluations than by objective status.
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Tu, J. (2019). From ‘Care of the Self’ to ‘Entrepreneur of the Self’: Reconfiguration of Health Care Responsibilities, Needs, and Rights. In: Health Care Transformation in Contemporary China . Springer, Singapore. https://doi.org/10.1007/978-981-13-0788-1_3
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