HEALTH SECTOR REFORM - LESSONS FROM CHINA

As a result of China's transition to a socialist market economy, its r ural health services have undergone many of the changes commonly assoc iated with health sector reform. These have included a decreased relia nce on state funding, decentralisation of public health services, incr eased autonomy of health facilities, increased freedom of movement of health workers, and decreased political control. These changes have be en associated with growing inequality in access to health services, in creases in the cost of medical care, and the deterioration of preventi ve programmes in some poor areas. This paper argues that the governmen t's strategy for addressing these problems has overemphasised the iden tification of new sources of revenue and has paid inadequate attention to factors that influence provider behaviour. The strategy also does not address contextual issues such as public sector employment practic es and systems of local government finance. Other countries can learn from China's experience by taking a systematic approach to the formula tion and implementation of strategies for health sector reform. Copyri ght (C) 1997 Elsevier Science Ltd.