Health Reform and the Rise of Informal Payments After 1978

Abstract

This chapter argues that during the reform era, many old institutions established in the previous period survived even in stronger forms. Doctors maintain their cadre status and are continuously bureaucratized. They are denied associational autonomy and organizational power and have little control over their work and economic terms. Bureaucratic medicine lingers on throughout the period despite the Party-state’s mounting efforts advocating universal particularism and the emphasis on Norman Bethune as a role model. But with the advancement of the economic reform and the market-oriented health reform, policies aiming at improving hospitals’ economic management and financial independence have significantly encouraged profit-driven activities. In this institutional setting, red packets become widespread as a way to cope with bureaucratic medicine and to obtain better quality services.