Society for East Asian Anthropology
Oral Presentation Session
Helen Lambert (University of Bristol)
In order to maintain its socialist claim and moral legitimacy, the Chinese national and provincial governments have in the last decade made deliberate and continuous policy efforts to de-marketize medical services, particularly in the rural institutions that provide Primary Care, the rural health facilities.
This paper examines the social-economic and clinical realities in which rural clinicians work when these top-down medical policies are translated into local practice, and the negotiations they must make on a daily basis. The rural health facilities are meant to embody the moral claims of the socialist state taking care of its citizens. As part of the national Public Health system, they are not supposed to operate for financial profit, as indicated by the zero mark-up policy on medicine and the New Rural Cooperative Medical Scheme (NRCMS) aiming to reduce the burden of medical expense for rural residents.
In practice, however, clinicians face varying economic pressures. The rural health facilities are insufficiently funded, and their medical practice is private in nature. Clinicians see themselves as having caring responsibilities for the patients, but they face pressure to generate revenue for themselves and their institutions. They compromise the national and provincial medical guidelines in order to do so. Meanwhile, they see themselves occupying a higher position in an imagined social-economic hierarchy while drawing on the powerful discourse of “suzhi” (human quality) to legitimize their use and abuse of antibiotics by blaming and characterizing rural patients as having inherently low “human quality”.