Reluctant "Maocare" : the shaping and practice of the rural healthcare system in the Wenzhou region : (1949-1978)

Abstract

The “remarkable health improvement” of China’s rural population during the Maoist period is touted as an extraordinary achievement, given its low level of economic development. The general belief in of Mao’s concern for rural health may be summarized as “MaoCare.” This dissertation rejects the myth of “MaoCare” by re-examining the shape and practice of rural healthcare system throughout the Maoist period (1949-1978) through the case study of Wenzhou. First, the research shows that the PRC government’s limited financial investment in public health could not sustain the “extension” of public hospitals below the county level. Self-financed personnel and clinics existed in the countryside most of the time. To some extent, the utilization of private resources made up for the lack of state investment on health, which guaranteed the state’s penetration below the county level. Second, the dissertation demonstrates that it was difficult to spread both the rural cooperative medical system and the institution of barefoot doctors in the countryside, given the poorly performing collective agricultural economy. In the end, many cooperative medical stations became “red hat clinics” with the local government’s permission. These “red hat clinics” enjoyed the title of “cooperative medical stations” while receiving no financial support from the production brigades. They were operated by self-financed physicians, who bore the title of “barefoot doctor.” Today, many people claim that the replacement of barefoot doctors with self-financed rural doctors after the Maoist era partially explains the increasing expenses of medical services for peasants. The changes of the rural cooperative medical system over time show that, in reality, self-financed physicians had already existed in the countryside during the Cultural Revolution. Thus, through the re-evaluation of the rural healthcare system during the entire Maoist period, this dissertation challenges the existing literature on this topic, which provides either over-idealistic or unsystematic assessments.