China’s double movement in health care

The concept of a ‘double movement’ is adopted from Karl Polanyi, in his seminal 1944 book, The Great Transformation. In Polanyi’s view, ‘the idea of a self-adjusting market implied a stark utopia. Such an institution could not exist for any length of time without annihilating the human and natural substance of society; it would have physically destroyed man and transformed his surroundings into a wilderness’. The extension of the ‘self-regulating’ market, he thought, was bound to provoke a countermovement aiming at protecting society against ‘the ravages of this satanic mill’. Polanyi’s thesis is helpful in understanding the great transformation in health care in China over the last sixty years. For both ethical and practical reasons, ensuring the health of every citizen must be an important goal for policymakers of any country, but particularly China, a country that still professes to uphold the socialist principle of equity. In Mao’s era the health of the population was one of the country’s proudest boasts. But the market-oriented reforms of the 1980s and 1990s gradually shattered the country’s social safety nets, including its once famous healthcare system, making it difficult for many rural and urban residents to afford treatment. In reaction to this, a burgeoning protective counter-movement emerged in recent years. A growing number of people, including government decision-makers, have come to realize not only that relying primarily on the free market to finance and provide health care would inevitably lead to reduced access to health services for the poor and the vulnerable, but that since health is so important to everyone’s wellbeing, it should never be allowed to flounder at the mercy of the market. The Chinese government has now committed itself to restoring an affordable and equitable healthcare system