Primary Health Care meets the Market: Lessons from China and Vietnam

Many low and middle income countries are considering radical health sector reforms. Their policy-makers are asking fundamental questions about how services should be financed, the relationship between service providers and government, and the role of the state in ensuring that health services are cost-effective and equitable. This paper outlines some lessons they can learn from China and Vietnam. Both countries developed low cost rural health services during the period between the early 1950s and the mid-1970s. Their example strongly influenced international health policy. However, other countries did not give adequate consideration to how to adapt structures developed in egalitarian command economies for market economies with substantial socio-economic inequalities. China and Vietnam have been liberalising their economies for several years. This has affected their health services in a number of ways. Those who can afford them have a wider choice of health services, but costs have risen and there are greater differences in access to medical care. The Chinese and Vietnamese governments are seeking strategies to make their health services more cost effective and equitable. Policy-makers and researchers in low and middle income countries can learn useful lessons from their efforts to adapt their services during the transition to a market economy.