By Jiong Tu – jt457 [at] cam.ac.uk
China’s barefoot doctor system is known for having provided inexpensive and accessible medical care to its large rural population in the 1970s. But the system became bankrupt with the advent of market reforms in the 1980s and many barefoot doctors either became private doctors or gave up medical practice. In 1985, even the name “barefoot doctor” was abolished, replaced by “village doctor.” Though barefoot doctors have passed from the historical stage, the legacy of the barefoot doctor system is felt in the troubles of aging former barefoot doctors that now find themselves pensionless. The approximately 1.5 million people who worked as barefoot doctors during the collective era are now perhaps the most resentful towards China’s on-going healthcare reform.
In rural China, it is increasingly a case of the old serving the old. With the migration of the young and middle-aged to cities and coastal areas, groups of aging village doctors serve those elderly “left-behinds.” But every year increasing numbers of elderly village doctors become too old to continue practicing. These aging village doctors are now demanding pensions. They pen autobiographies, send complaint letters to authorities, seek out media attention, and organize petitions. However, after years of struggle, these village doctors have yet to see any concrete results.
The Chinese government recognizes the village doctors’ pension needs, but it has redistributed pension responsibilities to individual provinces and local municipal authorities. But while provinces and municipalities in more developed regions may have the financial ability to tackle the pension issue, resource-strapped and poorer agricultural localities face difficulties handling such an immense financial burden. Since 2009, a rural pension scheme began to be implemented in China, and many local authorities have encouraged village doctors to buy their own pension insurance. But never having received compensation for their past “contributions,” village doctors do not agree with this proposal. They are still holding out that the pension issue will be resolved. The SARS epidemic of 2003, the Hu-Wen leadership from 2004, and the new health reforms implemented from 2009, all inspired hope that their efforts might finally be recognised and compensated. But today many old “barefoot” doctors still wait with little immediate hope for their pensions.
If you enjoyed this memo, subscribe to our e-newsletter for free and receive new memos weekly via email.
- J. McConnell, “Barefoot no more,” The Lancet (1993)
- Bulletin of the World Health Organization, “China’s village doctors take great strides” (2008)
- D. Zhang & P.U. Unschuld, “China’s barefoot doctor: past, present, and future,” The Lancet (2008)
- Xinhua News, “The sources and contributions of the village doctor” (2003) (in Chinese)
- Video link: “The voices of village doctors” (in Chinese)
See our other memos on China.