China's economic policies of the past 25 years have shaped its present health-care system. China's leadership has decided to have neither a national health-insurance system nor a national health service. Instead, it decided that its health system would mirror the workings of its industrial and agricultural system. Decisions to minimize imports, ban private economic activity, assign university graduates on a compulsory basis, control wages, maintain a large domestic standing army and prevent professions or universities from acquiring independent status led directly to the present system of medical care. Consequently, transplantation of China's striking achievements in health-care delivery to the United States or other countries is unlikely to occur in the absence of transfer of the underlying economic policies. (N Engl J Med 300:1453–1458, 1979) AS a result of the Shanghai Communique of 1972 and the efforts of the United States and China to form closer relations, a number of medical groups have visited China.1 These groups have examined selected facets of the public-health and medical-care system as it has evolved since 1949, and many of these health professionals have been impressed by China's considerable achievements in the medical-care area.2 3 4 5 As noted by previous visitors, monumental strides have been made in controlling major infectious diseases,6,7 improving nutrition and decreasing infant mortality and birth rates.8 9 10 Equally impressive is China's apparent success in bringing basic health services. © 1979, Massachusetts Medical Society. All rights reserved.
