In Reply: Dr Maignan and colleagues are correct that in China the public dissatisfaction with health services stems in part from poor quality. And, as they suggest, poor quality in turn arises not only from profit-driven behavior leading to both inappropriate overuse and underuse but also from the need for better skills and better regulatory capacity.
Medical education is an essential component of improving health quality and reforming the health system in China to serve the public interest, and measures undertaken to improve medical education are much needed, especially for primary care in rural areas. Health workers with higher levels of medical education would much rather serve in urban than in rural areas and in higher-level health facilities than in township and community health centers.1 Encouraging a more equitable distribution of qualified health professionals, as is highlighted in the reform plans, is very difficult and has proven challenging in many countries.2
Ho CS, Gostin LO. China’s Health System Reform and Medical Education—Reply. JAMA. 2009;302(12):1270-1271. doi:10.1001/jama.2009.1354