Makoto AKASAKA・Rieko IKENAGA・Yaping LIU

73

吉備国際大学研究紀要（人文・社会科学系）
第29号，73−87，2019Survey Report on Medical Institutions in Modern China
Makoto AKASAKA*・Rieko IKENAGA**・Yaping LIU***
Abstract
This paper is a research report on medical institutions in modern China. Since the reformand open-door policy in 1979, China has developed rapidly in all fields, but it has been said
that she failed to reform the medical field. In recent years, however, the medical system ofChina has been rapidly reformed along with economic growth, and since 2010 the speed ofreform has further accelerated. We visited hospitals in Hohhot City, Inner Mongolia China
from 9th to 15th September 2017 to survey the work situation of nurses in China andconducted a questionnaire survey. At that time, we visited a variety of medical institutions
ranging from general hospitals of the highest level to private clinics in Inner Mongolia, andinterviewed physicians, nurses, clerical staffs, etc. and got the opportunity to observe theinside of them. We will report the present situation of modern Chinese medical institutions inthis paper.
Key words：China・Medical Institution・Nurse

1. Introductionof family register and occupation, 1) ②millions ofrural doctors who trained for a short period andThis paper is a research report on medical

were sent to rural village in the Mao Zedong

institutions in modern China. Since the reform

era,2) ③chronical nurse shortage,3) ④troublesome

and open-door policy in 1979, China has developed

charge payment system, ⑤expensive medicines,

rapidly in all fields, but it has been said that she⑥medical disparity between regions, etc. In recent

failed to reform the medical field. There have beenyears, however, the medical system of China

many problems in the medical system in China

has been rapidly reformed along with economic

as follows: ①medical insurance system with large

growth, and since 2010 the speed of reform has

disparity in benefit value depending on the typefurther accelerated.

Kibi International University Department of Social Science8, Iga-machi Takahashi, Okayama, Japan (716-8508)＊＊
Kansai University of Social Welfare School of Education
3-380, Shinden Ako, Hyogo, Japan (678-0255)＊＊＊
Public Administration College, Inner Mongolia University of Finance and Economics
185, Beierhuanlu, Hohhot Inner Mongolia China (010070)＊

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Survey Report on Medical Institutions in Modern China

We visited hospitals in Hohhot City, Inner
Mongolia China from 9th to 15th September

Healthcare Service Station, ⑧Zhaoyong Zhongxiyi
clinic (private clinic).

2017 to make clear the work situation of nurses

This time, with the help of Professor Yaping

in China by qualitative and quantitative survey.

Liu, former vice dean of the Public Administration

At that time, we visited a variety of medical

College, Inner Mongolia University of Finance andinstitutions ranging from general hospitals of the

Economics, the above medical institutions could behighest level to private clinics in Inner Mongolia

investigated.4)

China, and interviewed physicians, nurses, clericalstaffs, etc. and got the opportunity to observe

3. Features of Chinese hospitals

the inside of them. There are almost no papers
or books that systematically introduced Chinese

Before showing the overview of the Chinese

medical institutions in Japan until now. In view of

hospitals visited this time, I will point out several

this situation we will report the present situation

points that are significantly different fromof modern Chinese medical institution in thisJapanese hospitals.

paper.
(1) Hospital’s grading in China
2. Hospitals to be surveyed and Survey method

Hospitals in China are classified into three,based on the number of beds and medical

Because the investigation period was limited inenvironment standards. The first-grade hospital

this survey, medical institutions that we could visit

is a typically township hospital that has less thandirectly, and did interview survey with doctors,

100 beds. The second-grade hospital is usuallynurses, clerical staffs were as follows. ①Inner

founded in a medium size city, county and district.

Mongolia Autonomous Region People’s Hospital

It has more than 100 beds, but less than 500. The(Third grade A), ②Inner Mongolia Autonomous

third-grade hospital is the general hospital at theRegion Cancer Hospital (Third Grade B),

cities and provinces and has more than 500 beds.5)③Inner Mongolia International Mongolian Hospital

Strictly speaking, based on the level of service(a branch hospital located in Inner Mongolia

provision, medical technology, medical equipment,

University of Finance and Economics: First grade

and medical quality, each grade is divided intoA), ④Wudazhen clinic.

three subsidiary levels: like the third grade A, theConcerning other hospitals mentioned in thisthird grade B, the third grade C (9 levels in all).

paper, we handed questionnaire to a doctor or a

As one special rank (3AAA) is assigned for thenurse of those medical institution and collectedmost high-grade hospital, they are finally classified

a few days later. Those hospitals are following

into total 10 levels. In addition, in urban areas offour. ⑤Inner Mongolia Medical College Second

China, there are community healthcare service

Hospital (Third grade A), ⑥Hohhot First Hospital

centers and clinics as medical institutions other(Third grade B), ⑦Hohhot Shincheng Community

than hospitals.6)

Makoto AKASAKA・Rieko IKENAGA・Yaping LIU(2) Doctors of Western medicine and Chinese75

distinction between Western medicine and Chinese

medicine

medicine, there are doctors of different levels such

In China, not only Western medicine’s doctors

as doctor, assistant doctor, and rural doctor. The

but also Chinese medicine’s doctors (Chineserural doctor is as described above (see footnote

medicine, Mongolian doctor, Tibetan doctor,

2). Assistant doctor is the license given for person

Uighur doctor, etc.) can practice medicine at the

who graduate from the three-year medical college,

hospital as formal doctors. In addition, there areor five-year middle vocational school’s medical

doctors who have license of both Western andcourse. After graduating from each school, they

Chinese medicine.

receive one-year training at medical, prevention,
health institution under the guidance of a doctor.

(3) Doctor’s rankAfter finishing one-year training, they take state

Chinese doctors are ranked such as resident,

examination for the assistant doctor’s license.

attending physician, deputy chief, chief. Those

There are four kinds of assistant doctors. Clinical

who want to become doctors must take the state

medicine, traditional Chinese medicine, oral cavity,

examination after learning at the medical school

public health. They work as doctors in medical

for five years. If they pass the exam, they receive

institutions, but there are restrictions on diagnosis.

training at each medical department for one year.

Moreover, public health doctor cannot do medical

Interns decide their specialty during this training

care.

period. After completing the training, they takethe state examination for getting qualification of(5) The number of nurses to doctors is very

medical practitioners. If they pass it, they engage

small.

in medicine at a hospital for four years under

Small hospitals often have more doctors than

the guidance of a senior doctor. After finishingnurses. As of the end of 2016, the ratio of Chinese

this four years training, they take the exam todoctors to nurses was 1: 1.14 (Japan=1: 3.6). The

be a senior doctor. If they pass it, they will bereason for the small number of nurses in China is

recognized as a full-fledged doctor and be able tothat Chinese nurses do medical practices basically,

perform medical examination at the outpatientsuch as injections, drips, sutures of lacerations,consulting room.

medicine management,7) and do not need to carefor patients. Those are family member’s jobs, and(4) Physicians who can’t do medical practice

if family cannot attend on patient, they must hire

The way to become a doctor in Japan is only

a caregiver. In the urban big hospitals there areone. Persons who want to be doctors must

nurses with professional qualifications such as

graduate from the medical school and pass thesurgical specialist nurse, cancer specialist nurse,

state examination for medical practitioners. Chinse

anesthesia specialized nurse etc. These specialized

medicine’s doctor is not considered a formal

nurses get higher salaries than general nurses.

doctor. However, in China, in addition to the

In recent years, the number of nurses in China

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Survey Report on Medical Institutions in Modern China

has increased rapidly, 1.71 times in six years fromat the hospital you pay the registration fee of2010 (2.05 million) to the end of 2016 (3.5 million).8)

the department that you would like to receive a
medical examination. If you are diagnosed that

(6) Nurse’s ranks

medical inspection is necessary, you must pay

There are two kinds of nurse licenses in Japan:

an inspection fee. Then you have the necessary

registered nurse and assistant nurse, but in China

examination, receive the examination result, see athere are three ranks: nurse practitioner, nurse,

doctor again.

assistant nurse. However, the assistant nurse

If you are diagnosed that injection or drip is

is not the fixed qualification, but a provisional

necessary, you pay the fee and go to the treatment

name until a person who graduated from aroom with receipt. If medication is necessary, pay

vocational school / nursing junior college worka charge of medicine, submit medicine receipt

in a hospital for one year and pass the national

at hospital’s pharmacy and receive medicine. It

nursing examination. After passing the nursing

is very inconvenient charge payment system

qualification examination, they become a nurse

compared with Japan, but it is a necessary systemand engage in regular nursing work. A nurse

to collect medical expense from patients surly.

obtains the qualification for candidacy for thenurse practitioner examination after three to five(9) Health insurance card with credit card

years in the case of a vocational school / nursing

functionjunior college graduate, and after working one

According to Chinese abroad student (graduateyear in hospital in the case of university graduate.

school), the electric payment system is spreading
rapidly in China. The Chinese medical insurance(7) Recruitment of nurse

card has a credit card function, and if there

There are various routes such as employment

is money in the individual account you can

office, internet advertisement, introduction frompay medical expenses with it. If your personal

nursing junior college and university, etc. foraccount’s money runs out, you must pay it

nurse recruitment method. Although it is often

by yourself. In case of hospitalization, you pay

adopted only just by interviewing in the case of

the deposit at the inpatient ward or outpatient

private medical office and rural clinics, third-grade

reception. The money paid is deposited to yourhospitals or university hospitals perform severe

patient registration ticket, and hospitalization

recruitment tests that cannot be imagined in

expenses are deducted therefrom every day. If

Japan.9)

the money deposited to your registration ticket
get fewer, the hospital advises you to deposit(8) Tiresome charge payment system
In medical institutions in China“pre-paymentof medical expense”is common. First, it costs a
charge to use an ambulance.10) When you arrive

the necessary medical expense until leaving the
hospital.

Makoto AKASAKA・Rieko IKENAGA・Yaping LIU(10) Doctor nomination system77

at a hospital outside the jurisdiction of the

In China’s hospital, you have to pay ahealth insurance, you must prepay the medical

registration fee called a“guahaofei”first. The

expenses, and after completing the treatment

charge varies depending on the area and theyou must return to your hometown and proceed

hospital grade, and it also depends on the doctor’sthe insurance refund. Although it is a very

rank whom you want to have a medical

troublesome compared with Japan, it is a system

examination. For example, in the case of Beijing,

not to concentrate patients on famous hospitals inwhich is one of the regions with the highest

urban areas.

medical expenses, the physician’s nomination fee is
50 yuan, but 60 yuan for the deputy chief, 80 yuan

4. Outline of various medical institutions

for the chief, and 100 yuan for medical specialists.
In nighttime 70 yuan will be added to the doctor’sNext, we will introduce the outline of thebill, and in case of emergency more 70 yuan willhospital which visited and made the interview inbe added.11)

this survey.

In China, it is considered a matter of course
to pay the charge for every special service suchas transport by ambulance, skilled doctor’s(1) P e o p l e ’s Hospital of Inner Mongolia
Autonomous Region (Third grade A)

exsamination, emergency medical care, etc.
Even at a clinic without a hospitalization facility
such as a community healthcare service center,a registration fee is necessary, but the fee isconsiderably cheaper compared with a general
hospital. Although the registration fee is theone for medical record creation and registration
originally, at the same time, it is also a system
to prevent the patients from concentrating on a
popular (skilled) doctor.

Photo 1. People’s Hospital of Inner Mongolia
Autonomous Region(11) Designation of a hospital
In Japan, if you have a health insurance card,

1) Outline of hospital

you can visit any hospital, but in China some

Inner Mongolia Autonomous Region People’shospitals to be consulted are designated for

Hospital is the highest level national hospital inresidents beforehand. Of course, you can be

Inner Mongolia Autonomous Region establishedreceived examination at a famous hospital in a

in 1974. According to Mr. W. L, the Director

big city, but in that case the fee will be quiteof Secretariat, this hospital is the highest-level

expensive. Also, if you have a medical treatment

hospital in Inner Mongolia Autonomous Region

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Survey Report on Medical Institutions in Modern China

and has the dedicated ward to executives of
the Inner Mongolia Communist Party. The
hospital’s reception method and medical charts
are all informatized and automated, and otherbasic medical service, such as facilities, medical
technology, medical treatment systems, etc., are at
the same level as the major hospitals in Japan.

Photo 2. Automated receptionist
Normally, famous hospitals in China are① Number of physicians: 1,200 ②Number ofnurses: 2000 ③Number of assistant nurses:
600 ④Number of pharmacists: 200 ⑤Clinicaldepartments: 70 ⑥Number of beds: 3000
⑦Bed using ratio: 100% ⑧Average hospital
stay:10days ⑨Number of outpatients: 810 / day
Figure 1. Outline of hospital

Photo 3. Doctor and nurse
2) Nurse’s working environment

crowded and outpatients are kept waiting for

In Japan, the working form of nurse is rapidly

several hours to be examined. However, there ischanging to a two-shift system, but in China thea system called special outpatient in China, if you

three-shift system is common. The holidays are

pay a high registration fee (guahaofei), you can see

two days a week. Six months maternity leave isa doctor immediately. According to the director

guaranteed. The starting sarary is 1,856 yuan.

of the secretariat, to receive an examination

Even if various allowances are added to this, theof the famous chief physician at this hospitalsalary of young nurse in the early 20s is around

immediately, you have to pay about 20 thousand

3,000 to 3,500 yuan. According to a nationwide

yen. Of course, consultation fee, treatment fee issurvey of nurses held in December 2016, theextra. It is quite expensive, but if you will pay for

average monthly salary of nurses in first-tierit, you can get those special service. It seems to be

cities (19 cities) like Beijing and Shanghai is

a preferential treatment for the wealthy, but it is

6,700 yuan, second-tier cities such as Wuxi andnormal for Chinese.

Changchun (30 cities) are 5,600 yuan, which seems
to be slightly lower than the average monthly
income of urban workers. Incidentally Hohhot
is a third-tier city (70 cities). Once this hospital
equipped a nursery school, but now it is closed,

Makoto AKASAKA・Rieko IKENAGA・Yaping LIU

79

and childcare allowance is being payed instead.

Tumor Hospital in 2012. Although it is a general

Because of authoritative hospital, various nurse’shospital, the cancer specialty hospital as can betraining systems have been developed andseen from its name. It is the nurse of this hospital

practiced. Each nurse station faces the aisle wherethat answered our interview. Unfortunately,

medicines, infusions, etc. are kept.

photography inside the hospital was not permitted.
① Number of physicians: 300 ②Number ofnurses: 300 ③Number of assistant nurses:
200 ④Number of pharmacists: 40 ⑤Clinicalde pa r tme nts : 1 3 ⑥N umbe r o f be ds : 900⑦Bed using ratio: 70% ⑧Average hospital stay:
14days ⑨Number of outpatients: 65 / day
Figure 3. Outline of hospital

Photo 4.Nurse station① Work form: Three-shift system ②The ratioof patients to nurse: 7: 1 ③Weekly holiday: 2
days ④Initial salary: 1,856 yuan ⑤Number ofnurses: not enough ⑥maternity leave: about
half a year ⑦Turnover rate: Approximately
3% ⑧Recruitment method: referral from juniorcollege and university, public subscription⑨Training system: training for new nurses, in-Photo 5. Inner Mongolia Autonomous Region
Cancer Hospital

hospital workshops, guidance by senior nurses,
training on the Internet, dispatch to outsidetraining session, etc.
Figure 2. Nurse’s working environment2) Nurse’s working environment
Nurse’
s working form is a two-shift system
unusual in China. Weekly holiday is secured, but
the monthly income is rather small. The starting(2) Inner Mongolia Autonomous Region Tumor
Hospital (Third grade B)

salary of nurse who graduated from a vocational
school is 1,500 yuan, and a university graduate
is 2,500 yuan. There is no bonus. Nurses are1) Outline of hospitalquite insufficient, and in busy time, the number

In 1921, this hospital is established as Guisuiof patients taking charge of are increased to 10.

Railway Hospital. It got under the jurisdiction

Generally, in China, the turnover rate of nurse isof Inner Mongolia Medical College in 2004,

low. According to the nurse who answered therenamed Inner Mongolia Autonomous Region

interview, the cause is ①it is difficult to find a job

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Survey Report on Medical Institutions in Modern China

in China,②students who feel themselves aren’tfrom Tibetan medicine, but there are also doctors

suitable for the nurse will not select nurse careerof Chinese medicine and Western medicine. Most

after graduation.

of the patients are students because it’s located in① Work form: Tow-shift system ②The ratioof patients to nurse: 7: 1 ③Weekly holiday: 2
days ④Initial salary: 1,856 yuan ⑤Numberof nurses: rather deficient ⑥Turnover rate:

university campuses, but it accepts patients otherthan students. The hospital director, director ofnursing department, and five nurses participatedin the interview survey.

Approximately 3% ⑦Recruitment method:①Number of physicians: 16 ②Number of nurses:

referral from junior college and university,

6 ③Number of assistant nurses:6 ④Number

internet advertisement ⑧Training system:of pharmacists: 4 ⑤Clinical departments: 8

Training for new nurses, In-hospital workshops,⑥Number of beds: 40 ⑦No hospitalization

Guidance by senior nurses, Training on thefacilities ⑧Number of outpatients: 90 / dayinternet, Dispatch to outside training session,

Figure 5. Outline of hospitaletc.12)Figure 4. Nurse’s working environment(3) Inner Mongolia International Mongolian
Hospital (a branch hospital in I.M.U.F.E:
First grade A)

Photo 7. Interview survey in the hospital2) Nurse’s working environment
All nurses are Mongolian people because thisPhoto 6. Inner Mongolia International Mongolian
Hospitalis the specialized hospital of Mongolia medicine.
Working form is three-shift system and the ratioof patients to nurses is 20: 1. This hospital has

1) Outline of hospital

16 doctors and 12 nurses. A weekly holiday isThis hospital is a branch hospital (First grade

one day. When we visited here, few outpatientsA) of Inner Mongolia International Mongolian

because of the day of college student physical

Hospital and located in Inner Mongolia University

examination, but usually very busy, sometimesof Finance and Economics. This hospital mainly

the staffs can’t take a weekly holiday. According

treats patients by Mongolian medicine derived

to the hospital director, they also examine

Makoto AKASAKA・Rieko IKENAGA・Yaping LIU

81

outpatients other than university students, but thecommittee which is the smallest administrative

insurance system is different, so the numbers oforganization is placed. In addition, in the large

them is small. The director of nursing department“shequ”,community healthcare service centers areaffirmed that the starting salary of the nurse islocated. They have no surgery or hospitalization

4,000 yuan, but we suppose it’s 3,000 yuan or so.

facility, mainly are performing primary care. As ofJune 2016, there are 34,285 community healthcare
centers (and service stations).13)

Photo 8. Examination table① Work form: Three-shift system ②The ratioof patients to nurse: 20: 1 ③Weekly holiday:
1 day ④Initial salary: 3,000 yuan ⑤Numberof nurses: rather deficient ⑥Maternity leave:
178 days ⑦Turnover rate: Approximately 0%⑧Recruitment method: Referral from juniorcollege and university, Internet advertisement⑨Training system: Guidance by senior nurses,
Training on the Internet.
Figure 6. Nurse’s working environment

Photo 9. H o h h o t S h i n c h e n g C o m m u n i t y
Healthcare Service station
Community healthcare center’s medical levelis not high, but there are some merits for the
inhabitants as follows. ①They can see a doctor
immediately. ②The medical expense is cheap.
③If they have the letters of introduction, written
by community healthcare center’s doctor, they areable to have medical examination without waiting(4) Hohhot Shincheng Community Healthcare
Service Station
In urban areas of China there is a residential
area called“shequ”. Although the scale is 100
to 600 households, there are also some districts
consisting of thousands of households. In manycases, “shequ” is surrounded by high fences
or iron fences. Security guards are stationed
at all entrances of “shequ”. There are small
supermarkets, convenience stores and various
shops in those districts, and the residence

Photo 10. Service station’s consultation Room82

Survey Report on Medical Institutions in Modern China

for a long time in a hospital.

2) Nurse’s working environment
A weekly holiday is one day. The salary is 2,300

1) Outline of the community healthcare service

yuan. Nurses are somewhat deficient. In somestationcase, they hire a person who applies for Internet

As can be seen by looking at the photo 10,

advertisements, but usually hire a nurse introduced

the Shincheng community healthcare service

from acquaintances. According to a nurse of thisstation’s building is considerably deteriorated. It

service station,“There is only one reason for ais controlled by a residents’committee, but its

nurse to quit. In short, salary is too cheap”. No

management is entrusted to a freelance doctor.

training like an in-hospital workshop. Because of

Two doctors are seeing patients. One doctor isno night shift, work is not so painful. Although

the doctor of western medicine, and another is thesometimes she gets violent remarks from patients,

doctor of Chinese medicine. Other staffs are three

in such cases, she persuades them to calm.

nurses and a pharmacist. There are eight beds but
a hospitalization is impossible. The consultation
hours are 8: 00-12: 00 am and 14: 30-18: 00 pm.
The average number of patients per day is about
30 people.
① Number of physicians: 2 ②Number ofn u r s e s : 3 ③N u m b e r o f p h a r m a c i s t s : 4④Clinical departments: 2 ⑤Number of beds:
8 ⑥No hospitalization facilities ⑦Number of
outpatients: 30 / day
Figure 7. Outline of Service Station

Photo 12. Service station’s pharmacy① Work form: Day-shift(8:00-12:00 am and14:30-18:00 pm) ②Weekly holiday: 1 day③M o n t h l y s a l a r y : 2 , 3 0 0 y u a n ④N u m b e rof nurses: not enough ⑤Turnover: often⑥Recruitment method: Introduction fromacquaintance. Internet advertisement⑦Training system: not particularly
Figure 8. Nurse’s working environment

Photo 11. Service station’s treatment room

Makoto AKASAKA・Rieko IKENAGA・Yaping LIU

83(5) Zhaoyong Zhongxiyi clinic (private clinic)

purchase easily at there.14)

Photo 13. Zhaoyong Zhongxiyi clinic

Photo 14. Patients who are put on a drip in thetreatment

1) Outline of the clinic① Number of physicians: 2 ②Number ofA clinic operated by an individual. Althoughnurse: 1 ③Number of pharmacist: 1 ④Clinicalthe number of medical institutions in China isdepartments: 2 ⑤Number of beds: 6 ⑥No

decreasing, the number of private hospitals is

hospitalization facilities ⑧Number of outpatients:

increasing (206, 849 at the end of June 2017).

10 / day

Zhaoyong Zhongxiyi Clinic is a private clinic in

Figure 9. Outline of Zhaoyong Zhongxiyi Clinic

Chifeng city. The staffs are two physicians, anurse and a pharmacist. The clinical departments2) Nurse’s working environment

are Western medicine and Chinese medicine.

Day shift only. Working hours are 8:00-12:00 am

There are 6 medical treatment beds but noand 14:30-18:00 pm. Although consultation hourhospitalization facilities. The average number ofis decided, since it is a local private clinic, it will

outpatients per day is about 10 people.

also examine patients who are out of time. As the

The consultation hours are 8:00-12:00 am andweekly holidays are not decided, she takes two

14:30-18:00 pm. Because it is a regional privateor three holidays a month when patients are few.

clinic, it will examine emergent patients even if

Though the monthly salary is only 1,800 yuan, it

on holiday. As can be seen in Photo 13, Chinese

cannot be helped because of rural clinic. As theclinics often treat by intravenous drip injection.

number of patients is so small that the work is

According to Chinese student(graduate school),

not busy. No particular training like a workshop.

antibiotics were once abused in Chinese hospital,

As she was born here and knows almost of

but in recent years the danger has been pointed

patients, no violence or insults from them.

out and restricted in use. In China anyone could

Dissatisfactions on this work are few holidays andbuy antibiotics at the drug store around 2011

monotonousness.

when the author stayed. According to the above
Chinese student, anyone is still (illegally) able to84

Survey Report on Medical Institutions in Modern China①Work form: Day-shift (8:00-12:00 am and 14:30-18:00 pm) ②Holiday: 2 ～ 3 days /month③Monthly salary: 1,800 yuan ④Number ofnurses: enough ⑤Turnover: occasionally⑥Recruitment method: Introduction fromacquaintance internet advertisement ⑦Training
system: not particularly
Figure 10. Nurse’s working environment(6) Wudazhen clinic (private clinic)
Individual clinic in Houqiaobao Town in suburb

Photo 16. Wudanzhen clinicof Hohhot City. Doctor W is seventy-four years

clinic in a condominium room in China,”but theold. According to him, he has been working fifty

situation in Hohhot is unknown.

years as a doctor. He opened this clinic by himself

The medical consultation is started from 8:00

three years ago because the company wentin the morning, but a consultation is available

bankrupt. We guess he is a village doctor, called

24 hours. Patients are only inhabitants of the“Chijiaoyisheng (barefoot doctor)”trained in thecondominium, 2-3 a day. Though red labels

era of Cultural Revolution. He didn’t tell me howof western medicine, Chinese medicine andhe became a doctor.

acupuncture are putted on the window of theclinic, he says he is a general internist. 4 medical
treatment beds are in the consultation room andused for a intravenous drip injection to patients.
The nurse is a son’s wife (forty-five years old),and he gives her 2,000 yuan as living expenses
every month. A large amount of medicines was
lined up in the examination room shelf. We guessfrom his word of“selling medicines”, he is making
money through sales of medicine. According to

Photo 15. Condominium where this clinic is inpractice.

him,“the people of the apartment residents is

Because photographing of the clinic wascare systems in China are rapidly improving,forbidden, we asked the acquaintance tookand doctor like him trained during the Cultural

pictures of the clinic. The clinic is on the first

Revolution era will disappear before long.

floor of the residential condominium. According toabove Chinese graduate student (from Zhenjiang
City, Jiangsu Province),“It is illegal to open avery pleased to his clinic”. However, medical

Makoto AKASAKA・Rieko IKENAGA・Yaping LIU

85①Number of physician: 1 ②Number of nurse: 1③Number of pharmacist: 0 ④Number of beds:
4 ⑤No hospitalization facilities ⑧Number of
outpatients: 2 ～ 3 / day
Figure 11 Outline of Wudazhen clinic

5. Closing remarks
Modern Chinese medical institutions are being
rapidly modernized. In this survey report, we
introduced various medical institutions from thehighest level of hospitals to individual clinics that
seems to be illegal. If I can visit China in future
Photo 17. The Entrance of Wudazhen clinic

we would like to investigate and report on thepresent situation of the clinics in the rural areas.

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report of the nursing staff).”Iryo Rodo, January 2014, Extra edition: 3-84.
National Personnel Authority statistics. 2017.“The results of the reality 2017 private payroll survey of privatesector salaries.”http://www.jinji.go.jp/kyuuyo/minn/minnhp/min29.
Han Hui.2012.“Nihon ni okeru kango fusoku no jittai (Actual condition of shortage of nursing in Japan).”Journalof East Asian Studies No.10: 1-24.
Kobayashi Miki. 2016.kango no shitsu (Quality of nursing). Iwanami shinsho.
Kume Kazuoki・Kume Ryūko Murakawa・Yukari. 2010.“Byōin kango-bu no soshiki kōzō no tokuchō ni kansuru
ichikōsatsu (A Study on Characteristics of Organizational Structure of Hospital Nursing Department).”
Yamagata Journal of Health Sciences, Vol.13.

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Survey Report on Medical Institutions in Modern China

Mihashi Kahori.2004.
“Chūgoku ni okeru mura-i no yōsei to igaku kyōiku ― wa dashi no isha no sai kunren (Training
village doctors in China and medical education - retraining of barefoot doctors).”Journal of Japanese Society for
the History of Medicine. Vol.50-1.
Japan nursing association. 2016.Kango kankei tōkei shiryōshū (Nursing relationship statistics collection), 2016,
Nihon kango kankei shuppan-kai.
Japan nursing association.2015.“Ippan byōtō ni okeru kango haichi-tō ni kansuru chōsa (Survey on nursing
placement etc. in general ward).”https://www.nurse.or.jp/nursing/ practice/housyu/pdf/2016/ippanbyoto_2015.
pdf.
Lù xī jùn.2008.“Chūgoku toshi yashiroku eisei kikō ni kansuru ichikōsatsu (A Study on Chinese Urban
Community Healthcare Service Organization).”Shimane Journal of North East Asian Research.Vol.16.
Méitián Dédōng.2013.‟Chūgoku no iryō seido to kango mondai ni tsuite (On medical system and nursing problem
in China). The doctoral dissertation Osaka University of Economics.
Zhōngguó hùshì qúntǐ fāzhǎn xiànzhuàng diàochá bàogào (Investigation report on the status quo of Chinese
nurse) http://news. xinhuanet. com /gongyi/2017-05/11/c_129601688_2.htm

Notes1)Makoto Akasaka.2017.“Histrical Transition of China Medical Insurance System.”Journal of KIBI International
University.Vol.9.1-13.
2)“They are beginner level sanitarians who are called“barefoot doctor”and are not regular medical education,
but have been engaged in medicine as a village doctorwith sanitary knowledge and skills acquired by technicaltraining for a certain period. Although it was officially denied after the Cultural Revolution, in order to satisfy
the medical needs in rural areas, if they pass the qualification exam after retraining they were called a rural
doctor and allowed to practice medicine in the village hygiene room.”kaori Mitsuhashi, 2004.“Training village
doctors in China and medical education - rehabilitation of barefoot doctors.”Journal of the Japanese Society for
the History of Medicine. 50(1) 100-1.
3) Nursing education was deemed unnecessary due to the outbreak of the Cultural Revolution and the nursing
college was closed from 1966 to 1997. (Dedong Meitian. 2013.“Chūgoku no iryō seido to kango mondai ni tsuite(On China’s medical system and nursing problem).”The doctoral dissertation Osaka University of Economics.
4) Inner Mongolia Autonomous Region in China is a remote region of China but blessed with natural resources,
GDP per capita is fifth among the 31 Chinese provinces, autonomous regions and special cities, and disposable
income of urban residents is the tenth highest. Therefore as far as urban areas‘hospital investigation isconcerned, it can be considered that there is little bias in data.
5)The Japan Institute for Labor and Training http://www.jil.go.jp/foreign/jihou/2013_7/china_04.html.
6) As of June 2017, there are third grade hospitals 2,286, second grade hospitals 8,118, primary grade hospitals
9,461. www.jri.co.jp/file/report/shanghai/pdf/201706_shisetsu.pdf
7) Zhōngguó hùshì qúntǐ fāzhǎn xiànzhuàng diàochá bàogào (Investigation report on the status quo of Chinese
nurse). : http://news.xinhuanet. com/gongyi/2017-05/11/c_129601688_2.htm.
8)Chinese nurse net: http://hushi512.com/guonei/3081.html
9)We introduce the nurse recruitment examination of the Inner Mongolia Autonomous Region People’s Hospital,
the largest hospital visited this time (November 2016: Recruitment examination. December: announcement of
successful applicants). Procedure: ①Send a resume with a digital photo in online registration (November 17th
～ 19th). ②If registration is accepted, pay written exam fee 70 yuan (nonrefundable: November 18 ～ 20). ③

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Download and print entrance ticket to the examination hall. If you don’t have an admission ticket, you cannot
enter the examination hall (November 24-25). ④Written exam (100 minutes / 100 full marks: November 26).
1/4 is dropped by written exam. In fiscal 2016, 60 of the 241 candidates failed the written exam. All candidate’swritten exam result · The pass / fail will be posted on the Internet. ⑤Candidates who passed the written
exam proceed to qualification screening. At that time, submit ID card, diploma, degree certificate, nurse
qualification (or certification to pass the 2016 qualification exam) etc. and pay the examination fee 50 yuan
(nonrefundable). ⑥If qualification screening is over, you will have an oral exam (100 minutes・100 points). In
the interview examination, appearance, language expression, communication skill, expertise, comprehensive
knowledge etc. are scored by multiple interviewers. ⑦The total score will be calculated with written exam(40%) and oral exam (60%), the top 60 will be adopted, provisionally. In 2016, among the 181 candidates who
proceeded to qualification screening and oral exam, the top 60 passed. The results will be published on theInternet under the title“Inner Mongolia Autonomous Region People’s Hospital 2016 nurse recruitment total
result and physical examination related matters”. All candidate name, gender, total score, pass / fail will be
published on the internet. ⑧Applicants who passed the examination will work at the hospital for 6 months astrial employments. After the trial period, if they pass the examination they are officially adopted.
10)For example, in the case of Zhenjiang City, Jiangsu Province, pay 120 yuan if it is within 5 km. After that thefee is added every 1 km. Doctors and nurses are on board the ambulance, but treatment and medication in
the ambulance are of course chargeable. (December 6, 2017. Student of Kibi International University Graduate
School of Sociology: Jing Yifan).
11)Baidu baike：https://baike.baidu.com/item
12) Nurses recommended in each medical department participate in training. Not all nurses can receive training.
All expenses will be borne by the hospital.
13) Guójiā wèishēng hé jìhuà shēngyù wěiyuánhuì biān,2016, zhōngguó wèishēng hé jì huà yùchéng tǒngjì niánjiàn
2016. (China Health and Family Planning Statistics Yearbook 2017). Zhōngguó xiéhé yīkē dàxué chūbǎn shè.
14)December 6, 2017, Jing Yifan