Difficulty in Improving Medical Conditions in Lower-Tier County Hospitals

A core challenge in county-level economic development is integrating rural, town, and county healthcare into a “one center drives the county” model. In practice, this is difficult. The main problem is that medical staff often lack official bianzhi (tenure) and face low salaries, leading to talent drain and gaps in care. Locals then travel elsewhere for treatment, causing health insurance funds to flow out. Without those funds, local governments can’t receive fiscal subsidies, creating a vicious cycle where healthcare conditions keep worsening.

This helps explain the saying “persuading someone to study medicine invites heavenly retribution.” It’s not just folklore — it’s about income. If you can’t get a position at a big-city hospital, but your hometown only offers a non-tenured contract with low pay, it’s a tough reality. In the article’s case, 16 of the 19 existing bianzhi positions were revoked, leaving just three. Downward mobility into cities is tough.

Cui Changjie | County Medical Communities: Full of Obstacles