Until reforms in the late twentieth and early twenty-first century, physicians were quasi-government employees and with little freedom in the choice of the hospital to work with.
In addition, decades of planned economic policy discouraged physicians from opening their own clinics, and the practice of medicine was generally under the control of local units, such as factories, government, offices, or communes.
The CMA plays a leading and active role in the nation's medical education, training and professional exchanges.
Many physicians also receive commissions from prescribing prescription drugs and get "red envelopes" from patients (patients give money or gifts to their physicians for receiving treatment) or from sales representatives of drug companies.
In China, physicians are well respected, but as a group they are not at the top of the social structure of the country because their incomes fall in the middle class.
Influenced by a centrally-planned economy, many hospitals were managed as government agencies rather than medical service organizations.
The management team usually did not recognize the importance of developing and retaining high skilled physicians.
[1][2] For foreign or international students, the person needs to study for 6 years at the medical school, namely because the Chinese version is accelerated.
[citation needed] Also, international students have to prepare for and take the Hanyu Shuiping Kaoshi for admission, and during med school, the Medical Chinese Exam.
These students will complete their MD study and have to pass the national certification test during the residency.
The top three reasons that lead many physicians in Beijing to quit include: doctors are not well paid; hospitals are poorly managed; and there are not enough personal development opportunities.
Non-profit hospitals are government-owned, and will turn earnings into additional infrastructure or hand them back to the respective government authorities.
By the end of 2002, China has 306,000 healthcare and medical organizations, 63,858 of which are hospitals and clinics, 219,907 of which are nursing homes and 22,270 fall into other categories.
[citation needed] This poor operating performance can be partially due to that non-profit hospitals have little incentive to control costs, given the government's subsidies.
In 2004, Beijing Aikang Medical Investment Company bought a state-run-enterprise owned AAA hospital (the highest standard), and the acquisition was the first of this kind in China.
In Fuzhou, the capital city of Fujian province, four government-owned hospitals have been sold to private investors.
In Tianjin, China's third largest city, about 1,000 unemployed people have been trained by local authority and passed hospital support work test.
These people returned to work as certified support staff of a number of big hospitals.
Most hospitals are located at downtown areas due to people's reliance on public transportation in China.
In December 1998, a national medical insurance scheme was launched by the State Council.
By end of 2002, most of the county or above level cities had joined the scheme and covered a population of about 100 million.
Individuals pay an annual insurance premium for their basic medical treatment entitlements.
The basic insurance plan does not reimburse expenses for drugs not on the basic medical insurance drug list, the State Scheme Drug List for Basic Medical Insurance, which is based on clinical need, safety and efficacy, reasonable pricing, ease of use, and the desire to maintain a balance between Western and TCM products.
Hoping to reduce enterprise subsidies of all types, the State Council launched pilot reforms in 1994 of the two health insurance systems under its control.
Under the policy, urban residents must join a government managed basic insurance coverage plan for urban residents and pay a certain amount of monthly fees based on their income levels, and up to 70% of their medical expenses can be reimbursed.
Modern medical education in China started in the early 20th century at hospitals run by international missionaries.