Abstract
Health care systems in Singapore, Hong Kong, and mainland China are strikingly distinct from those in the West. Economically speaking, each of the aforementioned East Asian systems relies in great measure on private expenditures supplemented by savings accounts. Western nations, on the other hand, typically exhibit government funding and wariness about healthcare savings accounts. This chapter argues that these and other differences between Pacific Rim health care systems and Western systems should be assessed in light of background Confucian commitments operating in the former.
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Notes
- 1.
“The way an East Asian interprets another person’s actions and makes normative judgments is still powerfully informed by Confucian teachings. This is true even in the political sphere” (Bell and Hahm, 2003, p. 42).
- 2.
A dominant contemporary Neo-Confucian view is that Confucianism must integrate itself with liberal democratic ideals so that Confucian societies can be democratized in these terms. See, e.g., Liu (1996).
- 3.
An illustrative example in bioethics is the four bioethical principles proposed by Tom Beauchamp and James Childress in light of modern Western moral thought and experience. They claim that these principles constitute a basic minimum of the common morality that should be applicable normatively to every region of the world. See Beauchamp and Childress (2001).
- 4.
A good example is afforded by Hong Kong medical ethics, which has come recently to resituate the legal commitments it inherited from its British colonial past within Confucian guidelines for actual clinical practice. The result is that, if one looks to the general governing medical law regarding individually-oriented informed consent, one should assume that it was being applied in the same patient-oriented fashion as law in Britain. However, the actual, legally-recognized medical ethics norms for clinical practice orient the physician-patient relationship in more family-oriented terms. See Tse and Tao (2004).
- 5.
“The first among the East Asians to openly and enthusiastically espouse the idea that Confucianism had much to do with the rapid industrialization of the region were politicians. Most notoriously, Singapore’s senior statesman Lee Kuan Yew has invoked Confucian values – under the guise of ‘Asian values’ – with the apparent aim of justifying constraints on the democratic process. Authoritarian governments in the region have similarly appealed to Confucian values meant to contrast with Western-style democracy. … Confucian principles may also help to explain the fact that contemporary East Asian states rely mainly on nonstate agencies – community, firm, and family – to finance and provide welfare services, with significantly less direct state financing of services than other developed states” (Bell and Halm, 2003, p. 3). See, also, Goodman et al. (1998).
- 6.
There are numerous legitimate concerns about how to check and balance power and to avoid abuse in such East Asian polities as have just been described. Any reflection upon these concerns would require addressing a considerable literature and exploring a long list of issues. Such falls beyond the compass of this book, much less this chapter. Here the attempt has been much more modest: to offer a Confucian reconstruction of social and political reality one encounters. Also, traditional Confucian literature itself addresses issues of checking the abuse of power and establishing appropriate balancing institutions. This too falls beyond the endeavors of this book.
- 7.
The Confucian account offered in this section is based on the views of classical Confucian figures, Confucius (Analects, 1971), Mencius ((1970) and Xunzi (Knoblock, 1999), without addressing any disagreement among them. Their disagreements, if any, are not relevant to the argument of this chapter.
- 8.
To read such social democratic concepts into Confucianism involves at best a form of naïve presentism, and at worst a reconstruction of the past to meet the conceits of the contemporary age. It would produce a new account – a reform Confucianism, if you will – but would not constitute a presentation of the background cultural understandings currently influencing the moral and political thought of many people in the Pacific Rim (Fan, 2002a, b). Unfortunately, some most influential contemporary Neo-Confucians took pains to develop democracy from Confucian thought. For instance, see Mou (2000), (1987), and (1988). For an excellent analysis of the failure of his endeavors, see Jiang (2003).
- 9.
For a brilliant exposition of the Confucian view of li, see Fingarette (1972). For a systematic exploration of the appropriate relation between ren and li for Confucius, see Shun (2002). For a collection of the 20th century Chinese research on li, see Chen et al. (1998). Also see Chapter 12.
- 10.
For a very helpful exploration of Confucian elitism as well as its favored way of selecting legislators and officials through examination rather than democratic election, see Bell (2000).
- 11.
The Chinese system of private ownership already formed in the Warring-Sate Period of China more than two thousand years ago. Confucians before Mencius may have supported a special public-ownership system, the so-called Well-field System of Land. However, as Zhao and Chen indicate, Mencius’ call for “forming property for the people” (wei min zhi chan,
) helped to bring about the privatization of land. Since Mencius, Confucian scholars have always supported a marked system based on private ownership (See Zhao and Chen, 1991, p. 5). - 12.
For a vivid exposition of Confucian family values, see Liang (2003).
- 13.
“Barefoot doctors” refer to a group of young peasants who were selected to accept a short time medical training and to offer medical care for the peasants while at the same time participating manual agricultural labor by themselves. See Kunming (2002). Also see Fan (2006b).
- 14.
The People’s Republic of China State Council Decree 44/1998.
- 15.
The table was created with adapted English translations of the information offered by the National Survey on Health Care Service in 2003, available at http://www.moh.gov.cn/open/statistics/digest06/y25.htm. All websites used in this chapter were accessed in July 2008.
- 16.
State Council Development Research Center on the Health Care Reforms, see China News Network, available at http://news.sina.com.cn/c/2005-07-29/12246561593 s.shtml.
- 17.
Such judgments have been echoed by some Western scholars from views grounded in liberal social-democratic ideology. See, e.g., Blumenthal and Hsiao (2005).
- 18.
The sources of the information for this table are the following websites:
-
(1)
WHO:http://www.who.int/whr/2004/annex/country/sgp/en/index.html http://www.who.int/whr/2004/annex/country/chn/en/index.html http://www.who.int/whr/2004/annex/country/usa/en/index.html http://www.who.int/whr/2004/annex/country/gbr/en/index.html
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(2)
Hong Kong government:http://www.hwfb.gov.hk/hmdac/english/dis_papers/dis_papers_lhcshk.html
-
(3)
Winterthur Insurance (Far East) Pte Ltd: http://www.irmi.com/Expert/Articles/2002/Kristensen09.aspx
-
(4)
XL Winterthur International Co Ltd: http://www.irmi.com/Expert/Articles/2002/Kristensen03.aspx
-
(5)
Chinese National Survey on Health Service: http://www.moh.gov.cn.
- (6)
-
(7)
National Statistics (UK):http://www.statistics.gov.uk/StatBase/ssdataset.asp?vlnk=5053&Pos=&ColRank=2&Rank=272.
-
(1)
- 19.
See “China’s Statistics on Economic and Social Development in 2005” provided by the Chinese Bureau of Statistics, available at http://www.stats.gov.cn/tjgb/ndtjgb/qgndtjgb/t20060227_402307796.htm.
- 20.
For instance, economic reform so far has given the peasants’ families a right to manage their production on land, but not a right to own land. Rural land is often sold to land developers by local governments and village chiefs without benefiting the peasants. That is, the Chinese peasants still have not obtained reliable private property in Mencius’s sense, so that they cannot control their land as they wish and consequently raise their standard of living, health care included. Accordingly, quality basic health care for the Chinese peasants, like other items such as education and housing, have to be achieved by their first securing a right to own their land.
- 21.
For detailed analyses and explorations of the corruptions in the current Chinese health care reality, see Chapter 88.
) helped to bring about the privatization of land. Since Mencius, Confucian scholars have always supported a marked system based on private ownership (See Zhao and Chen, 1991, p. 5).Author information
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Fan, R. (2010). Towards a Directed, Benevolent Market Polity: Looking Beyond Social Democratic Approaches to Health Care. In: Reconstructionist Confucianism. Philosophical Studies in Contemporary Culture, vol 17. Springer, Dordrecht. https://doi.org/10.1007/978-90-481-3156-3_7
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