An Evolving Rehabilitation Service Delivery System in the People's Republic of China

Journal of Rehabilitation, July-Sept, 2001 by Nan Zhang Hampton

In the past ten years, the author has traveled to China several times for conducting research in rehabilitation services for people with disabilities. During these trips, she had opportunities to visit various rehabilitation programs in order to discuss, with rehabilitation practitioners and individuals with disabilities, the impact of the socioeconomic reform on the delivery of rehabilitation services for people with disabilities in China. It appears that China is experiencing a transitional period marked by rapid economic growth and profound social change. These changes have challenged the old residual welfare system which provided limited services for people with disabilities in the past. Facing the challenges, service providers and individuals with disabilities have attempted to develop a rehabilitation service delivery system that calls for collaboration between different governmental agencies and the active participation of people with disabilities.

This article presents an overview of the evolution of China's rehabilitation services delivery system. As Driedger (1989) states that disability is a worldwide issue. Understanding changes in rehabilitation services in a distant land (e.g., China) may expand American rehabilitation professionals' knowledge of rehabilitation from a different perspective. It is noteworthy that China is still a developing country with a Gross Domestic Product (GDP) per capita of $1,838 compared with a GDP per capita of $23,220 in the U.S. (Gelb, 1996). Results of previous studies (Mazumdar, 2000; Stretton, 1995) suggested that the development of social services in a country was related to the wealth of that country. Hence, when we review rehabilitation services in China, we need to consider this country's socioeconomic developmental level.

The Prevalence and Classifications of Disabilities in China

China is the most populous country and has the largest disability population in the world (Sonnander & Claesson, 1997). According to the Chinese Government (State Council, 1996), at least 60 million Chinese have a disability. In China, a person with a disability refers to "one who suffers from abnormalities or loss of a certain organ or function, physiologically or psychologically, and has lost in part or whole the ability to engage in activities in a normal way, and is thus hampered in his/her normal functions in certain areas of social life" (State Council, 1988). There are six categories of disabilities including visual, hearing, speech, physical, psychiatric disabilities, and mental retardation. Unlike the U.S., learning disabilities and substance abuse disorders are not included. Of the 60 million people with disabilities, 20.57 million have hearing disabilities, 11.82 million have mental retardation, 8.77 million have physical disabilities, 8.77 million have visual disabilities, 2.25 million have psychiatric disabilities, and 7.82 million have multiple disabilities (China Disabled Persons' Federation, 1998). About 25% of these individuals live in the urban areas and 75% reside in the rural areas (Lu, 1993). Working-age (15 to 60 years old) individuals constituted 45% of the total population of people with disabilities and the employment rate for those who lived in urban areas was estimated to be 70% in 1997 (China Disabled Persons' Federation, 1998).

Evolution of Services for People with Disabilities

Pre-reform era. From 1949 to the early 1980s, the Chinese government adopted a "residual" welfare approach to the delivery of services for people with disabilities (Deng, 1999). The goal of the services was to "provide for basic livelihood" (preventing people from starvation and becoming homeless) of people with disabilities through emergency relief, institutionalization, and sheltered employment. Two government ministries, the Ministry of Civil Affairs and the Ministry of Public Health, were responsible for making policies and operating rehabilitation, employment, and social services for people with disabilities. However, there was no national benefits system to assist people whose disability resulted in mobility, education, employment, and general financial difficulties.

The Civil Affairs Ministry was the most centrally involved in providing employment, rehabilitation engineering, and social services for people with disabilities. It established numerous "welfare enterprises" in which people with disabilities constituted at least 35% of the productive lines. These enterprises enjoyed tax exemption or deductions and were administrated by the ministry and the local civil affairs bureaus (LCAB) under the country's economic planning system. The Civil Affairs Ministry also established various social welfare institutions to accommodate people with severe disabilities who had no family members to support them. In addition, there were prosthesis factories, clinics, and a research institute of prostheses under the Civil Affairs Ministry and the LCAB. However, the majority of staff members in these institutions/enterprises and in the ministry's social welfare department did not have formal training in disability and rehabilitation-related issues.