China has had some initial success in its current health care reform efforts. Five areas of reform have been targeted and include providing universal coverage, equitable access to basic health insurance, establishing an essential medicine system, and improving primary health care facilities. The last area, the reform of the public hospitals, remains the most difficult to reform. General guidelines have been established by the national government and movement is being taken to delegate authority to local units for implementation. The aim of this paper is to compare China's formal government sponsored health care reform plan for public hospitals to the acknowledgement and acceptance by a sample of health care leaders in Guangzhou. Challenges are strong and include cost accountability, doctor training, employee empowerment, improprieties, and the influence of private hospitals. Based on this qualitative research, conclusions and recommendations are made by the authors as to what is necessary to have effective pubic hospital reform in China.
