@AlPage48: "If China instituted a similar "no charge to the user" system they would have to collect the costs in taxes somewhere else."

Actually China's public health care is already heavily state-funded. Yes, the public pays fees, but those are small compared to what same operations would cost somewhere else, even when considering the average income difference.

I asked about this from one Chinese doctor that I visited couple of years ago, and he outright said that they'd ask for more money and people would pay, but the government does not allow it. No wonder if there are some shady practises to increase the profits.

Bigger difference may be in state structures.

In China the threshold to become a tax payer is quite high (and much higher after latest IIT reforms) , so lot of people that would be tax payers with similar jobs in west, are solely net receivers here.

Also the state here gets revenue from many other things than taxes - state-owned tobacco industry being one relevant to public health.

The link between health and happiness is easy to ignore when you have both.

Being healthy does not generally make anyone happier, but losing that health would reduce happiness for most people.

I think that the whole "citilized city" tag that Kunming and its authorities were aiming for (failing at that), shows that what China tries to achieve is not much different from what has been achieved elsewhere, in terms of some sort of objective definition of "civilized".

Naturally some would not agree with the whole concept, but (especially in country like China, unfortunately) that is really irrelevant. What matters is what the leaders want.

It is a different thing to take a bicycle ride in a city every now and then, and being on extended roadtrip with it for a year or more.

Same taking a stroll in the park, and running a few marathons every year.

In (western) fast food joints one of the reasons to ask customers to clean their tables is the cost factor.

In busier places it's easily at least one person's full time salary to handle that, and that cost would be transferred to item prices for customers to pay.

And here we get to two major difference in developed western countries and China.

On one hand the salaries and additional employment costs in China are much lower, and on other the Chinese consumers are more price sensitive, in the sense that they'd happily pay more to show off their wealth.

Meanwhile in west the employers would save where ever they can without losing too many customers to competitors, and those customers understand this too. Taking care of your own rubbish means cheaper burgers.