Since 1949, the Chinese party-state’s approach to health policy has fluctuated with the vicissitudes of politics, oscillating between neglect and an instrumental use of healthcare to promote state legitimacy. This chapter examines health policy in China from 1949 until the 2000s, with a focus on rural areas. During the Maoist period, two factors hindered the erstwhile Ministry of Health in improving health services: budget constraints and political oscillations that prioritized ideology over expertise. In 1978, Deng Xiaoping initiated market reforms and subordinated healthcare and social policy to economic growth. In the early 2000s, due to pressure from society, shifts in governance style, and encouragement from at home and abroad, the Chinese government initiated a dialogue on healthcare reform that culminated in the 2009 plan to overhaul the health system. But because local government was still primarily responsible for funding health policy and faced budget constraints, legacies of health policy in the second half of the twentieth century continued to impact healthcare in the 2000s.