Decentralisation of payments

At Beijing's foremost university of traditional medicines there is a hospital. At a recent visit I was surprised to see the doctor now has an attending nurse who collects payments inside his examination room. In the past the patient always carried a slip of paper to a cashier down the hall, returning with the paper stamped to indicate receipt of payment. Now there is no stamp and the nurse even accepted a payment in advance of our future visit. She said we would not have to wait in line at the window to receive a number. I felt guilty experiencing the decentralization of payments at this prestigious hospital, but did not question the nurse as to why they had adopted this new custom. This isn't just any hospital, either, but one of only two hospitals in the country in which qigong treatment is sanctioned. While there a friend and first time visitor to China had a rib, a spinal disc, and a disjointed hip reset over the course of an hour while also receiving successful acupuncture for a headache that has plagued him for years. Watching this doctor go about his work professionally, I couldn't stop wondering what might have changed since the last time I was here such that doctors now no longer allow the hospital to be paid for their services. Was the doctor not getting paid? Or is this how the doctor has negotiated an increase in his wages? It has been suggested in some writings that as economic growth in China slows, provinces may begin to withhold tax revenue from the central government. Macau did this in 2008 and the central government responded by refusing to grant visas for Chinese gamblers to visit the Macau administrative region. Tax payments resumed, and all was soon forgotten. Leaving the hospital I thought of the way China's practices and customs are often surprisingly similar at the highest levels of diplomacy and at the bread seller on the corner. So my question is could the decentralization of payments be happening at all levels in China? That it is happening in hospitals is news enough...