A worrying diagnosis
One night in early spring, a couple from Central China's Hubei Province, Chen Zhengxian and his wife Yao Yuanxiang, tied themselves together and drowned themselves in the Yangtze River.
Chen, a farmer from Gongan County, was suffering from snail fever and hepatitis B, and Yao was tormented by sciatica. Medical bills were mounting and life savings had been exhausted. They saw suicide as their only escape and left behind a 10-year-old son, also a hepatitis B sufferer. The tragedy reflects the grim reality that hundreds of millions of people in rural China do not have access to affordable healthcare.
A doctor from a major hospital in Nanjing of East China's Jiangsu Province checks the eyes of a rural patient for free. Some urban hospitals occasionally send their doctors to rural areas. Yang Xi |
The Chinese government initiated the rural cooperative medical scheme in 20 provinces four years ago but is now coming under pressure to advance the program, which is still unable to meet the rural population's needs.
Wu Ming, professor with the Medical School of Peking University, said the problem of rural healthcare should not be underestimated. "The fact that 800 million farmers have limited access to medical care is so grave that it could diminish the government's efforts to close the yawning wealth gap," he said.
Under the cooperative scheme, each participant pays 10 yuan ($1.30) a year, while the State, provincial, municipal and county governments supply another 40 yuan ($5.20) to the fund. Farmers who join the scheme are then entitled to discounts, provided by the fund, on their medical expenses.
But residents in Chen's village believe the couple would have taken the same action even if they had joined a rural cooperative scheme. The money they needed had far exceeded any possibility of refund.
"With an average reimbursement rate for hospital fees only standing at a meagre 27.5 percent, the current subsidies are utterly inadequate in dealing with grave and terminal diseases," said Wu.
Farmer Ma Yongshan, from Beipiao County of Northeast China's Liaoning Province, was stricken by colon cancer and a brain infarction. He received a reimbursement of 6,590 yuan ($850) for his hospital fees after joining the scheme. He still has 10,000 yuan ($1,290) left to pay by himself, which is not easy for a farmer whose annual disposable income is around 3,000 yuan ($390).
"The program eased my burden - at least I could pay the bill on my own without borrowing. But if 60 percent of the expenses could have been refunded, that would have been a great blessing," Ma said.
Official figures show that 410 million farmers in 1,451 counties, around half of the country's rural population, have joined the scheme, receiving total refunds of 15.58 billion yuan ($2 billion) from a fund pool of 21.36 billion yuan ($2.80 billion). The proportion covered by the local governments vary according to the specific disease and their healthcare budget.
"Though headway has been made, it will take time for the current scheme - with its wide coverage and low-level refunds - to make a fundamental difference in resolving the problem of healthcare for the rural poor," said Feng Xiucheng, head of the rural cooperative medical office of Gongan County in Hubei.
Figures released by the World Health Organization show that the Chinese government's spending on health only takes up 2.7 percent of its total expenditure, far lower than an average of 10 percent in developed countries.
"Even in richer cities, people have to pay an average of 60 percent of their medical expenses. Low reimbursements are seriously hindering affordable access to medical care," said Ba Denian, a researcher with the Chinese Academy of Sciences.
Zhang Jinpu and his wife count the 17,800 yuan ($2,300) reimbursement given by the Suixi County Rural Cooperative Medical Bureau in Anhui Province for the 80,000 yuan ($10,400) they spent on their daughter-in-law who suffered from a heart attack last year. Li Bo |
"The inefficient use of funds and uneven money distribution - the lion's share of investment in healthcare actually goes to urban residents - have made the medical situation in rural areas even worse," said Xu Qingsong, professor with the Second Military Medical University in Shanghai.
Beipiao is one of the dozens of counties in Liaoning trying to encourage all rural residents to join the scheme. By the end of March, some 98 percent of the residents in Ma Yongshan's home village of Wujianfang had joined, up from 60 percent at the beginning of the year.
"More villagers have joined the scheme after seeing benefits," said Guo Zhenhe, head of Wujianfang Village.
Under the program, local farmers only need to pay 5 yuan ($0.65) each every year, half the national average. The central and provincial governments contribute another 36 yuan ($4.65) for each participant, but the county government pays only 5 yuan for each member from its revenue from the transfer of land use rights.
Zhao Jiqing, director of the Public Health Bureau of Beipiao, believes that the funding is not enough.
"Without consistent support from central government coffers, the new scheme can hardly sustain itself. It is imperative the government increases the fund pool to make hospital fees more affordable for farmers," he said.
The central government has pledged to expand the program to 80 percent of the rural population by December and double its investment in rural medical care from 5.8 billion yuan ($750 million) last year to 10.1 billion yuan ($1.30 billion) this year.
"If the central government could raise its spending on every participant by 10 yuan, the enrolled members will only need to pay an average of 49 percent of the expenses on their own," said Professor Hu Shanlian with the Medical School of Fudan University in Shanghai.
Xu Yadong, vice-president of the No1 People's Hospital in Beipiao, is a staunch supporter of the rural cooperative healthcare system.
"More farmers have come to the hospital and have begun to take chronic illnesses more seriously after joining the scheme," he said. "In the past, farmers would seldom go to hospital for fear of the high cost even though they were very sick."
Xu said 61.7 percent of the hospital's sickbeds were occupied last year - the figure for the previous year was less than a half.
"More money is needed to fix up local clinics and train medical staff at grass-roots level, otherwise patients will still have to negotiate bumpy roads to see doctors instead of being treated locally," he said.
(China Daily 05/16/2007 page20)
