China’s Leaders Grapple with Rural Health Crisis

By Chris Buckley

LIPING, China — Wu Hanhui grimaced in agony as he waited for packets of herbs and pills from a streetside doctor.

A kidney stone had tormented him for a week, and already much of last year’s earnings from his small farm was lost to useless tests and drugs at a small hospital.

Wu had traveled from his village to a primitive private clinic in Liping in southwest China’s poor, mountainous Guizhou province, hoping to find a more affordable herbal cure. The big county hospital nearby was too expensive for farmers like him.

"It’s hard enough to pay for this," he said, gesturing at the small clinic. "If I could afford it I’d go, but I don’t know how much it costs."

The plight of Chinese farmers, who risk accidents and disease with virtually no medical insurance, has provoked national leaders to move to restore rural medical cooperatives that collapsed during China’s rush to embrace market economics, and to establish a nationwide safety net of minimal medical insurance.

Rural health was set to be a central topic at this year’s session of parliament, the National People’s Congress, opening on Sunday (March 5). Doctors and farmers said they welcomed the government’s promises.

Last week, a leading government adviser told parliamentarians that Beijing would spend 4.73 billion yuan ($589 million) on rural medical cooperatives across the country in 2006, a near nine-fold increase on 2005, the China Youth Daily reported.

But experts said that whether the plans work — or fizzles like previous attempts to bring healthcare to China’s 750 million farmers — will be a long-term test of the central government’s policy skills and coffers.

"China’s current leadership has shifted the development strategy from an overwhelming emphasis on GDP to some emphasis on equity, including in healthcare," said Gu Xin, an expert on national medical policies at Beijing Normal University.

"The problems are that total financing may still be too low to make a fundamental difference, and it’s not clear that the poorest farmers who need this most will really benefit from it."

BAREFOOT

Under Chairman Mao Zedong, many Chinese farmers received rudimentary medical care from "barefoot" doctors who staffed clinics run by all-powerful communes by the 1970s.

But when the pioneer reformer Deng Xiaoping broke up the communes in the early 1980s, he also broke up the medical cooperatives. Since then rural medical care has stagnated.

Today, one in three rural Chinese patients whom doctors advised to enter hospital did not, mainly because they could not afford to, a recent Health Ministry study said.

Rural doctors must watch patients fall into chronic illness or even die for lack of proper care, said Lu De, who runs the township clinic in Zhaoxing, about 50 km (30 miles) from Liping.

"There are poor patients whom we want to help or send to the county hospital. We try, but sometimes we can’t because it’s too expensive," he said. "It’s a pressure on us, too."

Glaring disparities between urban and rural health policies and services have magnified the health gap. About 40 percent of urban Chinese have some insurance, but only a few cities and provinces have extended insurance to even a few farmers.

Chinese cities hold 20 percent of the country’s population but 80 of its medical resources, according to a recent World Health Organization study.

Premier Wen Jiabao and other leaders have pledged to counter these imbalances by creating "new-style medical cooperatives" to give farmers an umbrella of care for major illnesses.

To cover an individual under the new scheme, the central government will pay in 20 yuan, local government 10 yuan and the participant another 10, said Guizhou medical officials. When rural residents fall seriously ill, they will be able to cover most hospital expenses from the pooled insurance.

Guizhou, one of China’s poorest provinces, has the country’s highest rate of mortality among children under 5. The scheme will relieve pressure on local farmers, said Ao Jiahui, director of the Congjiang County Health Bureau.

"There are no rural cooperatives at the moment, so farmers have to pay everything themselves," he said.

But even those who favor expanding rural medical coverage see shoals ahead. Hospitals commonly demand that patients pay much of their likely bill before treatment. Ao said farmers were likely to have to pre-pay their part of the bill under the new scheme, potentially thousands of yuan for major surgery.

But if farmers must pay even a fraction of costs upfront, many will be unable to afford treatment even with insurance.

"Poor people in the countryside just can’t afford to pay upfront for healthcare, even if it’s subsidized, so the new type co-op schemes trialled so far have been utilized by the relatively rich, but not the poor," Gu said.

While lower costs could attract many farmers, the voluntary plan may not cover enough illnesses to make it attractive over a long time, reducing the pool of insurance funds, Gu added.

Unless China raises rural health protection, however, many farmers will be caught in a cycle of illness, unaffordable healthcare and deeper poverty, experts said.

About a third of China’s impoverished citizens become that way through illness, a Health Ministry survey said.

Wu, 41, nodded when asked if his family risked that fate.

He made about 1,500 yuan in 2005 from rice, rapeseed and vegetables and had two teenage children to support. His kidney stone had cost him over 1,000 yuan in medical bills.

"It’s already hurt my preparations for the spring planting. I probably won’t be able to finish the planting now," he said. "I’m not even sure who I can borrow from."

($1=8.034 Yuan)