Medical care reform: making it easier to see a doctor

By Gong Yidong, China Features

BEIJING, Dec. 25 (Chinese media) -- Going to see the doctor was too expensive for

54-year-old Chinese peasant Song Zhiyao, but the introduction of a rural

cooperative medicine scheme in 2007 has greatly eased his financial burden.

A new public-health reform under review might give even more help to Song

and millions of other Chinese citizens who have borne their own medical bills

for as long as two decades.

TOO MUCH TO PAY

Song has lived in Xijiang Village, Kaili City, of southwest China's Guizhou

Province for half a century, and misses the days of barefoot doctors before the

1980s.

"The villagers only paid a little money for the medical service at the

doctor's small clinic, as the costs were basically covered by the state," he

says. Although the young doctor could only handle injections or minor illnesses

like coughs, Song was largely satisfied.

It was a time when China prided itself on a government sponsored medicine

system, in which most Chinese enjoyed low-priced medical services.

But the climate changed in the 1980s when public health institutions were

left to feed themselves because of lack of government funds. A guiding principle

was that hospitals should and could be managed like enterprises according to

economic rules, a novel idea for most Chinese. It was a starting point for

hospitals to generate their own revenue by raising fees and aggressively selling

drugs.

From that time, Song and his fellow villagers came to feel the burden of

the costs of medicine. Living in a poverty-stricken county, Song and his wife

earn less than 10,000 yuan annually by constructing houses in the

five-thousand-people village, peopled by the Miao nationality.

In 2006, Song suffered severe piles and kept bleeding for a month. At

first, he chose to stay at home instead of seeking treatment.

Like Song, it is common for many Chinese peasants to "expect self-cure in

face of small illnesses and await death in the face of big illness".

But the severe health condition compelled Song to visit the doctor, but

neither the clinic in the village nor the county hospital could handle his

complex problem.

The medical resources in Guizhou and the larger inner regions of China

could hardly match big cities like Beijing, which is home to more than fifty

Class-A hospitals. In Guizhou, however, there are only six such hospitals and

most of them are based in Guiyang, the provincial capital.

Song traveled by bus and train to Guiyang, but he left immediately after

the check-up. "They told me to pay an initial fee of 8,000 yuan if I wanted

hospitalization, which went far beyond my capacity." At that time, two of Song's

children were attending secondary schools.

He then went to Kaili for an operation at the People's Hospital. The costs

were still high, as he spent 4,500 yuan for 11 days. "After the operation, they

advised me to stay in-house for another 15 days for further monitoring, but I

checked out. I was squarely short of money."

The hospital required him to sign a letter, claiming that "everything is

irrelevant to the hospital after discharge."

The good news came in the spring of 2007, when he was notified of a new rural cooperative medical scheme. Under the program, Song pays 10 yuan per year, and the government contributes another 10 yuan. If hospitalized, up to 80 percent of the expenditure can be reimbursed.

PATH OF REFORM

In spite of the improved benefits experienced by Song, the medical care

system of China has long been criticized. The focus is on the soaring medical

fees, lack of access to affordable medical services, poor doctor-patient

relationships and low medical insurance coverage.

Statistics from the Ministry of Health show that the personal spending on

medical services has doubled from 21.2 percent in 1980to 49.3 percent in 2006,

while the government funding dropped to 18.1 percent from 36.2 percent in 1980.

For this reason, medical services, along with tuition fees and housing, is

called one of the "three new mountains" that greatly diminish Chinese citizens'

sense of happiness, after the reform and opening up.

In 1997, the State Council issued a historic decision, defining medicine as

a social welfare sector, which for the fist time meant to correct the previous

concept that medical services were a type of commercial product.

In the next ten years, China implemented a series of medical reforms, such

as the basic medical insurance for urban employees and the new cooperative

medical scheme for farmers.

But the Development Research Center of the State Council, an influential

think-tank, concluded in a report in 2005 that "the medical reform in the past

decade is basically unsuccessful".

In October this year, the long-awaited health care reform plan was released

for public debate. A main target is to set up a health care system that covers

all urban and rural residents by 2020. Breaking with the market-oriented reform

over the past 20 years, the new plan defines government's responsibility by

saying that it plays a dominant role in providing public health and basic

medical service.

"Both central and local governments should increase health funding. The

percentage of government's input in total health expenditure should be increased

gradually so that the financial burden of individuals can be reduced," the draft

says.

The plan also promises to tighten government control over medical fees in

public hospitals and to set up a "basic medicine system" to quell public

complaints about rising drug costs.

Different from the past when the policy was solely made by the authorities,

the central government entrusted nine domestic and overseas organizations to

conduct independent research, including the World Health Organization and

Mckinsey Company, whose ideas were incorporated into the draft.

In just one month, the draft received 35,000 pieces of advice. But it once

again aroused heated debate. An online survey by Sohu, a major portal site,

finds that as many as 87.83 percent of pollster were unsatisfied or could hardly

understand the 10,000-word document, a compromised product of experts and

officials involving 16 departments.

Bai Yansong, a famous anchor of China Central Television, says the draft is

characteristic of its "obscure language, academic expressions and emptiness in

substantial content".

Observers are more concerned of the new plan's effectiveness.

Liao Xinbo, deputy director of Guangdong Provincial Bureau of Health, says

the draft has no new highlights as compared with the guiding policy in 1997, and

that it does not touch on the key issues of unbalanced distribution of medical

resources and mounting personal expenditure. The crux of the problem, according

to him, is the insufficient government funding.

Echoing his words, the total health expenditure by the government made up

4.76 percent of GDP in 2006, seeing a noticeable decline from 5.33 percent in

2000.

"Insufficient government funding will result in the disorientation of

public health institutions and inadequate provision of medical service for the

public," he writes.

But Gu Xin, a professor of government management from Peking University,

voices concerns that the government-dominated plan, if approved, would return

China's public health service back to the planned economy, which might

"consolidate the power of bureaucracy and create a hotbed for corruption."

For the Guizhou farmer Song, messages sent by the drafted plan may be felt

in years ahead. "My only hope is that I will not be tormented by serious illness

any more."