China's country folk try co-operative cure
Friday, 12 October 2007
Mure Dickie
After Song Xuefang began suffering from vomiting and pains that left her hardly able to walk, she and her husband pulled out their savings and sold their 30 sheep to pay for treatment.
It was not enough. Doctors in Mrs Song's dusty county of Jingyuan in China's north-western Gansu province could not tell what was wrong. When she checked in to a hospital in the provincial capital, the money quickly ran out.
Now Mrs Song, 65, is back in her village, mired in debt, taking daily doses of locally bought drugs that do little more than ease her symptoms. "It's left me less than alive," she says. "I don't get better and I don't die."
Mrs Song's distress is all too typical. The virtual collapse of the basic but publicly funded rural health system China operated before economic reforms in the 1980s means that for many, illness or injury now spell financial disaster.
In Jingyuan, however, officials say the situation is at last beginning to improve. The county is being touted as a successful pioneer of China's "New-type Rural Co-operative Medical Care" system, a fresh approach to funding that is a crucial component of Beijing's drive to improve the quality of life in the countryside.
Narrowing the rural-urban divide is central to the "harmonious society" policies pushed by Hu Jintao, China's president, and which are set to be a focus of discussion when Communist party leaders gather for their 17th five-yearly congress on October 15.
Supporters of the new approach say it shows better policies can make a real difference and the system is growing fast. Chen Zhu, health minister, says 720m rural residents, or 83 per cent of the total rural population, had joined the scheme by June and that it will cover all rural areas by 2008.
Success would have profound implications.
Concern about medical costs undermines the health of millions in China by forcing them to delay or curtail treatment. It also hinders efforts to persuade farmers to cut down on savings and boost consumption, seen as crucial to reduce the Chinese economy's reliance for growth on unsustainably high levels of investment.
Under the new co-operative system, rural residents and the local and central government all make annual contributions into a fund used to reimburse hospital fees. The system limits costs by imposing price limits on hospitals, which have long relied for financial survival on hefty mark-ups on drugs and treatment.
Wang Wenbing, deputy head of the Jingyuan Cooperative Medical Office, says it took just three months to set up the system in 2006 and that it has already helped many local patients.
But a visit to Jingyuan makes clear the system still faces serious challenges and may go only a limited way to curing the countryside's health crisis.
Much treatment, including outpatient care by clinics and drugs for many chronic complaints, is not covered. At the most basic village hospital, the co-operative fund picks up less than 65 per cent of the bill. At provincial level hospitals, at most 45 per cent of the cost of in-patient treatment is reimbursed.
With the average cost of a provincial hospital stay by a member of the Jingyuan system running at more than Rmb9,000 ($1,200, €850, £590) - about four times average annual rural income - even a short stay can still mean financial ruin.
But the fund cannot shoulder more of the burden. "[City and provincial hospitals] are very, very expensive. If we covered the same proportion of the cost, we would go bust," Mr Wang says.
He hopes for more cash from Beijing but while the central government has promised to "energetically promote" the new system, it has promised only Rmb10bn in subsidies nationally this year. Such fiscal caution reflects fear that money pumped into co-operative funds might be lost through corruption.
In Jingyuan, where 86 per cent of the rural population has signed up to make annual payments of Rmb10, Mr Wang insists strong safeguards are in place.
To ease the financial pressure on hospitals, authorities have been raising the proportion of doctors' salaries paid by the state. Local officials have even been told to donate part of their salaries to boost health funding.
But Dr Wei Tongjun, who works out of a renovated 12-bed hospital in Jingyuan's Gaowan village, says failings remain.
Patients often refuse prescriptions for expensive drugs, he says. Moreover, "the claims procedure is too complicated and another problem is insufficient publicity. Some patients don't understand the system".
Which means patients such as Mrs Song continue to get left out. "I don't know anything about it," she says of the new system. "I don't get out much."
........................................
FT Syndication Service
After Song Xuefang began suffering from vomiting and pains that left her hardly able to walk, she and her husband pulled out their savings and sold their 30 sheep to pay for treatment.
It was not enough. Doctors in Mrs Song's dusty county of Jingyuan in China's north-western Gansu province could not tell what was wrong. When she checked in to a hospital in the provincial capital, the money quickly ran out.
Now Mrs Song, 65, is back in her village, mired in debt, taking daily doses of locally bought drugs that do little more than ease her symptoms. "It's left me less than alive," she says. "I don't get better and I don't die."
Mrs Song's distress is all too typical. The virtual collapse of the basic but publicly funded rural health system China operated before economic reforms in the 1980s means that for many, illness or injury now spell financial disaster.
In Jingyuan, however, officials say the situation is at last beginning to improve. The county is being touted as a successful pioneer of China's "New-type Rural Co-operative Medical Care" system, a fresh approach to funding that is a crucial component of Beijing's drive to improve the quality of life in the countryside.
Narrowing the rural-urban divide is central to the "harmonious society" policies pushed by Hu Jintao, China's president, and which are set to be a focus of discussion when Communist party leaders gather for their 17th five-yearly congress on October 15.
Supporters of the new approach say it shows better policies can make a real difference and the system is growing fast. Chen Zhu, health minister, says 720m rural residents, or 83 per cent of the total rural population, had joined the scheme by June and that it will cover all rural areas by 2008.
Success would have profound implications.
Concern about medical costs undermines the health of millions in China by forcing them to delay or curtail treatment. It also hinders efforts to persuade farmers to cut down on savings and boost consumption, seen as crucial to reduce the Chinese economy's reliance for growth on unsustainably high levels of investment.
Under the new co-operative system, rural residents and the local and central government all make annual contributions into a fund used to reimburse hospital fees. The system limits costs by imposing price limits on hospitals, which have long relied for financial survival on hefty mark-ups on drugs and treatment.
Wang Wenbing, deputy head of the Jingyuan Cooperative Medical Office, says it took just three months to set up the system in 2006 and that it has already helped many local patients.
But a visit to Jingyuan makes clear the system still faces serious challenges and may go only a limited way to curing the countryside's health crisis.
Much treatment, including outpatient care by clinics and drugs for many chronic complaints, is not covered. At the most basic village hospital, the co-operative fund picks up less than 65 per cent of the bill. At provincial level hospitals, at most 45 per cent of the cost of in-patient treatment is reimbursed.
With the average cost of a provincial hospital stay by a member of the Jingyuan system running at more than Rmb9,000 ($1,200, €850, £590) - about four times average annual rural income - even a short stay can still mean financial ruin.
But the fund cannot shoulder more of the burden. "[City and provincial hospitals] are very, very expensive. If we covered the same proportion of the cost, we would go bust," Mr Wang says.
He hopes for more cash from Beijing but while the central government has promised to "energetically promote" the new system, it has promised only Rmb10bn in subsidies nationally this year. Such fiscal caution reflects fear that money pumped into co-operative funds might be lost through corruption.
In Jingyuan, where 86 per cent of the rural population has signed up to make annual payments of Rmb10, Mr Wang insists strong safeguards are in place.
To ease the financial pressure on hospitals, authorities have been raising the proportion of doctors' salaries paid by the state. Local officials have even been told to donate part of their salaries to boost health funding.
But Dr Wei Tongjun, who works out of a renovated 12-bed hospital in Jingyuan's Gaowan village, says failings remain.
Patients often refuse prescriptions for expensive drugs, he says. Moreover, "the claims procedure is too complicated and another problem is insufficient publicity. Some patients don't understand the system".
Which means patients such as Mrs Song continue to get left out. "I don't know anything about it," she says of the new system. "I don't get out much."
........................................
FT Syndication Service