MILLIONS OF CHINESE CANT AFFORD TO GET SICK


2003.12.02
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Government launches ambitious rural health care plan

Listen to the original broadcast in Mandarin

Millions of people living in rural China without access to affordable health care are now expected to get government-assisted care by the end of the decade. But while the government has outlined an ambitious plan for rural areas, it may find it very hard to implement, according to a recent investigative report by RFA's Mandarin service.

Currently, very few of China's 900 million rural residents have any provision for health care, leaving them to finance the enormous cost of getting sick from their own meager funds.

An official from the Hubei provincial government told RFA's correspondent Shi Shan that this simply means most illnesses go untreated. "I have seen many peasants in the past," she said in a recent interview. "After you tell them about the results of the diagnosis and the potential cost, they immediately turn around and leave."

"No matter how serious their illness is, even if it's a life-threatening illness, their family will simply take the patient home. They can't afford the medical bills," she said.

The average income in China's countryside is currently around 2,300 yuan (U.S. $277) a year. And 35 percent of peasants make less than 150 yuan (U.S. $18) a year.

Small wonder there is a common catchphrase among the country's farming communities: "Can't afford to get sick."

In an attempt to redress the balance, the Ministry of Health in Beijing announced a long-awaited plan last year to bring affordable health care to all. One of the main targets of the plan is maternal and infant health; an approach that is also part of a softer government strategy on family planning.

But the plan may yet founder on the problems encountered with its implementation. "We haven't come up with a comprehensive plan because situations vary in each region," Chen Zhonglin, a sociology professor from the Tianjin-based Nankai University, said in an interview with RFA. "In well-off regions, the local government and individuals can afford to pitch in."

Chen, whose department is involved in researching ways of implementing the government's plans, said different approaches would be needed in different parts of China. "In poor regions, the local government has to take up a bigger portion. We can't use a cookie-cutter solution for all regions," he said.

Officials hope that by 2010, the mortality rate of pregnant women and women in childbirth will be 25 percent lower than 2000 levels, and that the death rate of infants will also drop by 20 percent. In 2000, maternal mortality rates in China's rural areas were close to 70 in every 100,000, with the infant death rate at about 32 per thousand, according to official figures. That's higher than either national averages or the rates in cities.

But there are serious flaws. The plan includes many ambitious targets, but gives little indication of how local governments are expected to achieve them. China's taxation system is still in its infancy, and impoverished local governments are often left to their own devices when it comes to funding public services.

Critics of the plan point to the huge discrepancy in wealth between China's coastal cities, which have prospered in the boom years of the 1990s, and the rural areas, where economic activity is fairly stagnant. Others say the Ministry of Health's suggestion that rural areas implement a regional pool insurance system for major sickness is unrealistic.

For the Hubei government official, the key to the problem and its solution lies in the disintegration of health care standards at township hospitals, which once filled a crucial gap between local doctors�who are relied upon for minor ailments�and the big county hospitals, which are too expensive for most farming families.

"The three-tier health care system has long gone," the official said. "Ordinary people seldom send patients to those hospitals... In most cases, instead of getting treatment, they end up with the wrong diagnosis and therefore treatment is delayed."

She said township hospitals need to be revitalized to deal with serious illnesses�which they are currently unable to do. "This is because they don't have the facilities and equipment. They don't have the proper diagnostic equipment and blood banks," she said.#####

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