Mon, May 12, 2003 - Page 5 News List

Cash squeeze puts China's poor out of reach of hospitals


In a small-town hospital in China's Inner Mongolia, doctors and nurses are powerless to help a patient with suspected lung cancer and coughing up blood.

They do not have the staff or equipment to open his chest to remove the lumps that are killing him and could not get them from another hospital; those links simply do not exist.

They don't even feed him; that is left to his family. They would not let his wife charge her mobile phone. "It's a waste of electricity," she was told.

"I've learned two important things from this. First is, never smoke," the man's son said after visiting him in hospital. "The second is, health-care conditions in this country are horrible."

And this is the system battling SARS, which first appeared in China and has killed more people and infected more here than anywhere else in the world.

The Communist Party long hailed its successes in eradicating epidemics from smallpox and plague to cholera, which killed millions in the decades before it took power in 1949. Legions of "barefoot doctors" and universal health care helped improve life expectancy into the low 70s by the mid-1980s.

But market reforms over the past 25 years that revived the economy have left the health-care system in need of life support.

The SARS outbreak has brought myriad problems into focus. The China representative of the World Health Organization (WHO) said the system had collapsed. Others agree.

"The market regulatory mechanism does not work," said Ray Yip of the UN Children's Fund.

Party leaders, faced with a potential SARS catastrophe, have declared a heightened commitment to public health and experts hope they will wake up to the urgent need for sweeping reforms.

Cai Renhua, director of the Health Ministry's National Health Economics Institute, said SARS caught the system off guard.

"The government should guarantee basic spending on public health, whether there is an epidemic or not," he said. "Spending less in normal times means spending more in war."

A confusing assortment of hospitals run by all levels of government, military and the private sector remains -- and operates under warped pricing schemes that benefit the wealthy.

Two in five city people have no insurance. That includes most of China's 100 million migrant workers. And while the price of visits, hospital stays and basic laboratory tests are kept artificially low, patients are still gouged.

The Health Ministry said 60 percent of patients left hospital in 2000 before they were fully recovered because of the cost.

In the countryside, where more than two thirds of China's 1.3 billion people live, it is much, much worse.

As 1970s-era collectives were disassembled in the early 1980s, insurance coverage rates fell to around 7 percent. Some 90 percent of rural people pay medical bills in cash.

"For many, maybe as many as 30 million of the rural population, they have virtually no services," said James Killingsworth, a WHO country adviser in China.

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