Wed, Dec 02, 2009 page9

• China tries to fix a crumbling health care system

  Second-hand kidney dialysis machines and do-it-yourself ventilators are just some of the extremes Chinese have gone to for medical care

  • By Gillian Wong / AP
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  Unable to rely on China’s broken health care system, the Ji family was desperate.

  Doctors had taken 15-year-old Ji Xiaoyan off a ventilator and discharged her because her family could no longer pay her hospital bills. So an uncle cobbled together a makeshift ventilator from bicycle and washing machine parts, driven by a noisy electric motor.

  The contraption pumped air into the teenager’s lungs through a washer hose plugged into an incision in her throat for more than a month, until the family got donations for treatment.

  

  “I knew my child didn’t want to leave this world. We had to save her no matter what,” said Yang Yunhua, the girl’s mother, a farmer in Henan Province. “But we are only poor people.”

  Such horror stories prompted the government to launch a three-year, 850 billion yuan (US$124 billion) effort this year to rebuild the crumbling health care system.

  China once provided rudimentary but universal care to everyone.

  As the country shifted from socialism to a market economy over the past 30 years, health care frayed. Medical costs soared faster than incomes, and treatment today depends on the patient’s ability to pay. Nearly one-third of the poor say that health is the most important cause of their poverty, according to the WHO.

  “People are paying too much out of pocket for their services for their health care. Many are becoming impoverished in the process,” said John Langenbrunner, a World Bank health economist in Beijing.

  “The level of dissatisfaction, at the local level, is very high and the government is responding to this,” he said.

  Affordable medical services also could help reduce China’s dependence on exports by encouraging people to stop saving so much for potential medical costs and spend their earnings on consumer goods.

  The government’s goals include:

  • Improving health services, in part by building 2,000 county hospitals and 29,000 township hospitals and ensuring that each of the country’s almost 700,000 villages has a clinic.

  • Expanding state health insurance from 70 percent to 90 percent of the population, or an additional 200 million people. That is equivalent to two-thirds of the US population.

  • Reducing drug costs by controlling prices for medications deemed essential.

  Longer term, the government is seeking ways to cut back on unnecessary treatment and drug prescriptions that are blamed for skyrocketing fees at public hospitals.

  The challenges are daunting.

  “In a country with 1.3 billion people, to achieve the goal of health for all is by no means an easy job, particularly at a time of global financial crisis and economic downturn,” Chinese Health Minister Chen Zhu (陳竺) wrote this year in The Lancet, a British medical journal. “However, we are determined to transform these challenges into opportunities.”

  Eight months into the three-year plan, reform remains a work in progress. Sixty percent of the funding is supposed to come from regional governments, and it is unclear how poorer ones will come up with the money.

  The central government has laid out a broad strategy but left specifics to local officials. The result is a series of experiments.

  While learning by doing is fine, there appears to be little formal evaluation of these trials, which may make it difficult to pinpoint what works, Langenbrunner said.

  “The challenge for China is to try to evaluate the various kinds of schemes that it is trying and then see which schemes seem to work better and adopt them,” said William Hsiao (蕭慶倫), a China health policy expert at Harvard University.

  Shenmu County in the north is offering free health care for its 390,000 residents. The southwestern metropolis of Chongqing is trying to manage urban and rural insurance programs together to save money.

  In Ningxia, an inland region in the impoverished west, farmers now pay 30 yuan a year to join a rural cooperative insurance program that allows them to see a village doctor for 30 common illnesses including colds, bronchitis and diarrhea for only 1 yuan, including medication.

  “It’s so convenient. I don’t have to travel far to see the doctor, and it’s affordable,” retired farmer Shi Xiulan, 56, said one afternoon at a clinic in the village of Xihu.

  She spends 1 yuan for diabetes and high blood pressure medications, instead of the 300 yuan she used to fork out at the county hospital.

  “Peasants like us usually have no money for medicine,” she said.

  It is too early to declare the Ningxia program a success. Hsiao said a lack of coordination means rural clinics are competing with township and county hospitals for patients, while village doctors are quitting because they cannot earn enough under the new policy.

  “I don’t feel like doing this anymore,” said Ji Caixia, a 56-year-old doctor in Lijiajuan, a village of rice and corn farms in northern Ningxia. “Even the farmers can earn about 80 yuan a day when they do work in the city. I can’t earn any money. No one will want to do this work since the money is so little.”

  In earlier days, workers were provided cradle-to-grave medical care while an army of “barefoot doctors,” or rudimentarily trained paramedics, vaccinated children and improved sanitation in the countryside. Chen, the health minister, was himself a barefoot doctor during the upheaval of the 1966 to 1976 Cultural Revolution.

  That all broke down after China developed its free market system.

  Now many do not seek care until it is too late, while others resort to risky measures. A national health survey last year found that about 70 percent of people forgo recommended hospitalization because they cannot afford it.

  In Beijing, a man named Wei Qiang said he and nearly a dozen other migrant workers pooled their money for secondhand kidney dialysis machines and treated themselves in a dirty suburban apartment when they started running out of money for hospital treatment.

  The parents of Ji Xiaoyan, the teenager who survived on a makeshift ventilator, ended up spending 160,000 yuan to treat her for a rare neurological disorder that paralyzed her from the neck down.

  Most of the money came from friends and family to supplement the family’s meager savings from farming and the father’s 1,000 yuan monthly salary as an elementary school teacher.

  “If not for the help from the loans and donations we received, I don’t think my daughter would be alive today,” her mother said on a recent afternoon at home.

  Ji has since recovered partial use of her limbs and no longer needs a ventilator to breathe. Her mother massaged her thin arms and legs as part of a daily physiotherapy routine. Scribbled in white chalk all over the living room’s concrete walls were the names and phone numbers of people who helped.
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