In January 2003, Ren Guangyou, a 67-year-old farmer from Jiugong Township, Daxing District, Beijing, handed over his hospitalization bills to the township Medical Care Clearing Center. He received partial reimbursement in the sum of 30,000 yuan (US$3,628.71). This was his first experience of the tangible benefits of joining the cooperative medical care system that is currently emerging in rural China.
Ren entered the cooperative medical care system in July 2002. An annual payment of 30 yuan (US$3.63) brings him an entitlement of up to 40,000 yuan (US$4,838.28) of indemnity for medical fees incurred by serious illness. In December 2002, Ren was hospitalized for miocardial infarction. He was obliged to pay out 80,000 yuan (US$9,676.56) to the hospital -- no small sum for an 8-member family that subsists on an income of just 2,000 yuan (US$241.92) per month. This reimbursement through his participation in the system was, therefore, a great relief. "It's a way for people to help each other by pooling their money and providing funds for those in difficulty. A system such as this should have been launched much earlier," said Ren.
The trial cooperative medical care system in China's rural areas is co-funded by farmers and the government. It indemnifies farmers against sums they must pay out for treatment of serious diseases. Since 2003, central and local finances have set aside 10 yuan (US$1.21), plus no less than 10 yuan respectively, per capita medical subsidy for farmers in central and western China that have registered in the system. According to Zhu Qingsheng, vice minister of health, the system's intention is to give farmers financial access to medical care. It is to be implemented nationally in 2010.
To most Chinese farmers medical care is unaffordable. A household that has just begun to get ahead financially is rapidly dragged back into dire poverty when one of its family members falls seriously ill. After collapsing one day, a 7-year-old boy in rural Hebei Province was diagnosed with congenital heart disease. In order to save their only child, his parents borrowed from as many people as possible, but still failed to raise enough to pay for the necessary operation. Tragedies such as this are all too common in rural families across the nation. According to Cheng Xiwen, vice director of the State Council Development Research Center, farmers' incomes are half those of urban residents. Yet they must bear 90 percent of their medical expenses, as compared with the 60 percent paid by their urban fellows. Many cannot afford to see a doctor when they fall ill. "Medical and health work is a key aspect in China's campaign to build an overall well-off society. Work of this nature is most needed in the countryside and is, therefore, most arduous," was Vice Minister Zhu Qingsheng's comment.
Daxing District is one of the first in rural Beijing to implement a cooperative medical care system. According to Sun Fuxiang, an official at the district's Public Health Bureau, since 2001 the district has established 148 medical stations offering farmers better access to medical service. Each station has 3 to 5 medical workers and serves 3 to 5 neighboring villages. Ma, a senior citizen of Jiugong Township, expressed satisfaction with his medical station, saying, "It's much better equipped than the old clinic in my village." In addition, the district offers training to medical workers in existing village clinics to improve their professional skills.
In an effort to promote the cooperative medical care system, Sun Fuxiang and his colleagues toured villages and distributed booklets to local farmers. In July 2002 the system was implemented on a trial basis in three Daxing townships. Some 60,000 of the total 80,000 residents participated. During the following 6 months, the system paid the hospitalization fees of more than 600 farmers, and reimbursed a total of 1.31 million yuan (US$158,454) in medical expenses to residents of the three townships. "In the beginning some farmers were wary of the system, unable to believe that the government would actually pay out. These doubts vanished when they personally witnessed their neighbors receive recompense," recalls Sun Fuxiang.
Thanks to the cooperative medical care system, more farmers in Daxing pay attention to their health, and go to hospital when ill. Xiao Yanqin, a local farmer's wife, says that despite taking care of only part of her medical expenses, the system gives her some sense of security. In order to arouse disease prevention awareness among farmers, Jiugong Township regularly invites experts to give lectures on health and hygiene, and is planning to arrange annual medical examinations for its residents.
Cooperative medical care measures for farmers were first adopted in China in the 1950s. Soon after the People's Republic was founded, the Chinese government set up a great number of medical stations in counties, townships and villages around the nation, and sent medical contingents to the countryside to raise standards of hygiene and sanitation. At that time the collective economy dominated, production teams -- the basic unit of farmers in rural areas -- were responsible for the majority of funds for medical stations, while individuals paid only a small proportion of medical expenses. These efforts succeeded in bringing medical services to rural residents, but fell far short of satisfying their total demands, as at the time the whole nation lacked medical supplies and personnel.
After China launched reform and opening-up, farmlands were contracted to rural households, putting an end to the collective economy pattern. This halt in financial input signaled the collapse of the old medical care mechanism, and farmers were obliged to pay all their medical expenses. As the national economy grows, medical costs climb at a rate much higher than increases in farmers' incomes. The burden on rural families is thus heavier than ever. "Owing to increasing economic strength, China is now able to implement a new cooperative medical care system for its rural population. If each of the 800 million farmers in the nation is subsidized at the level of 10 yuan annually by central finance, the 8 billion total is not such an insurmountable figure," explains Vice Minister Zhu Qingsheng.
Given the uneven economic development across the nation, the system applies different policies in various regions. For example, in Jiangyin City in coastal Jiangsu Province the system is run by insurance companies and supervised by the public health department. A farmer can expect as much as a 20,000 yuan (US$2,419.14) hospitalization reimbursement on paying 10 yuan annually. By the end of 2002, 96 percent of rural residents in the city had registered in the system, and over 30,000 people received indemnity. In the outlying and impoverished central and western areas, however, the system is entirely government funded. But Zhu is optimistic about the system's prospects: "The cooperative medical care system will be implemented in all rural areas in China, because it is in the immediate interest of farmers."
(China Today June 2003 Issue)
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