Yang Shufang, 73, never hesitates before buying the high-priced medicine she needs to treat her diabetes since she can get most of the cost reimbursed by the State-owned factory where she once worked.

Yang, who makes the purchases at Xuanwu Hospital in Beijing, is one of the few fortunate Chinese with job-based medical insurance. Most others are not so lucky.

A recent survey by the Ministry of Health shows that more than 44.8 percent of the nation's urban residents and 79.1 percent of its rural population are left out of the medical insurance system.

Yang's 50-year-old son is one of them. Laid off from his factory with 100,000 yuan (US$12,048) in severance pay, he does not receive any medical insurance or factory pension.

"People can quickly spend their money and what can they do if they get sick?" Yang asked.

Premier Wen Jiabao has repeatedly stated the central government's determination to improve the public health system, while putting forward a series of measures to solve existing problems. He did so again in his government work report at the National People's Congress session last month.

"I feel reassured by the premier's report. With a mere 1,000 yuan (US$120) yearly pension, I would dare not go to hospital if I had no medical insurance," Yang said.

To most Chinese, hospitals mean a nearly unaffordable expense, since China has not built an affordable quality healthcare system for its growing 1.3 billion population.

Figures from last year's World Health Report show China's total health expenditures were about 5.5 percent of its GDP in 2001, compared with 13.9 percent spent by residents in the United States.

Sixty percent of medically related expenditures in China come from out-of-pocket payments.

Market-oriented healthcare reforms in the 1980s cut subsidies to public facilities and encouraged providers to recoup their expenses from charges to users. Public health units then turned to aggressive drug sales and extra services to fuel revenue growth, driving up the level of health spending, despite a significant drop of the proportion of people actually covered by health insurance.

The rising private spending has deterred many from seeing doctors except in the most extreme emergencies. A survey by the Ministry of Health shows 48.9 percent of Chinese will not go to a hospital even when ill, and 29.6 percent refuse to stay in a hospital when they likely should.

Medical situations are even worse in vast rural areas.

According to the Ministry of Health, rural Chinese enjoy only 20 percent of the country's medical resources though the vast farming areas are home to 900 million of the 1.3 billion population.

Sixty-two-year-old Zheng Ciheng, a farmer from Miaogao Village in Dongjiang County in Longkou in East China's Shandong Province, has suffered from a cerebral thrombosis and a painful bone spur in his back for years.

Zheng cannot afford medical treatment, and his daughter has been ill and bed-ridden since 1999, throwing the family into extreme poverty.

He has sought treatment at church instead of a hospital, believing religion may help him forget his pain.

To help farmers like Zheng from remaining in dire poverty because of illnesses within their families, the Chinese Government decided in 2002 to build a co-operative medical system in rural areas.

The government's goal is to establish a rural healthcare system based on voluntary participation of rural people. The scheme would require financial contributions from individuals, collectives and the government.

Each farmer must pay a few tens of yuan each year to have future medical expenditures covered at various percentage levels.

Pilot programs involving about 70 million farmers have been carried out in about 310 counties among China's approximately 2,000 counties.

While the public health system is being improved in rural areas, cities are carrying out trials to help the poor, migrant workers and disabled people.

Wuhan, capital of Central China's Hubei Province, opened Huimin Hospital for the poor and the disabled early this year.

"It could cut about 70 percent of the expenditures," said Xiong Wangping, deputy director of Wuchang District Health Bureau.

The hospital aims to provide services for 50,000 poor workers and 8,000 disabled at an affordable charge among the district's 900,000 population.

The practice has filled the gap left by the 1998 decision to subsidize the urban poor, in terms of food, clothing and housing, but not medical expenses.

Despite great efforts made, there is still a long way to go for the country to map out a medical system that will meet the disparate needs of rural, urban and floating populations.

But for common people, the wish for healthcare is basically the same as Yang's: "Hospitals should always be a place to rescue the dying and help the sick."

(China Daily April 2, 2005)