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Q: In China, the more than 800 million farmers living in rural areas are a vulnerable group in society. It's always a headache for them to go to hospital. It has been said that China is promoting a new cooperative medical system in its rural areas. What are the details of this new system? Also, what kind of benefits will farmers enjoy if they join the rural cooperative medical system? From the 1960s to the 1980s, for medical treatment, farmers mainly relied on barefoot doctors (a term created in the late 1960s to refer to part-time paramedical workers who serve rural people), rural cooperative medicare and a network of rural medical service, sanitation, epidemic prevention and health care. At that time, this kind of cooperative medical system covered about 90 percent of rural areas throughout the country, playing an active role in protecting farmers' health. In the 1980s, however, the rural collective economy gradually collapsed with the implementation of the household contract responsibility system, under which remuneration was linked to output, in rural areas. This resulted in financing difficulties for the rural cooperative medical system, leading to its coverage shrinking from 90 percent to about 10 percent. Since farmers have to pay for medical treatment fees themselves in most rural areas, some farmers had financial difficulty in seeing a doctor or seeking medical advice. According to government research, 20 to 30 percent of poverty-stricken families have become poor or returned to poverty because of illness. Illness has become a major factor causing poverty among farmers. In 2003, China started to promote a new type of rural cooperative medical system, which is organized by the government and joined by farmers on a voluntary basis. It is funded by a combined effort of individuals, collective parties and government. The rural cooperative medical system has the following features First, it adheres to the principle of voluntary participation. Each farmer joining the new cooperative medical system is required to pay 10 yuan (US$1.21) in medical fees (the amount is slightly higher in richer eastern coastal areas). On this basis, the Central Government and local governments, as well as towns and villages, will contribute a certain amount of funds in support. Second, the system gives priority to a financial pool scheme for serious diseases, and essentially solves the problem of farmers becoming poor or returning to poverty because of diseases they can't afford to cure. While focusing mainly on serious diseases, it also takes minor illnesses into consideration. What we call a serious disease refers to treatments carried out in hospitals or treatments that cost a lot of money. Under the rural cooperative medical system, even if it is an outpatient treatment, if the fees are substantial, the farmer can apply for reimbursement in proportion. Third, in the past, it was the village or town that took charge of the financial pool scheme, while now the responsibility moves to the county-level government. Farmers participating in the cooperative medical system can directly write off some parts of their medical expenses every time they seek medical services in the designated medical institutions in counties or cities. This has greatly improved the ability of farmers to stay healthy and prevent disease. Fourth, there are leading groups and administrative organizations in provinces, cities and counties, in addition to central agencies. A set of rules and regulations has been established that is gradually being perfected to make the system better and more uniform. Fifth, the new rural cooperative medical system is implemented simultaneously with the medical relief system for the impoverished farmers in rural areas. For those living in extreme poverty who cannot afford the payment for cooperative medical treatment or who must pay for all the medical fees themselves but cannot afford it, the medical relief system will provide a subsidy for them. From July 2003 to the end of 2004, there were 333 counties and cities carrying out trial work on the new rural cooperative medical system, covering about 100 million of the rural population, with 80.4 million farmers actually participating in the schema. What benefits will farmers have if they join the rural cooperative medical system? This is a question concerning many Chinese farmers. There is an old Chinese saying, "Nothing is so certain as the unexpected." Research shows that once farmers' medical expenses account for 70 percent of their annual income, they may become poor. So, there is also a saying among farmers, that is, "One does not afraid of poverty, but diseases." If there is one person in a family suffering from a serious disease, he or she will probably be a burden to the family. If the farmers join the cooperative medical system, they themselves will most benefit from it. Just take a look at the lowest standard: A farmer pays 10 yuan (US$1.21) once a year and can get a maximum of 2,000 to 3,000 yuan (US$242-363) in compensation if they fall ill, hundreds of times higher than the fee paid each year. Even if they fall ill 10 years from now, they don't lose money. What's more, if they still have great financial difficulty, they can apply for additional medical relief. The rural cooperative medical system is a new institutional development. But to make the system popular with farmers, and to firmly establish such a system in China -- a developing country where the rural economy is yet to be developed and regional differences remain large -- still requires exploration in practice as well as ever-perfected institutions and a spectrum of policies.
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