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?
A: As you've mentioned, there are more than 800 million farmers
living in China's rural areas. How to solve their difficulty in
visiting the hospital is not only a matter of concern for every
farmer, but also one of the most important issues for the Chinese
Government.
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.
A local doctor diagnoses a little girl in
a Tibetan village 4,700 meters above sea level.
