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Doctors head to hamlets in health care reform
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China's 850 billion yuan (US$124 billion) health care reforms, announced last week, are meant to improve care for rural and poor residents and spur domestic demand.

The reforms could also benefit migrant workers and college graduates.

It's an unusually tough time for job seekers in China. Human Resources and Social Security Minister Yin Weimin has warned of a "grave" employment situation, despite "a reverse in the declining trend" in the urban job market in the first two months of this year.

About 20 million migrant workers have returned to their rural homes, and some 6.11 million college students are due to graduate this summer.

Moreover, 1 million of last year's graduates who failed to get jobs in 2008 are still trying their luck this year. They all need jobs.

Xiao Chen, an undergraduate at the prestigious Peking Union Medical College, said he received no offers and not even a single interview from any of the big hospitals in Guangzhou, capital of southern Guangdong Province, where he sent dozens of job applications.

Only two district-level hospitals had vacancies in anesthesia departments. But career prospects there were dim, he said.

In China, aspiring doctors are able to work as technicians and being "promoted" to physician status. But with China's medical education and qualification system becoming more like those in the West, where graduate degrees are required, that path is becoming uncertain.

Ke Zunfu, an MD candidate at Sun Yat-sen University in Guangdong Province, said lack of opportunity for medical graduates was a national phenomenon.

Large hospitals are recruiting graduates with master's or doctoral degrees. Some of them would hire undergraduates, but only for "marginal" departments such as anesthesia and radiology.

While graduates scramble for jobs at big urban hospitals, many of the smaller urban hospitals and rural clinics can't find enough staff.

"Most graduates are not willing to work in small and rural hospitals because they are afraid there is little chance to improve their medical skills and be promoted," said Nie Ruqiong, a doctor with the No. 2 Affiliated Hospital of Sun Yet-sen University.

A report submitted by the Harvard University School of Public Health to the World Health Organization said China's health care development was restricted by the limitation of health care resources and uneven development between urban and rural areas, and among different regions.

Liu Xinmin, an official with the Ministry of Health, admitted that the distribution of hospital resources was extremely unbalanced, with about 80 percent of hospitals in cities.

Even though village or township clinics are available, many rural patients opt for big hospitals in the city just because they do not trust local medics, he said.

The State Council, or the Cabinet, announced a three-year action plan on health care reform last Tuesday.

Over the next three years, the country will train 1.37 million village doctors and 160,000 community doctors.

City-level hospitals, which usually have better expertise and equipment, will each be required to help three county-level hospitals to improve the skills of medics.

Doctors at city hospitals and disease-control agencies will be asked to serve in rural hospitals for at least one year before they can be promoted.

To improve primary health care facilities, China will give priority to building about 2,000 county-level hospitals. And each county would have at least one hospital that was essentially in compliance with national standards.

The government has pledged to fund construction of 29,000 township hospitals this year and the upgrading of 5,000 township hospitals.

It will also finance the construction of village clinics in remote areas so that every village will have a clinic in the next three years.

A commentary by the Hong Kong-based Ta Kung Pao newspaper said the health care reform would offer "proper jobs" for both college graduates and migrant workers, since it would promote development of the service sectors in both the medical care and insurance sectors.

Among the jobs that it forecast would be created were:

1. Assistants for senior doctors, who would serve as practitioners for two years before being promoted.

2. Permanent hospital attendants, who would replace non-staff ones.

3. Information managers, who would be responsible for installing and maintaining IT applications in hospitals.

4. Workers at community clinics, including general practitioners, home attendants for chronic-care patients and electronic patient file managers.

5. Medical inspectors to monitor all levels of health care institutions.

6. Planners, managers and agents of the medical insurance fund, as well as IT workers who keep records for the fund.

Even some foreign employers see business opportunities in the reform.

US computer group IBM said last week it expected that at least 1,000 hospitals in China would spend at least US$1.5 million each to set up electronic medical records under the plan, the Financial Times reported.

The company saw huge business potential in construction and upgrading of hospitals and clinics.

Matt Wang, vice president of IBM's China Development Lab, told the London-based newspaper that the project was a rare example of a foreign company directly benefiting from China's economic stimulus package.

(The authors are Xinhua writers.)

(Xinhua News Agency April 13, 2009)

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