One night this spring, a couple from central China's Hubei
Province, Chen Zhengxian and his wife Yao Yuanxiang, tied
themselves together and drowned themselves in the Yangtze
Chen, a farmer from Gongan County, was suffering from snail
fever and hepatitis B and Yao was tormented by sciatica. Medical
bills were mounting and life savings had been exhausted. They saw
suicide as their only escape route and left behind their
ten-year-old son, also a hepatitis B sufferer.
The tragedy reflects the grim reality that hundreds of millions
of people in rural China do not have access to affordable
healthcare. The Chinese government initiated rural cooperative
medical services in 20 provinces four years ago but is now coming
under pressure to advance the program, which is still unable to
meet the rural population's needs.
Under the cooperative scheme, a participant pays 10 yuan
(US$1.3) a year, while the state, provincial, municipal and county
governments supply another 40 yuan (US$5.2) to the fund.
Contributors are then entitled to discounts, provided by the fund,
on their medical expenses.
But residents in Chen's village believe the couple would have
taken the same course of action even if they had been members of a
rural cooperative scheme. The money they needed had far exceeded
any possibility of an adequate refund.
"With an average reimbursement rate for hospital fees only
standing at a meager 27.5 percent, the current subsidies are still
utterly inadequate in dealing with grave and terminal diseases,"
said Wu Ming, professor with the Medical School of Peking
Farmer Ma Yongshan, in Beipiao County of northeast China's
Liaoning Province, was stricken by colon cancer and a brain
infarction. He received a reimbursement of 6,590 yuan for his
hospital fees after joining the scheme.
But he still has 10,000 yuan left to pay by himself, which is
not easy for a farmer whose annual disposable income is around
"The program eased my burden - at least I could pay the bill on
my own without borrowing. But if 60 percent of the expenses could
have been refunded, that would have been a great blessing," Ma
Official figures show that 410 million farmers in 1,451
counties, around half of the country's rural population, have
joined the scheme, receiving total refunds of 15.58 billion yuan
from a fund pool of 21.36 billion yuan.
The proportion covered by the local governments varies according
to the specific disease and their healthcare budget.
"Though headway has been made, it will take time for the current
scheme - with its wide coverage and low-level refunds - to make a
fundamental difference in resolving the problem of healthcare for
the rural poor," said Feng Xiucheng, head of the rural co-operative
medical office of Gongan County, Liaoning Province.
Figures released by the World Health Organization showed that
the Chinese government's spending on health only takes up 2.7
percent of its total expenditure, far lower than an average of 10
percent in developed countries.
"Even in richer cities, people have to pay an average of 60
percent of their medical expenses. Low reimbursements are seriously
hindering affordable access to medical care," said Ba Denian, a
researcher with the Chinese Academy of Sciences.
"The inefficient use of funds and uneven money distribution --
the lion's share of investment in healthcare actually goes to urban
citizens -- has made the medical situation in rural areas even
worse," said Xu Qingsong, professor with the Second Military
Medical University in Shanghai.
Beipiao is one of the dozens of counties in Liaoning which is
trying to encourage all rural residents to join the scheme. By the
end of March, some 98 percent of the residents in Ma Yongshan's
home village of Wujianfang had joined, up from 60 percent at the
beginning of the year.
"More villagers have joined the scheme after seeing benefits,"
said Guo Zhenhe, head of Wujianfang village.
Under the program, local farmers only need to pay five yuan each
every year, half the national average.
The central and provincial governments contribute another 36
yuan for each participant, but the county government pays only five
yuan for each member from its revenue from the transfer of land use
Zhao Jiqing, director of the Public Health Bureau of Beipiao,
believes that the funding is not enough.
"Without the consistent support from central government coffers,
the new scheme can hardly sustain itself. It is imperative the
government increases the fund pool to make hospital fees more
affordable for farmers," he said.
The central government has pledged to expand the program to 80
percent of the rural population by December and double its
investment in rural medical care from 5.8 billion yuan (US$750
million) last year to 10.1 billion yuan this year.
"If the central government could raise its spending on every
participant by 10 yuan, the enrolled members will only need to pay
an average of 49 percent of the expenses on their own," said
Professor Hu Shanlian with the Medical School of Fudan
Xu Yadong, vice president of the No. 1 People's Hospital in
Beipiao, is a staunch supporter of the rural cooperative healthcare
"More farmers have come to the hospital and have begun to take
chronic illnesses more seriously after joining the scheme," he
said. "In the past, farmers would seldom go to hospital for fear of
the high cost even though they were very sick."
Xu said 61.7 percent of the hospital's sickbeds were occupied
last year - the figure for the previous year was less than a
"More money is needed to fix up local clinics and train medical
staff at grass-roots level, otherwise patients will still have to
negotiate bumpy roads to see doctors instead of being treated
locally," he said.
The rural healthcare system was once a core element of Chinese
socialism. After the founding of the People's Republic of China in
1949, rural people had access to subsidized health clinics run by
"barefoot doctors", who were basically middle-school students
trained in first aid. The primitive service, essentially free,
played a role in doubling the country's average life expectancy
from 35 years in 1949 to 68 years in 1978.
When China began its economic reforms in the early 1980s, the
system was dismantled as the country attempted to switch to a
market-oriented healthcare system.
The Ministry of Health has moved to send roughly 5,500 doctors
and nurses from Chinese cities to the countryside this year to help
treat rural patients, introduce new facilities and train local
"Besides upgrading rural medicare facilities and improving the
skills of rural doctors, the distribution of charity funds is also
necessary," Professor Hu said.
According to Wu Ming, professor with the Medical School of
Peking University, the problem of rural healthcare should not be
"The fact that 900 million farmers have limited access to
medical care is so grave that it could diminish the government's
efforts to close the yawning wealth gap by throwing disease-plagued
farmers back into poverty," he said.
(Xinhua News Agency April 21, 2007)