Health is Com­ing: a brief His­tory

The World of Chinese - - Cover Story - - HAN RUBO (韩儒博)

Long ru­mored and much needed, a com­plete over­haul of China's be­lea­guered health­care sys­tem is now in the works. “Re­forms are tak­ing place across the sup­ply chain, mak­ing health­care more ac­ces­si­ble and af­ford­able, es­pe­cially in ru­ral com­mu­ni­ties,” claims a re­cent re­port by CCTV.

Un­der the planned econ­omy, health­care was pro­vided by the so­cial­ist state—though for many ru­ral res­i­dents, this usu­ally en­tailed wait­ing for one of the coun­try's 40,000 “bare­foot doc­tors” (赤脚医生ch#ji2o y~sh8ng). These were itin­er­ant peas­ants, given ba­sic med­i­cal train­ing and in­structed by pro­duc­tion brigades in 1965 to pro­vide es­sen­tial health­care and “phys­i­cal work” for China's 540 mil­lion farm­ers. Along with vac­ci­na­tion drives and “Four Pests” cam­paigns against rats and mosquitoes, they helped re­duce in­fant mor­tal­ity, and in­crease av­er­age life ex­pectancy to 65 years old.

Af­ter eco­nomic re­forms, the state re­treated from health­care in the 1990s and pub­lic hos­pi­tals be­came for-profit in­sti­tu­tions. Un­der­paid and of­ten un­der­trained staff reg­u­larly took bribes to treat pa­tients, or pre­scribe cer­tain med­i­ca­tions. Coun­try dwellers now had to travel to cities for proper treat­ment, push­ing a strained sys­tem to a state of nearper­ma­nent break­ing point. By the time the SARS epi­demic broke out in 2003, hos­pi­tals had be­come crowded, hos­tile en­vi­ron­ments, rife with mis­trust and of­ten out­right vi­o­lence.

With only 30 per­cent of China cov­ered by in­sur­ance, new re­forms be­gan to roll out in 2003 for ru­ral res­i­dents; this was fol­lowed by a cov­er­age plan for city dwellers in 2007. The aim is to en­sure com­plete cov­er­age by 2020, re­duce phar­ma­ceu­ti­cal costs, and in­vest heav­ily in ru­ral health­care to re­duce the bur­den else­where (an av­er­age ur­ban hospi­tal typ­i­cally sees 20,000 out­pa­tients a day). But the task of re­duc­ing this bur­den on pub­lic hos­pi­tals in fa­vor of spe­cial­ist and emer­gency care faces re­sis­tance— from the hos­pi­tals them­selves.

Many de­pend on a high turnover of pay­ing cus­tomers to re­main prof­itable, while spe­cial­ists are costly to se­cure and in­sure. A pref­er­ence for city hos­pi­tals means mi­grants still flood ur­ban wards—and when their ex­pec­ta­tions are not met, tem­pers can flare.

Mean­while, although 95 per­cent of Chi­nese now have ba­sic cov­er­age, the cost of drugs and treat­ments has kept ris­ing—even pa­tients who are now in­sured are pay­ing just as much as be­fore.

China has a “limited med­i­cal re­fer­ral sys­tem,” mean­ing pa­tients are of­ten re­ferred to dif­fer­ent hos­pi­tals and spe­cial­ists, then back again. Of­ten, ac­cord­ing to irate pa­tients, this is sim­ply to shirk re­spon­si­bil­ity for a par­tic­u­lar com­plaint. CCTV says a push to­wards in­te­grat­ing these ser­vices, us­ing big data, AI, and so­cial credit schemes, will of­fer “a ma­jor con­tri­bu­tion to­wards the goal of a healthy China.”

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