Health is Coming: a brief History
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.”