"....From the jus' so's ya know Department....":
It seems that Clintwit-onomics doesn't work real well in China either..... But, Largo's clean water systems may become more important than ever.....
China weans workers off sick state Welfare net stretched to breaking point.....
ZHENJIANG, China, Feb. 19. Twenty-five years ago, when Zhang Ying joined a state-owned textile factory in eastern China, free medical care was one of the job?s perks. The state pledged subsidized treatment for every imaginable ailment, from sniffles to surgery.
?I NEVER SPENT a penny,? said Zhang, 48. ?Often you?d be given a week?s supply of medicine when you only needed it for two days. The rest you?d just throw away.?
But in the two decades since Zhang joined the Jiangsu Zhenfang Group, the burden of providing free medical care has stretched China?s welfare net to breaking point.
As hospitals dole out more and more free medicine, medical costs have rocketed. Precious resources are wasted. And with no competition between hospitals, services have gone downhill.
The advent of capitalist-style reforms in 1979 has seen a growing number of unemployed and private-sector employees slip through the net completely.
This year, China aims to wean its workforce off state support by setting up an urban medical insurance system covering 50 million workers.
?the previous system was suited to the planned economy, but we must now adapt it to suit the market economy,? said Chen Jinfu, a senior official at the Ministry of Labor and Social Security.
?Our aim is to provide basic affordable medical care to every worker, not to support expensive operations for the minority.?
BURDEN SHIFTS
The new system is based on a model pioneered in the eastern city of Zhenjiang on the banks of the Yangtze River.
All workers pay two percent of their salaries into a personal medical insurance account meant for minor medical expenses.
In theory, the employer contributes a further six percent of workers? salaries, about a third of which tops up the personal account, while the rest goes to a pool of funds which workers can access for hospitalization and more expensive medical costs.
The problem is designing a system that caters for all employers ? from booming private enterprises to state-run basket cases ? and workers whose annual medical costs range from 10,000 yuan ($1,200) in Shanghai to just 100 yuan in the poor interior.
Welfare authorities then have to decide how to spend the billions of yuan they collect, and cap rising medical costs.
And that still leaves question marks over how as many as 18 million urban unemployed and 31 million retired workers will pay for medical care.
DELICATE TASK
Chen admits it?s a delicate task. ?If we move too fast there could be some serious management problems and ordinary people might not be able to accept it psychologically,? he said. ?that could cause social instability.?
Social instability is a Chinese political euphemism for one of Beijing?s greatest fears ? mass unrest among an army of unemployed with no access to welfare the state once guaranteed.
In reality, local authorities down to the county level can set a higher or lower contribution rate for employers depending on ?local economic conditions,? Chen said.
?some enterprises can?t afford it,? he said. ?If every company had to pay six percent, whole enterprises might stop working,? he said. ?they would not be able to pay basic salaries. So there is no lower limit.?
But that is only half the job.
SUPPLY SIDE (..Gee, sounds like something Reagan would say..)
For the scheme to work, authorities must compile a vast catalogue of pharmaceuticals and medical services which will be covered by the system, say welfare officials and analysts.
?the most complicated problem we are facing is how to carry out management of medical services,? Chen said. ?We must set a definite scope for drugs and medical costs, as to which are included in the medical insurance system.?
To ensure that funds under management are sufficient to pay for designated products and services, health authorities must cap medical costs, which ballooned 28 times between 1978 and 1997.
That requires a radical overhaul of the hospital system, which has long relied on selling pharmaceuticals at inflated prices to a captive market.
To encourage competition, authorities will designate hospitals and pharmacies to participate in the scheme, and allow workers to choose where to go.
GROWING PAINS
The Zhenjiang scheme, operating since 1995, covers 90 percent of the city?s 391,000 workers and 93 percent of its businesses.
Since 1995, welfare authorities have gathered 1.16 billion yuan in medical funds, paid out 1.12 billion yuan, and invested the rest in government bonds and bank accounts.
With a local economy that grew 11 percent in 1999 ?compared with national growth of 7.1 percent ? most firms can afford the relatively high employer contribution rate of eight percent.
Yet even there, the system suffers growing pains. ?Worst off are the firms which are facing economic difficulties but have not yet been declared bankrupt so cannot be exempted,? said Gai Wenjun, director of the Zhenjiang Social Insurance Bureau.
Nor has it been easy to persuade hospitals to wean themselves off their expensive drugs.
Hospitals have cut the proportion of income from pharmaceuticals to 40 percent from 55, and cut annual income growth to 16 percent from more than 33.
?Obviously, some hospital chiefs were opposed to the idea,? said Gai.
At the Zhenfang Group, Zhang says the system is working well. Her individual account has been more than enough to cover basic medical costs and she earns interest on what she doesn?t spend.
?I don?t mind paying because it?s still my money,? she said. ?I also go to the hospital less because it is my money.?
But she has yet to suffer any serious illness since signing up. If she does, the pool fund will pay for expenses that fall between 10 percent and about 400 percent of her salary.
Above that, she?s on her own. |
