Jay, Can you share fraction of your clan's fortune with these folks?
From your favorite NYT:http://www.nytimes.com/2001/03/14/world/14CHIN.html
Without 'Barefoot Doctors,' China's Rural Families Suffer
By ELISABETH ROSENTHAL
BAZUO, China — As Zhang Youlian
wept in the dirt courtyard surrounded
by towering peaks, her tears spoke to her
year of calamities.
First, her 35-year-old husband fell ill and was
taken from their rice fields to the hospital with
chest pain that he had ignored for too long.
Then, her 4-year-old caught his hand in a
thresher. Covered with blood and cradling the
wide-eyed boy in her arms, she stumbled
down miles of steep rocky paths until she
found a car that drove them to a doctor.
Her husband died in the emergency room.
Her son is now missing half his hand. And her
personal losses have been compounded by
unthinkable debt. Although neither patient
was admitted to the hospital, bills for their
treatment totaled more than $500, seven
times the average yearly income here in their
village in southwestern Yunnan Province.
And, as with most rural families, there was
neither medical insurance nor welfare benefits
to cover the costs. "I borrowed it from family
members," Ms. Zhang said. "I don't know
how I'll pay it back."
Huge numbers of China's 800 million rural
residents are in a medical free fall, as the
once-vaunted system of "barefoot doctors"
and free rural clinics has disintegrated over
the last decade, a side effect of successful
market-oriented changes.
As central government planners have
withdrawn from people's lives, they have
taken with them most subsidies for social
services like health and education, hoping that
local coffers and initiatives would fill the gap.
They have not.
The rural health system has become a hodgepodge of hospitals and clinics that are
often privately run and almost always prohibitively expensive, where treatment for a
cold can eat up two months' income and giving birth in a hospital two years of
hard-earned cash.
With health costs that increased 400 to 500 percent from 1990 to 1997, according
to a new United Nations report, medical care in many rural areas is so costly that
people have stopped seeing doctors except in extreme emergencies. The ill endure
pain, chronic infection and the risks of childbirth at home.
Illness is the leading reason why Chinese families fall below the poverty line,
researchers say.
"If you are really sick, you borrow and go to the doctor," a neighbor of Ms. Zhang,
Chen Jiuxiang, said. "But most people still don't want to go, because we are poor
here and they know it will cost a fortune. Twenty years ago it was different. It was
easy to see the doctor and cheap, too. Even if you had to go to the hospital with a
very serious illness, it would cost at most 100 yuan," or $15.
Health statistics are beginning to reflect the large numbers who now do without. The
number of tuberculosis cases has quadrupled in 15 years, and infant mortality, which
had been declining steadily for most of 40 years, is beginning to creep up in poor
areas, according to the United Nations report, which has not been officially
released.
Although government outreach programs in remote areas once gave China
immunization rates that were the envy of the developing world, the effort has started
to slip.
"Coverage is uneven in poor areas such as Shanxi and Guizhou Provinces, where
measles coverage is as low as in many sub-Saharan African countries," the report
said.
Many Chinese echo that assessment.
"China is not achieving its own basic health criterion," said Prof. Zhu Ling, an
economist at the Chinese Academy of Social Science who has been studying health
care. "People aren't getting basic health services because they can't afford them."
Dr. Nie Chunlei, deputy director of the Rural
Health Division in the Health Ministry,
emphasized that indicators had continued to
improve for the country as a whole. Infant
mortality decreased throughout the 1990's,
and almost 90 percent of villages have at least
one clinic.
But Dr. Nie acknowledged that "development has been very imbalanced," with poor
farming areas and less-developed western provinces left behind.
"In very poor places," he said, "the government and the collective don't have the
money to subsidize health care, and so the peasants have to pay it all. In many
cases, they don't have the money to see a doctor."
In cities and more prosperous coastal farming areas, health care has improved in the
last decade, with government hospitals offering more sophisticated tests and
specialized medicines. Still, even in cities, just a minority of residents has
comprehensive coverage, and nearly everyone grumbles about increasing costs.
The situation is far more dire in the vast poor rural regions, where local officials had
neither the money nor expertise to maintain a health system after central government
assistance had dried up. Many areas simply cut loose government clinics and
hospitals, requiring them to support themselves.
Today in rural areas, an increasing number of clinics are privately owned for-profit
ventures that set their own rates, and even state- owned clinics are often contracted
out.
"In some provinces, there is no system left, and it's every man for himself," said a
Chinese health expert who works at a state research institute.
The Health Ministry has acknowledged the problem and has helped local
governments develop pilot projects to address it. But budget cuts have reduced its
staff by 45 percent since 1998, and there has been little concrete progress.
The government still limits the doctors' consultation fees to 60 cents a visit, a sum
that has not changed for decades despite inflation.
But there is little regulation of charges for medicines, injections and tests, which are
prescribed in abundance.
Market forces have brought modern medical technology into the countryside. Clinics
in remote rural villages now dispense a wide variety of Western drugs. Even small
county hospitals have CAT scanners.
But in poor places like Bazuo, such fruits of progress are generally out of reach. The
United Nations report said even a simple hospital stay could cost more than the
yearly income of most peasants.
Song Youzhi never saw a doctor when she was pregnant with Wang Xiaorui, now
3, because, she said, "I felt O.K." When contractions began, she stayed at home
and gave birth with the help of a relative.
Nearly all the women in Bazuo give birth without prenatal care, in unheated houses
with no running water. Some are deterred from seeking medical help because their
mud- brick houses are hours away by footpath from the dirt road that zigzags down
the mountain to the township hospital. But for others like Ms. Song, who lives quite
close to the hospital, the issue is money.
"Of course, it's safer and more comfortable in the hospital," Ms. Song said. "But it's
too much money — 600 to 700 yuan. And I didn't have that."
She added that her family earned $60 a year growing ginger and red peppers.
By discouraging expectant mothers from seeking professional help, such fees have
contributed to high rates of infant mortality and women's deaths in childbirth. In the
county that includes Bazuo, children died before their 5th birthday at a rate of 64.7
per 1,000, twice the national average. In some parts of Yunnan Province, the rate is
as high as 200 per 1,000, meaning that one of every five children will die before
turning 5 years old.
Although the Health Ministry would like all
women to give birth in hospitals, the United
Nations report estimates that 29 percent of
women in poor counties can afford prenatal
examinations and that 6 percent can afford
hospital deliveries.
In counties where pilot projects have reduced hospital charges for childbirth, the
percentage of hospital deliveries has more than doubled. But experts say many
women are reluctant to spend any money in rural health centers because conditions
are often poor.
Chinese health researchers say the new market-driven care offers few advantages to
hundreds of millions of rural poor. And, they say, the new setup fails at tasks that the
old system performed so well like public health campaigns and immunization drives.
Self-supporting clinics cannot make money trekking out to distant villages to
vaccinate children or exhorting women to obtain prenatal care, they said.
Although Dr. Nie of the Health Ministry said immunization rates remained very high,
he added that in remote areas the lack of vaccinations was becoming "a very serious
problem." Although a basic immunization set is still technically free, patients often
pay "administration fees," as well as fees for needles and syringes. No new
immunizations have been added to the free program since 1978, not even hepatitis B
vaccine, which would help fight a disease that is endemic in China.
Professor Zhu, the economist, has proposed that the central government allocate
money from its antipoverty program to underwrite rural care. Some basic and
preventive services need to be free for poor people, she said. Otherwise people will
not receive them.
At the urging of the central government, additional cities and prosperous rural
counties, where farm income is supplemented by small businesses, are developing
fledgling insurance plans or cost-sharing programs, under which a local government
may pay parts of medical bills, Dr. Nie said.
But even there, the local governments contribute at most half the cost, and Dr. Nie
acknowledged that the model would not work in much of the country.
"Finance is a very difficult question," he said. "We've been thinking a lot about this in
the last two years. But the central government doesn't have the resources to solve
this alone. It can't bear the cost." |
