China's rural heath worries

Parents dread their children getting ill

China's mainly rural population is facing a growing healthcare crisis. The abolition of Maoist-era rural communes has left millions of people without access to free medicine. The BBC's Duncan Hewitt reports from Anhui province.

As he visits the only patient in the spartan ward at Lujiao county hospital, doctor Guo Qi lowers his voice to a whisper.

He does not really need to. Fifteen-year-old Zhu Youfu is stretched out motionless on the bed, staring at the ceiling, apparently oblivious to his surroundings.

Less than a third of China's health spending goes to the countryside, where 70% of its people live

His middle-aged father, a farmer, stands beside him gazing dejectedly at the floor. His son has heart problems and may only live another five years. And the medical bills are mounting up.

Family sacrifices

Dr Guo says the family has already spent more than 10,000 yuan ($1,200) taking the boy to different hospitals. That is several years' wages for a local farmer.

The boy's mother has also had to give up her fruit stall in the nearby town so she can look after him.

Farming families cannot rely on the state

The family have applied to the county government for emergency aid, but it has yet to come. It is a common story, says Dr Janos Annus, chief representative in China of the World Health Organisation.

"If someone falls sick, the access to health care in rural areas in China in general is very poor," he says. "Health insurance coverage for rural people is around 7% only - people have to pay from their own pocket.

"The rural healthcare system based on the co-operatives was abolished around the mid 1980s, with the provision that a new system would be built to replace it. But that system has not been built yet."

There are some exceptions in wealthier areas near big cities, and sometimes special subsidies for women and children. But overall less than a third of China's health spending goes to the countryside, where 70% of its people live.

Crippling debt

Rural hospitals rely largely on patients' fees for their income and demand payments up front. As a result, China's health ministry recently admitted that two thirds of rural patients miss out on hospital treatment because they cannot afford it.

"For a big illness the burden is hard for a rural family to bear," says Wang Jun, deputy head of the Health Bureau in Anhui's Feixi county.

There are too many well-equipped hospitals in China and too few people who can afford to use them

Dr Janos Annus, WHO

"They have to borrow money, go into debt - and they often have to pay high interest.

"It affects their lives, their farming. If someone gets ill in a family it can be years before they can recover.

"This is a major problem for the rural economy. We must do something about it."

Feixi is one area of China which is now trying to build a new rural health system from the wreckage of the old one.

In a local farmhouse, village doctor Zhang Zhenquan unwraps a fresh disposable syringe and prepares an injection for a patient suffering from lead poisoning.

Until recently Dr Zhang would not have made home visits for free. Like many village doctors in China, he worked privately, with profit a major motive.

Now Feixi county has taken over the management of all village clinics, forced unqualified doctors to retire, and given others like Dr Zhang a partial subsidy - as long as they stick to official prices and standards of hygiene and service.

Local scheme

Patients and doctors say the patients now get better treatment for less money. In the past, some say, whether you got good treatment or not depended on whether you had a good relationship with the doctor.

Urban communities are suffering too

Feixi county has also set up a rudimentary medical insurance scheme. For a small contribution of a few yuan a year, villagers will receive up to 5,000 yuan ($600) in the event of major illness.

That is nothing like full coverage, but Feixi health bureau deputy head Wang Jun says it is the best they can do.

"It's impossible to provide publicly funded health care schemes like government officials or teachers get in the cities," he says. "It's unfair but there are too many people.

"The government can't afford to pay so much money to support every farmer. We can just try to help a bit."

But with the Chinese Government increasingly concerned about instability in the countryside, there have been growing demands for more spending on rural health, and for an end to the confusion which has left every county with a different health system.

The government has now announced plans for its first ever national conference on rural health, with the goal of setting up a unified system and increasing investment.

Janos Annus of the WHO says it is a sign the problem is being taken seriously. But he warns there must be a fundamental change in attitude away from spending on often unnecessary infrastructure, towards providing individuals with basic health insurance guarantees.

"There are too many well-equipped hospitals in China and too few people who can afford to use them," he says "A well-functioning health system which is accessible for all who need it is a prerequisite for future social stability of the country.

"Health is a cause of poverty - and no access to health is a result of poverty. If this vicious circle continues it will lead to the deterioration of all the economic gains and achievements the country has made in the past 50 years."