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Last Updated: Friday, 19 October 2007, 15:43 GMT 16:43 UK
Chinese divided on health reforms
By Jill McGivering
BBC News, Hubei province

China's Communist leaders have overhauled the healthcare system, intending to make it more affordable for the poor. But are the reforms exacerbating China's problems?

Dr Cho Yuen
Cho Yuen has been a village doctor for 40 years

I visited a small village in Hubei province - a cluster of old and new houses set in paddy and wheat fields.

The doctor, Cho Yuen, was in her small clinic sweeping the cement floor, alongside an old-fashioned shop counter stacked with dusty packets of pills.

When she had finished sweeping she put on her white coat, ready for patients.

She has been the doctor here for 40 years, she says proudly. The system is better than before, she adds, because patients have more choice.

Her wages are paid by the village committee, she says. The patients pay only for the pills. Anyone who cannot afford medicine can apply for financial help.

Tiered system

Her positive picture would delight Professor Wang Bao-zhen, an expert on healthcare at Wuhan University and an adviser to China's Ministry of Health.

Villagers in Hubei province
Many poor villagers cannot afford the new health fees

Prof Wang told me about the latest attempt by the Chinese government in Beijing to help the rural poor.

Many in the countryside are struggling to cope with the new burden of health fees, a result of the collapse of the old state-funded health system which existed before China's programme of economic reforms.

Nowadays the urban rich take out medical insurance. But the poor, many of them in the countryside, go into debt to pay their medical bills - or simply go without treatment.

The central government is now responding with a new system, the New Rural Co-operative Medical Care System.

The annual cost of medical cover under the programme is 50 yuan (US$7, 3.50) per person, Prof Wang explained.

Of that, 20 yuan is paid in by the central government, 20 yuan by the provincial government and a contribution of 10 yuan is made by the patient.

Already, she said, almost 80% of the whole rural population of China had signed up - about 685 million people.

China map

The scheme may certainly ease the burden for people who do not have complicated long-term problems - but it is steeply tiered.

If patients go to a small hospital or clinic in their local town, the scheme will cover about 70% to 80% of their bill. If they go to a county one, the percentage of the cost being covered falls to about two-thirds.

And if they need specialist help in a large modern city hospital, they have to bear most of the cost themselves - the scheme would cover only a third of the bill.

Wealth gap

Certainly when I visited Wuhan's Tong Ji Hospital, there was a lot of discontent.

Most of the patients who talked to me had travelled from outside the city for treatment and crowded round to tell their stories.

One man said his son suffered from kidney disease and had needed extensive treatment for the past five years. The family had already spent about $40,000 on medical bills, he said.

Patients wait outside Wuhan's Tong Ji hospital
Many people at a Wuhan hospital were unhappy with the system

They had run out of savings and were now in debt. If this went on, he added, the family would be torn apart.

Another man, now 66 and retired, said the health system was much worse than before.

Nine years ago his son died of liver cancer, but the family had not been burdened with big medical bills.

Now, though, he is struggling to pay for a recent operation on his neck.

The surgery was not a success, he says, and he now needs more treatment.

Some of the cost of the operation was paid by the government but he had to ask his relatives to pay for the rest.

The struggle to provide affordable healthcare is another illustration of the growing gap between China's rich and poor.

The central government, anxious about social tension, is eager to address it. Their grand rural health scheme is an important step - but, for many, it is little more than a partial solution.

This article is part of a week of special coverage on how China is ruled.

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