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China's punctured health care system

After years of free market reform, the old communist-style provision of cradle-to-grave welfare in China is a distant memory for anyone under 30. For millions of the country's less wealthy, this means that basic healthcare is simply unaffordable, the BBC's Jill McGivering reports from Beijing.

Operating theatre in China
Even with health insurance, long-term medical care is expensive

The hospital corridor was dingy and smelt of urine. The peeling paint and cracked floor tiles exuded shabbiness and it was made narrower by the trolleys parked down the sides.

On one trolley lay an old man, hollow-cheeked, and vomiting into a bag. His middle-aged son hovered by him, looking embarrassed and hopeless.

On another, I found a young man, lying on his back, attached to a drip. His face was young and serene, his eyes closed. He was unconscious.

His wife, a pretty young woman in her 20s, bent over him, touching his face. She seemed bewildered. In all the chaos, no-one was paying her much attention.

Her husband had been knocked off his bicycle by a car, she told me as she stared up blankly at the clock - less than three hours ago.

He had not regained consciousness.

Amid this dynamism and growth, China is having a health care crisis

They were both from the countryside, she said, and were here in Beijing to work. But whatever insurance they had was not valid in the city.

I asked what his injuries were, what treatment he needed. She shrugged.

"It must be serious," she said, gazing down again at her young husband's still face.

Maybe the man who knocked him down would pay the bills?

'Barefoot doctors'

These snapshots of poverty and hopelessness seem out of place in modern China, with the new Beijing airport and its visionary roof which soars and ripples like a cresting wave.

Skyscrapers in Beijing
China is attracting record amounts of foreign investment

The streets of China's cities ooze wealth. Roads are jammed with new cars, gleaming skyscrapers, designer clothes... all against the endless soundtrack of construction drills.

But amid this dynamism and growth, China is having a health care crisis.

Not many here miss Mao. By comparison with those dark days, there is more freedom today, more opportunity and much more money.

But in the old days, healthcare was free or almost free through work units and state enterprises.

China had its famous barefoot doctors - an impressive network of rural health workers - farmers with a rudimentary training. Anything complicated they had to refer to proper doctors in hospitals, but they held the health frontline.

When the wind of economic reform began to blow in the 1980s they were swept away. Many small clinics went too.

Health became, like so much else, subject to market forces.

Those with money could buy a higher standard of care. Those without were the people I was meeting in Beijing's cheaper public hospitals.

'Westernised deaths'

The collapse of services for the poor has been complicated by the way China's need for healthcare is changing as rapidly as its skylines.

Before, people died from things like pneumonia and tuberculosis.

Rural Chinese family
Chronic illness can still bankrupt an entire family

Now, they sit in cars instead of walking or cycling, eat fattier diets with more meat... and they smoke. Their lives are more Westernised. So too are their deaths.

Four out of five people in China now die from non-communicable diseases: cancer, heart disease and strokes.

Treatment for these is complicated, expensive and likely to last for years. This is quite a challenge for 1.3 billion people, many millions of them still poor.

The government is struggling to change course. It has woken up to the fact that health is not just about welfare but political too.

The burden of health fees has sparked rage in the countryside. Those who feel excluded from the boom realise their meagre savings are under constant threat. If they become chronically ill, they could become bankrupt too.

So the government is suddenly pumping billions into new social insurance schemes.

Seven hundred million people across China's vast countryside have now signed up for a new rural health scheme whereby a small annual fee from each person is matched by a payment from the state.

It gives some cover, but not enough.

Only a percentage of medical bills is covered and in some cases, a very small percentage.

Chronic illness can still bankrupt an entire family. So it is a safety net, but one that is full of holes.

Tired resignation

In another hospital, I found a gaggle of rural patients crouching on the forecourt. They were out-patients, waiting for appointments or test results.

I met a white-haired old lady, sitting in the shade on a bare concrete slab. Her clothes were shabby and old-fashioned, her shoes worn and her face lined from the sun.

I could tell at a glance she came from the countryside.

When I spoke to her, her tone was weary.

She had made a long trip by bus to come to Beijing, she said.

She struggled to describe what was wrong with her but it sounded like a bowel tumour.

Could she afford the tests and possible treatment, I asked?

She shrugged and grimaced. She seemed utterly exhausted.

"We're just farmers," she said. "We don't have any money. What can we do?"

From Our Own Correspondent was broadcast on Saturday 28 June, 2008 at 1130 BST on BBC Radio 4. Please check the programme schedules for World Service transmission times.



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