The old lady might still be
hesitating if she should have her liver disease treated, if not for
the cooperative medical care.
Pang Chunxiang, 61, from the Beizhai Village of northwest China's
Shaanxi Province, was glad to receive more
than 9,000 yuan reimbursement for her surgery that cost her 23,814
yuan (about US$3,072), roughly tenfold of the poor farmer's annual
Pang is only among millions of beneficiaries of the rural
cooperative medicare scheme, launched nationwide after the outbreak
of SARS (Severe Acute Respiratory Syndrome) in 2003.
Under the system, a farmer who is willing to take part in the
program is to hand in 10 yuan a year out of his own pocket, while
the state, provincial, municipal and county governments jointly put
in another 40 yuan for the farmer.
The participant could have part of his expense reimbursed in case
he is hospitalized. The rate of reimbursement varies according to
different kinds of illness and the actual cost of medical expenses
In Shaanxi Province, the average rate is 35 percent and the fund
has reached 612 million yuan (about US$78.6 million) since 2003,
covering more than 12 million farmers, or 44.5 percent of the rural
population in the province.
The total reimbursement was 390 million yuan (about US$50 million)
last year, almost seven times of the amount in 2005, said Li
Hongguang, head of the Shaanxi Health Department.
Cooperative medicare is not new in China. It was adopted by the
government as a national policy in 1956 and had helped built one of
the best rural healthcare networks in developing countries over the
A market-oriented reform since the 1980s, however, have led to the
dismantling of the system. Without government support, rural
hospitals and clinics had been left to struggle for survival. Many
of them were simply abandoned as doctors looked for greener
Rocketing medical bills have pushed health service farther from
A survey by the Ministry of Health showed one third of poor rural
patients choose not to go to hospital, and 45 percent of farmers in
hospital ask to be discharged before they have recovered.
"With the co-op medicare system, an illness does not mean a
catastrophe anymore," said Lu Zhenshan, a farmer in his fifties who
claimed 30 percent reimbursement after having a heart
So far, China's central and local governments have invested over
18.9 billion yuan (about US$2.4 billion) into the medicare scheme
to provide 400 million times of reimbursements to the
Nationwide, the system has covered 51 percent of the rural farmers,
and will be extended to cover all the rural areas by 2008,
according to Gao Qiang, the Minister of Health.
The new system also brought changes to rural clinics. In the
Niudong Clinic where Lu Zhenshan attended, the hospitalized
patients totaled over 60 last year, quadrupling the number in years
before the program was launched. Among the patients, one third had
chronic diseases, for which they had been reluctant to go to
"If not for the co-op system, our clinic would be bankrupt," said
Li Xiangmin, head of the clinic, noting that their revenue was
286,000 yuan in 2006, a sharp increase from the less than 200,000
yuan before. He is thinking of purchasing some new medical
But the national drive is also met with difficulties. "Many
counties and towns do not have enough financial power to supply
their portion in the fund," said Li Ling, professor from the
Chinese Economy Research Center in Beijing University.
In addition, many clinics are in shortage of eligible doctors and
equipments. In over 1,600 clinics in east China's Anhui Province, there are only 723 college
graduates, less than two percent of the total number of doctors.
Half of the clinics are not equipped with stomach pump and 30
percent without electrocardiograph.
Fund resources need to be expanded, and the funds from richer
counties may need to be diverted to support the poor ones, Li Ling
More efforts are needed to lower the costs of medicine, and support
under-funded and poorly equipped village clinics, she added.
(Xinhua News Agency February 21, 2007)