ONE-FIFTH of the world’s population is suffering a calamitous collapse in healthcare provision, warn several papers in this week, which examine the effects of free-market economic reforms on the Chinese health system since 1978.
Faced with huge disparities in access to healthcare between the urban rich and rural poor, the government is planning a shake-up entitled “Healthy China 2020”, which includes an early goal to restore universal access to primary healthcare by 2010. As China is wrestling with problems suffered by many countries – soaring healthcare budgets, the rise of “western” diseases such as obesity and cancer, and unequal access to healthcare – all eyes will be monitoring its response.
The rural poor in China have been hardest hit by free-market reforms which changed healthcare from a universally accessible system funded by government and farming cooperatives to one geared to the open market and favouring those who can pay over those in most need of medical care.
Advertisement
“Before the reforms of 1978, more than 90 per cent of the rural population was covered by a cooperative medical scheme,” says Margaret Whitehead at the University of Liverpool, UK, who is lead author of a key paper in (. “After market reforms, less than 10 per cent of the rural population was covered.”
The journal reveals the massive shift towards patients paying for their own treatment. In 1980, such “out-of-pocket” costs made up just 20 per cent of total expenditure on health in China. By 2000, the public was paying a whopping 59 per cent of China’s healthcare costs directly. In France, where most healthcare is publicly funded, the comparable figure is just 11 per cent. This swing has left 43 per cent of rural households unable to afford medical care. Forcing health providers to cover most of their costs by charging patients has also skewed the system, by encouraging doctors to prescribe the most expensive instead of the most effective treatments.
Collectively, the reforms have bankrupted millions of families, pushing them into a “medical poverty trap” where they sell all their assets to pay for care. “Instead of the health system improving people’s health, it’s making them poorer,” says Whitehead. “It’s a complete market failure, and because China is so big, it’s a massive failure.”
To the Chinese government’s credit, says Whitehead, it is tackling the problem, not least because of public pressure. The new initiative was announced two months ago. “It will involve about 200 medical experts divided into seven special programmes,” writes Shanlian Hu of Fudan University in Shanghai (. But the devil will be in the detail of what this task force produces, says Shenglan Tang of the World Health Organization’s Beijing office, and co-author of the Whitehead paper. “It’s not clear how far the government wants to reduce the percentage patients have to pay,” he says.
Whitehead says the world will be watching China’s efforts: “What is awe-inspiring is the sheer scale of it.”
