Further, Deeper Rural Medical Reform

By staff reporter WANG XINYI

HEFEI, capital of Anhui Province, is the site of the experiment that has defined the course of China’s development since the late 1970s. The household-based land contract system it invented heralded in the nation’s opening-up and reform. Three decades later Hefei has once again come into the limelight, leading medical reform in rural areas.

Back to Non-Profit Status

“Medicines are less expensive now,” one voice pipes up. Another says, “We farmers now have insurance. It’s something I would never have dreamed of in the past.” When asked for comments about the latest medical reform, the waiting patients at Yangmiao Health Center are eager to have their say. “There are good services in this town hospital so we don’t have to travel to the nearest cities,” explains a third as yet more patients arrive.

The reforms they are praising are contained in the New Rural Cooperative Medical Care System, a government subsidized insurance launched in 2003 that offers affordable medical services to rural residents. The government has also increased funding for public hospitals to restore their non-profit status, and put price capping on hundreds of commonly used medicines to rein-in prescribing excessive amounts of medicine, a rampant practice by profiteering doctors in the past and a source of wide complaint among patients.

Tong Hui, deputy director of the Yangmiao Health Center in Changfeng County, confesses that when the reforms were first put in place many worried whether, with medicine profit margins cut to nil, hospitals could sustain the quality of their services and pay level of their staff.

“Now such fears have been dissipated,” Tong says. In fact, this health center is now in a better shape than ever. Government funding is allotted in time and in full, and streamlined management has cut overheads and allowed space to provide better incentives for staff members.

Ni Youhe, 56, a physician at the center, is happy with the ways things have developed. “Now we are no longer under the pressure to prescribe more drugs, a change that has improved doctor-patient relations.”

Ni recently got a payrise of more than RMB 1,000 per month and last year won a cash bonus of RMB 10,000 for his outstanding performance. His benefit portfolio has also expanded. Now, like those in urban hospitals, doctors working in rural areas like him are included in the Public Housing Fund, whose payments are met by equal contributions from individuals and their employers every month.

Prior to the reform, the Yangmiao Health Center was no exception among the nation’s public medical institutions, which often resorted to pushing medicine sales to increase revenues.It was not unheard of for a doctor’s salary to be linked with the amount of drugs he or she prescribed.

Now the state has released a list of commonly used medicines covered by the New Rural Cooperative Medical Care System. Hospitals are now required to sell these drugs to patients at wholesale prices. The government also strictly controls the process from these drugs’ production to distribution to keep the cost at the lowest, so that their retailing prices will stay within reach of the average citizen.

To everyone’s delight, professional and moral excellence is again the evaluation yardstick for medical workers. “We are once again an honorable profession,” Ni beams.

Mr. Zhang, an inpatient of Dr. Ni, suffers from chronic bronchitis, a disease common in rural areas due to delayed treatment. Many farmers avoid doctors in anticipation of exorbitant medical expenses, waiting until a mild ailment develops into a serious problem that demands more costly treatment.

When Mr. Zhang was first diagnosed with bronchitis four years ago, he was making ends meet by working odd jobs in Shanghai. Horrified that the medical bill of more than RMB 300 from his first hospital visit ate up half of his monthly living budget, he felt that he couldn’t afford to continue treatment. “I thought that because I was young I could cope without the help of medication,” he recalls.

Every year, however, the condition reoccurred, and each time it grew more acute, until last year it forced him to suspend work and came back to his hometown. It was when he returned home that he learnt of the New Rural Cooperative Medical Care System. “I was told I needed just RMB 50 to join the program. Thinking that I won’t lose much even if it wasn’t as good as it claimed, I applied,” Zhang says. When he was laid up by the chronic disease again a few months later and spent two weeks in hospital, he was surprised to learn that the insurance covered 70 percent of his expenses and that he only had to pay RMB 1,000. “It was way beyond my expectations.”

And with more common-use drugs and medical conditions covered by the new insurance for rural residents, patients like Zhang will find they are liable for smaller amounts.

Kang Xinkuang, another inpatient at the health center, has kidney failure and has to receive hemodialysis regularly. The treatment cost him RMB 12,000 in 2010, of which RMB 6,400 was reimbursed by the insurance. The next year the charge for this therapy dropped to RMB 11,000, while the reimbursement rose to RMB 8,400. He thus paid just RMB 3,000 altogether.

Medical Services for Every Rural Community

After taking a patient’s blood pressure for free, Zhang Xingxian, one of two general practitioners at the clinic in Sishu Village, Yangmiao, put the data into the patient’s health file in his computer. Since 2009, thanks to government funding, all patients’ visits are digitally documented at the facility.

“As it is now the harvest season, farmers prefer to see the doctor early, so we start work before 8 am. When there are few visitors in the afternoon, we make home visits or sort through health records. My colleague and I work two shifts, and our services are available around the clock,” Zhang says.

In 2009 the Chinese government commenced a three-year program to enhance and expand the nation’s medical service network, promising to extend it to every rural and urban community. The resulting explosion of community-level medical care providers has brought affordable and convenient services into the reaches of the underprivileged who are in need of continual medical care. What’s more, accompanying preventative measures like free check-ups and public counseling are helping to prevent many people from developing chronic diseases in the first place.

The clinic in Sishu Village accepts payments through the New Rural Cooperative Medical Care System and charges less for diagnosis and treatment than bigger hospitals in the county or city, which is a draw to the 1,904 farmers in the village. What is more appealing to local villages, however, is its vicinity in relation to their homes. When villager He Yichao ran up a fever at midnight, he called the clinic and within a few minutes a doctor was at his door. For elderly patients over 65 years old, who are entitled to four free health checks at the clinic every year, such convenience is most valued. Wei Huageng, 68, is plagued by hypertension, coronary heart disease and cerebral infarction, and he needs long-term medication and regular check-ups to keep his condition under control. The establishment of the village clinic saves him from making frequent laborious trips to the county hospital.

Reform Imperative

The running of village level medical facilities like that in Sishu are still in the process of reform. Zhang Xingxian is paid RMB 1,200 a month, not bad in comparison with young people in the village, but far less than what he earned when running his own clinic years ago. His salary is fixed, however, instead of tied with work performance, and he is not included in the Public Housing Fund or pension and unemployment insurance like others who work for state-owned organizations.

Zhang however has no plan to quit. Having seen the dramatic changes in the village’s healthcare services over the past three years, he is confident that it won’t be long before doctors’ benefits are improved, too.

China’s plan to extend medical care to over 90 percent of its population by 2012 has been realized, forming the world’s largest medical care network. A survey by the National Audit Office in April showed that both the medical infrastructures and services have been significantly meliorated in the countryside at village, township and county levels. The urban-rural gap in the access to medical services has been greatly narrowed. Furthermore, the financial burden on rural patients has been greatly assuaged, with 832 million rural residents, or 97 percent of the nation’s rural population, under the New Rural Cooperative Medical Care System by the end of last February.

Though much work has been done, reforms will not stop here. In a national meeting on medical reform on April 18, the government pledged to introduce further changes, consolidating existing achievements and mending weak links such as low pay and pension policy for village doctors. Zhang Xing-xian’s confidence is well placed.