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Medical care reform: making it easier to see a doctor Going to see
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20:18, December 25, 2008

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the doctor was too expensive for 54-year-old Chinese peasant Song Zhiyao, but the introduction of a rural cooperative medicine scheme in 2007 has greatly eased his financial burden.

A new public-health reform under review might give even more help to Song and millions of other Chinese citizens who have borne their own medical bills for as long as two decades.


Song has lived in Xijiang Village, Kaili City, of southwest China's Guizhou Province for half a century, and misses the days of barefoot doctors before the 1980s.

"The villagers only paid a little money for the medical service at the doctor's small clinic, as the costs were basically covered by the state," he says. Although the young doctor could only handle injections or minor illnesses like coughs, Song was largely satisfied.

It was a time when China prided itself on a government sponsored medicine system, in which most Chinese enjoyed low-priced medical services.

But the climate changed in the 1980s when public health institutions were left to feed themselves because of lack of government funds. A guiding principle was that hospitals should and could be managed like enterprises according to economic rules, a novel idea for most Chinese. It was a starting point for hospitals to generate their own revenue by raising fees and aggressively selling drugs.

From that time, Song and his fellow villagers came to feel the burden of the costs of medicine. Living in a poverty-stricken county, Song and his wife earn less than 10,000 yuan annually by constructing houses in the five-thousand-people village, peopled by the Miao nationality.

In 2006, Song suffered severe piles and kept bleeding for a month. At first, he chose to stay at home instead of seeking treatment.

Like Song, it is common for many Chinese peasants to "expect self-cure in face of small illnesses and await death in the face of big illness".

But the severe health condition compelled Song to visit the doctor, but neither the clinic in the village nor the county hospital could handle his complex problem.

The medical resources in Guizhou and the larger inner regions of China could hardly match big cities like Beijing, which is home to more than fifty Class-A hospitals. In Guizhou, however, there are only six such hospitals and most of them are based in Guiyang, the provincial capital.

Song traveled by bus and train to Guiyang, but he left immediately after the check-up. "They told me to pay an initial fee of 8,000 yuan if I wanted hospitalization, which went far beyond my capacity." At that time, two of Song's children were attending secondary schools.

He then went to Kaili for an operation at the People's Hospital. The costs were still high, as he spent 4,500 yuan for 11 days. "After the operation, they advised me to stay in-house for another 15 days for further monitoring, but I checked out. I was squarely short of money."

The hospital required him to sign a letter, claiming that "everything is irrelevant to the hospital after discharge."

The good news came in the spring of 2007, when he was notified of a new rural cooperative medical scheme. Under the program, Song pays 10 yuan per year, and the government contributes another 10 yuan. If hospitalized, up to 80 percent of the expenditure can be reimbursed.

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