One afternoon this spring, a small village in Guangxi province took the blood pressure of every inhabitant. Nothing striking about such a basic procedure, you might think. But there was one thing about the exercise, reports Xinhua, that struck locals as rather unusual. It was done free of charge.
In recent decades China’s farmers have got a raw deal where healthcare is concerned. In the wake of the 1949 revolution, Mao Zedong had sought to improve their lot by creating the so-called ‘barefoot doctors’. They weren’t as well trained as brain surgeons, but they were highly effective in treating more common complaints and offering preventative medical advice at the grassroots level. The sheer number of new medical personnel also meant that rural folk had more access to healthcare than ever before.
The barefooters were phased out in 1981 and in the subsequent years, villagers were paying ever higher fees to consult a doctor – assuming they were even fortunate enough to have one nearby.
So the recent round of healthcare reforms has probably had a more profound effect on the countryside than anywhere else. Back in Liantang village, Xinhua’s reporter spoke to 68 year-old Ouyang Qiurong about the changes. “In the past we went to the village’s local clinic for medical treatment at our own cost. Now the town and village have new health centres and the state reimburses us, which is really a very good thing.”
The scale of the expansion has been enormous. About Rmb40 billion has been spent nationwide to build 1,877 new county-level hospitals, 7,000 grassroots medical care institutions and 11,000 village clinics.
Underpinning this expansion of medical ‘hardware’ has been the creation of a universal healthcare programme. As recently as 2005 only 300 million Chinese were covered by basic medical insurance and almost all of them were living in urban areas, mostly with jobs tied to the state.
Since 2009 the number of rural citizens with access to ‘rural cooperative medical care’ – i.e. basic insurance – has surged by 830 million, reports Xinhua.
Professor Yao Lan of Tongji Medical School, which is part of Huazhong University, considers this a great achievement: “From covering 300 million to covering 1.2 billion people, China has spent just five years building the largest network of universal health insurance. China has set a new record: Germany took nearly a hundred years to achieve universal medical insurance.”
The goal of the ongoing twelfth five-year plan is to bring down the cost of healthcare for individuals further, so that individuals pay 30% or less of bills. The rest will be covered by the state and the newly expanded insurance schemes.
Not all are convinced that the process is going smoothly. In an opinion piece in the New York Times, a senior fellow for global health at the Council on Foreign Relations said the cost for rural residents remains a problem.
Says Huang Yanzhong: “This past summer, when I visited one of China’s richest counties, someone informed me that a farmer had to pay the equivalent of his annual net income for stomach cancer surgery. Still preoccupied with GDP growth, local governments, which are supposed to finance about 70% of all public health spending, have few incentives to spend much on healthcare.”
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