Cash up front

A major hospital reform falls through

Cash up front

Waiting for funding

Five years ago Fu Xueping, a 25 year-old farmer from the eastern province of Zhejiang, was paralysed from the neck down after a motorcycle accident.

Unable to afford the medical bills, Fu’s parents brought him home from hospital and began manually ventilating his lungs with an air bag 18 times a minute for every hour of every day.

Hu Songwen, a 43 year-old with a kidney disease from the eastern province of Jiangsu, faced a similar dilemma when it came to paying for his three-times-a-week dialysis treatments. So he built his own blood cleansing machine out of kitchen equipment and medical parts, performing his own dialysis for the last 13 years.

While the ingenuity of such efforts is breathtaking, the stories illustrate a wider issue: how the bulk of Chinese still struggle to afford essential healthcare.

The Health Ministry claims that basic insurance now covers 95% of the population after a scheme rolled out in 2009, But experts point out that it doesn’t provide for much, forcing families, especially those from rural backgrounds, to take tough decisions when medical emergencies strike.

“The insurance scheme covers a very large percentage of the population, but not at a very deep level. So when healthcare costs are higher, there are still out-of-pocket expenses, and that remains a major challenge,” Dr Michael O’Leary, the World Health Organisation’s Representative to China told Voice of America in December.

This creates nervousness on the part of those who feel they need to save for a rainy day – a factor in why domestic consumption remains a relatively low percentage of GDP. It also creates jitters on the part of hospitals, which take payment up front on concerns that treated patients won’t be able to pay.

Is that about to change?

For a brief 24 hours last month it appeared as if this much hated system – doctors have been known to reverse emergency treatments when it becomes clear that patients can’t pay – was going to be abolished, after CCTV aired a news segment suggesting that patients would be able to pay “after” their treatment.

But the next day, February 20, the Health Ministry issued a clarification saying it was a trial scheme and that it would only be rolled out in a few counties.

Jiao Yahui, a ministry spokesperson, told Xinhua that it had not requested a fuller launch “given the limitations in social trust”.

More seasoned cynics on weibo poured scorn on those who had believed the scheme would be made more widely available.

“This could never have been true,” wrote one. “Hospitals don’t even give you an invoice if you are a penny short.”

But newspapers seized on the idea and urged the government to implement it across the country as soon as possible.

“The requirement for an advance deposit may keep patients from receiving timely treatment, especially in medical emergencies where time makes a life-or-death difference. The new practice should be introduced in as many medical institutions across the country as possible,” the China Daily wrote.

The Legal Daily also argued that trials in the southern city of Shenzhen showed payment avoidance applied to less than 1% of bills.

“We can’t wait for the system to be perfect before we put it into practice. The ‘treatment first, payment later’ system might as well be practiced first and we can solve any problems it might have along the way,” the newspaper proposed.

It seems unlikely that this will happen in the short term but at least there was other good news to soften the blow.

This week China’s parliament approved a 27% rise in health spending for the coming year.

Extra money like this means that liver patient Hu can now get his dialysis done at a hospital for the same amount that he spends on each session at home. But Hu professes himself unsure if he will take advantage of the new service, arguing that the hospital is too far away and that he has survived this long using his own machine.

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