Access to Care in Rural China: A Policy Discussion By Simone Brant, Michael Garris, Edward Okeke and Josh Ronfeld
Executive Summary
Providing healthcare in poor, rural regions is a notoriously
difficult task and enormous obstacles exist in trying to provide珍惜每一天
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quality care in areas that are impoverished and remote. Although
车辙是什么意思China’s economy has rapidly expanded in recent years, many of the
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health care challenges, the one that particularly afflicts China’s
contemporary rural society is access to health rvices. Prently
more than 90% of China’s rural residents are uncovered by any
health insurance system. High medical costs and the inaccessibility
of medical rvices have broad implications for China’s future. One
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indicator of the current state of the health care system in rural China
has been declining health indicators and poorer health outcomes. A
new Cooperative Medical Scheme has been introduced, but in order
for it to be successful, the Chine government must take a number
of measures. This paper prents a few recommendations.
Paper prepared for the International Economic Development Program
The Gerald R. Ford School of Public Policy
University of Michigan
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April, 2006
Introduction
Providing healthcare in poor, rural regions is a notoriously difficult task. Enormous obstacles exist in trying to provide quality care in areas that are impoverished and remote. There are education challenges in informing the public about health prevention and techniques as well as difficulties in constructing a health infrastructure with limited resources. China’s rural areas are no exception. Although China’s economy has rapidly expanded in recent years, many of the benefits have been concentrated in urban areas. The rural areas are still extremely poor. In fact, rural areas were arguably better off, in terms of health care, before the Chine government implemented the reforms that catalyzed China’s recent economic growth. Of the many rural health care challenges, the one that particularly afflicts China’s contemporary rural society is access.
Access to appropriate and needed medical treatment in health care systems is bad on five principles: availability, accommodation, accessibility, acceptability, and affordability (Penchansky et al. 1981).1 Problems with any of the by definition compromis access to care. For instance mistrust of health care providers in rural China (acceptability) (Liu et al. 2003); or long travel times and cost of transportation (accessibility) are factors affecting access to care in rural China today (Liu et al. 2003). Although each of the factors is intimately related to access to care, the primary problem limiting access to care in rural China is affordability. Affordability refers to the ability and methods that people in rural China u to pay for needed health care rvices.
1 Lecture by Professor Richard Lichtenstein, University of Michigan School of Public Health on “The 5 A’s of Health Care Access.” On September 29, 2005.whisper是什么意思
Historical Background
Access has become an important issue in modern China becau recent reforms have undermined a once successful rural health care strategy. In June 1965, at the beginning of China’s Cultural Revolution, Mao Zedong criticized the Ministry of Public Health when he said, “In medical and health work put the emphasis on the rural areas!”(Sidel et al. 1982). China’s population was notoriously unhealthy at this time, with an average life expectancy of approximately 40 years (World Bank. 1997). China’s health care system was one of the first institutions to undergo major reforms during the Cultural Revolution. The new emphasis was on prevention, sanitation, and financial “lf-reliance” (zili gengsheng) (Sidel et al. 1982.).
Prevention was a successful, cost-effective public health strategy. Rather than using expensive medicines to treat illness, emphasis was placed on immunizations, prenatal care, family planning and sanitation. The preventive strategies could be implemented without medical experts and so the Chine government trained individuals lected by their peers (Sidel et al. 1982), who lived and
worked within their local communities to implement national health campaigns. The paraprofessionals were known as the “barefoot doctors”. The barefoot doctors focud on grassroots public health interventions that prevented common infectious dias such as schistosomiasis and malaria. The simple interventions had a substantial impact on rural health.
Becau of their common backgrounds and minimal required training, the government was able to provide widespread access to the barefoot doctors. In regards to issues of acceptability, rural Chine citizens trusted the barefoot doctors becau they were more interested in positive health outcomes than power and prestige, and they were members of the community. Barefoot doctors provided affordable care to all villagers. They provided free
preventive and primary care, while patients paid a coinsurance fee for medicines, and condary care. A higher fee was charged for inpatient care.
Throughout the Cultural Revolution, it was emphasized that a physician’s reward should be measured in spiritual rather than material terms. Thus, focusing on the common good ead the challenge of financing a health care system as exemplified by the barefoot doctors who were content with treating their less educated neighbors for the same pay as a farmer. This program was a clear success. By 1982, life expectancy had incread to 69 years (World Bank, 1997).广州留学机构
During the late 1970’s, China’s health care system underwent significant changes. Economic reforms toward privatization and a free market philosophy had taken hold in Chine society. The gradual shift away from patriotism as a basis for work-motivation shattered the ideological ba of the barefoot doctor movement. China’s movement towards a market economy caud the central government to reduce investment in health rvices (Blumenthal et al. 2005). Thus, health care was no longer covered comprehensively for rural Chine citizens. Without government funding, the barefoot doctors program collapd. Former barefoot doctors were now forced to be profit driven.
Since 1985, institutional health providers such as hospitals have been required to be financially lf-sufficient, since government funds generally cover no more that 15% of operating costs (World Bank. 1997), hospitals have been forced to focus on lling profitable procedures such as x-rays, injections, drugs and lab tests. This profit-making focus often results in patients receiving unnecessary procedures and having to pay higher medical costs than necessary. Over-treatment is estimated to be 60.5% of the total cost for treatments in rural health care clinics and 75% of drug prescriptions in rural health care facilities are thought to be unnecessary (Meng et al. 2000). Yet, the overall effect of the rural health care system becoming
profit driven is vere increas in prices, which cau vere constraints on the affordability of acce
ss to care in rural China (Y Liu et al. 2003). The major price increas have coincided with a decline in medical insurance coverage in rural China making health care inaccessible to most of China’s rural residents.
Table 1: Ri in Medical Costs and Decrea in Insurance coverage in China
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Source: Y Liu et al. 2003
Current Situation
Although China is experiencing one of the greatest periods of economic growth in history, the percent of GDP being spent on health care has failed to increa. The rural Cooperative Medical Sys
tem is practically non-existent in 90% of China’s villages. Where the CMS system still exists it is mostly voluntary, causing many villagers to not participate. And corruption among local officials has further hurt the chances of reviving a cooperative medical system (Meng et al. 2000). Table 2, below, displays the stagnant level of GDP spent on health care in China.
