Reforms bring affordable health care to poverty-stricken county

For farmer patient Luo Birong, hospitalization was a luxury until the implementation of health care reforms in her home county of Sangzhi in central China's Hunan Province changed the situation.

The middle-aged Luo is from Chishiping village in Sangzhi's Changtanping Township. One year ago, she was diagnosed as having a ganglion, or a mass of nerve cell bodies, in her wrist.

Luo refused to be hospitalized, as the 800-yuan (127 U.S. dollars) treatment fee was too heavy a burden for her family.

Luo's case is not the only one of its kind in Sangzhi, a poverty-stricken county with an annual per capita income of only 2,910 yuan. Unable to afford medical bills, county residents who fall ill are often forced to leave their afflictions untreated.

But things began to change last August, when the county began trying out a new health care policy that allows all inpatient clients at the county's township-level hospitals to have nearly all of their medical bills reimbursed. The policy requires inpatient clients to pay just 150 yuan toward their medical bills, with the government covering the rest.

Encouraged by the reform, Luo went to a hospital in Liyuan Township in mid-April to have her ganglion treated. She received reimbursement to the tune of 1,179 yuan, covering nearly all of the 1,329-yuan bill she received for her eight days of hospitalization.

Health care reform is one of China's most challenging tasks. The Chinese government unveiled an 850-billion-yuan (US$127.7 billion) three-year plan for medical reform in 2009, aiming to provide universal and affordable medical services to the country's 1.3 billion people.

As part of the plan, a cooperative medical service has been introduced in China's vast rural areas over the past three years. The service is similar to the reimbursement policy introduced in Sangzhi, asking rural residents to pay a small amount of money toward their bills in exchange for substantial reimbursements.

Zhang Desheng is a diabetes patient from the village of Xian'e in Liyuan township. His condition requires him to make regular hospital visits, the cost of which soared to nearly 8,000 yuan a year at one point.

These days, Zhang needs only to pay 150 yuan each time he receives treatment at the local hospital.

"I previously had to sell a cow to be hospitalized, but now, selling two hens is adequate, Zhang said.

Quan Jiaolong, deputy chief of the county's health bureau, said rural cooperative medical funds collected from local residents and the government have exceeded 100 million yuan, which is intended to cover all medical bills incurred in the county's 46 township-level hospitals.

"All we have to do is take full and good advantage of the funds," Quan said.

The county has also made efforts to cut costs for patients by banning the use of expensive medications and maintaining stricter control over the expenses of local hospitals.

In the 46 township-level hospitals, any medication prescribed must be on a national-or provincial-level "essential drug list" consisting of 505 fundamental medications, Quan said.

"All of the hospitals' drugs are factory priced with no markups," he said.

Expenses incurred by hospitals are required to be recorded, audited and approved by the local health bureau, Quan said.

Unlike traditional public hospitals, in which medical practitioners are paid based on hospital income, township hospitals in Sangzhi have begun paying their staff on the same scale as civil servants.

Experts believe these measures will effectively reduce unnecessary prescriptions, arbitrary charges and redundant checkups, all of which are commonly used in public hospitals to increase the incomes of hospitals and doctors.

More than 15,000 of Sangzhi county's residents have benefited from the reforms, which have since spread to other locals in Hunan. About 46 million of the province's residents are expected to receive full coverage for their medical bills by the end of this year.

Ma Jin, a professor of public health at Shanghai Jiao Tong University, warned that the reforms only cover basic medical costs.

"Reimbursement is only available for bills at township-level hospitals, which means those with serious diseases, who usually have to be treated in larger and better-equipped hospitals, will still have to pay by themselves," Ma said.

"The reforms should be more deeply implemented," he said.