China's insurance builds AIDS care safety net

After living with AIDS for eight years, it has become routine for Yuxuan, pseudonym of a 33-year-old man in east China's Jinan City, to pick up antiviral infection drugs from a nearby disease control center every month.

"The prescription drugs are all free. I only pay for the blood test that I need once a year," he says.

However, speaking about World AIDS Day on Saturday raising awareness of the difficulties experienced by people living with AIDS, Yuxuan says he has been lucky not to have suffered any opportunistic infections yet, which would entail expensive medical treatment.

One of his HIV/AIDS friends developed paralysis after an infection. He has spent 200,000 yuan (32,000 U.S. dollars) for treatment, which is not covered by any public insurance available for AIDS patients, according to Yuxuan.

He dreads something similar happening to him, saying, "If it did, my family would be broke."

Happily, this is set to change, as part of increasing China-wide efforts to finance AIDS-related health services. The provincial government of Shandong, where Yuxuan lives, announced ahead of World AIDS Day that it is aiming to include medical care for AIDS into the Medical Insurance of Serious Illness by 2015.

Gao Dai, deputy director of the Disease Control Department of the provincial health bureau, said on Saturday that good progress is being made to cover medical costs for more diseases linked to AIDS-related opportunistic infections with basic medical insurance.

Vice Premier Li Keqiang promised on Monday that the government will study the possibility of having spending on anti-HIV infection treatment covered by the basic medical insurance scheme for urban residents, as it already is in rural areas.

Currently, besides the prescription antiviral infection drugs handed out all for free, publicly funded medical care programs in townships and cities, including the Basic Medical Insurance for Urban Workers and the Basic Medical Insurance for Urban Residents, can only help refund basic medical expenditure for HIV/AIDS patients, but not that of hospital treatments.

Yuxuan, therefore, goes to a general hospital whenever he has a minor problem such as a cold.

"I just go to see doctors in general hospitals like other normal people without mentioning my having AIDS," he explains.

He doesn't like to go to local designated AIDS hospitals, where, as he says, medical facilities are not on a par with general hospitals.

"If I had really serious problems, I would go to more prestigious AIDS designated hospitals like You'an Hospital and Ditan Hospital in Beijing," he adds.

Like Yuxuan, most Chinese living with HIV/AIDS receive therapies at home unless they have serious complications and need hospital care.

The Ministry of Health said on Wednesday China had reported a total of 492,191 cases of HIV/AIDS by the end of October, including 68,802 new ones this year.

China's AIDS prevention and control has a four-tier system, with the lowest level disease control centers set up in districts and counties.

Hu Yanxia, director of the HIV/AIDS Prevention Research Institute under the Jinan municipal disease control center, explains that if a lower-level center monitors that somebody is HIV positive, it reports to its higher level units and sends the blood sample to designated test labs. The center then traces the patient's therapy for the rest of his or her life and ensures the patient gets access to antiviral infection drugs.

"The whole procedure features closed-off management for the protection of the patient's privacy," she says.

China has established a free voluntary counseling and testing (VCT) network by equipping 2,966 counties around the country with 14,305 AIDS screening labs, 339 confirmation labs and 8,899 VCT outpatient clinics.

Besides the free services and the basic health insurance, AIDS patients can also get a steady monthly subsidy from governments at various levels.

In central Henan Province, which has a high HIV/AIDS prevalence mainly through blood transfusion accidents during the local blood-selling scandal of the 1990s, the provincial government provides 600 yuan per month to each of its 55,424 residents living with HIV/AIDS.

As 90 percent of the HIV carriers in Henan are rural residents, their medical payment can be covered by the New Rural Cooperative Scheme.

For example, an enrollee can have 90 percent of his medical bill of over100,000 yuan refunded through the program.

The provincial government has vowed to increase public funding to the insurance fund to 150,000 yuan this year, up from 100,000 yuan last year.