Insurance a cure for medical woes(3)

Two-tier system 

Zhao and Li bought identical health insurance, so they should have enjoyed equal benefits, but their cases are very different. Millions of migrant workers face the same plight as Li if they get sick far from home. 

China had 262.61 million migrant workers in 2012, according to official data from the National Bureau of Statistics, but Dai Baozhen, vice-president of the school of management at Jiangsu University believes the real figure could be much higher. 

The second generation of migrant workers is totally different from the first. People are heading to the cities not only to earn a living, but also to settle down and, unlike their parents, many choose to take their families with them. 

"More farmers are now expected to pour into cities and towns to seek a new life after Premier Li Keqiang pledged that migrant workers would enjoy the same benefits as urban residents. However, there are many difficulties to overcome before that goal can be realized. One of them is the provision of effective medical insurance," said Dai. 

Professor Liu Minghui attributed the differences between the treatment received by Zhao and Li to the nature of the urban-rural divide, which has resulted in a two-tier medical insurance system. 

"Because of their special situation, migrant workers occupy a gray area between the Basic Medical Insurance System for Urban Employees and the NCMS," said Liu. 

"The NCMS mainly provides health care for permanent rural residents but, in an ideal world, migrant workers would also be provided for under this system. However, although these people have spent a long time working and living in the cities and towns, if they want to benefit from the welfare system, they have to go back to the place where they have hukou. But that would be extremely expensive, of course, and if they have a serious illness, time is also a factor. Therefore, it's hard for them to gain any real benefits from the NCMS," he said. 

Migrant workers are classified as urban residents when official statistics are collated, but compared with genuine urban residents, migrant workers rarely enjoy the same access to welfare, Liu said. 

"Since China launched the reform and opening-up policy at the end of the 1970s, the national labor force has become much more mobile. The main flow trend is from undeveloped inland areas to developed coastal areas. The huge disparity in the levels of economic development from region to region has resulted in major differences in the levels of medical insurance cover and welfare," said Bai Chong'en, vice-president of Tsinghua University's school of economics and management, at the China Development Forum 2013 held in Beijing in March. 

"At present, medical insurance falls within the scope of each city, but the situation differs from each province and region and that has limited the transfer of reimbursement for medical fees from place to place and hindered the flow of labor resources," said Bai. 

Under the State Council's 12th Five-Year Plan for Social Security (2011-2015), the relevant government departments are obliged to formulate ways of ensuring that medical payments can be reimbursed no matter where a patient receives treatment, whether it's the place where they hold household registration or not. 

"It's not the first time the central government has made this stipulation, but so far the effects have not been obvious," said Bai.