Health System Ill Due to Market Reforms

By Antoaneta Bezlova, IPS, 18 August 2000

BEIJING, Aug 18 (IPS) - The news that hit the headlines of Chinese newspapers this month was shocking: A three-year-old boy, who suffered serious burns in the middle of the night, was refused treatment by four hospitals and later died.

By the time Maomao reached the fifth clinic in his hometown of Urumqi, capital of the Xinjiang Autonomous Region in north-west China, it was too late. The boy died from serious dehydration as the frantic night was changing into another day.

Despite the remoteness of Xinjiang region, the incident shocked the entire country.

The news, first reported by the local 'Xinjiang City Daily', made it right to the 'People's Daily' -- the highly-censored flagship of the Communist Party.

In early August, the paper ran a heart-wrenching report of the night Liu Guangxiang, whose pet name is Maomao, was turned away by the hospitals. It also published a critical expose of how the medical staff was trying to completely shirk responsibility for the tragedy.

An avalanche of readers' letters followed reports of the case by newspapers across the country, reflecting public concern about a deepening crisis in China's health system and the increasingly frequent occurrence of such deplorable incidents as Maomao's rejection by hospitals.

How could there be so many cold-hearted people?, screamed one letter, sent to the 'China Youth Daily'. Don't we all have children and where has our humanity gone?

But Maomao's death points to something more than just a crisis of moral values.

As China dismantles its socialist welfare system that gives cradle-to-grave support, it is making people pay for everything from housing to education and medical treatment. However, the least successful and most criticised of reforms have been those of its health system.

After market-oriented reforms were launched in the 1980s, Beijing introduced parallel health reforms based on patients' charges and privatisation.

This meant that the state was no longer a free provider of health services, and that hospital directors were responsible for making their concerns profitable.

This is also what proved to be the fatal trap for Maomao and his parents.

On the night of Jul. 16, the boy accidentally fell into a tub of boiling water, and suffered severe burns. While the mother was holding the screaming child, his father Liu Huadong went to knock at his neighbours' doors and beg for money needed for the hospital deposit.

Upon hearing what has happened, Liu's neighbour willingly parted with his 5,000 yuan (600 U.S. dollars), an amount he had set aside for home renovation.

But when the family reached Urumqi No. 1 People's Hospital, the doctor on duty refused to treat the child unless the parents paid 20,000 yuan (2,400 U.S. dollars) in advance.

Dreading the worst, Liu went down on his knees and begged the doctor to start treatment, saying he would raise the money with friends later. He was curtly refused.

Over the next three hours, the parents took the boy to three other hospitals, but were refused at each one.

The Autonomous Region Construction Workers' Hospital did not have a ward for burning injuries. The Autonomous Region People's Hospital and Xinjiang Medical University Hospital did not find free beds for the child.

Maomao died a couple of hours after being admitted to the Military Region General Hospital, his fifth stop during the deadly journey that night.

Couldn't they admit the child first, and discuss the next step later? asked Maomao's tearful mother.

Yet no one wants to bear expenses for those who cannot pay. Due to a lack of funds from the state, all four hospitals that refused treatment were found to be in the red, according to media accounts.

Deposits by patients before hospital treatment serve as a guarantee to prevent potential non-payment. Because many cities still lack a medical insurance system, sometimes people have to pay exorbitant medical fees from their own pockets.

Underfinanced, hospitals sacrifice medical practices in favour of profitable curative treatment, such as sale of medicines, systematic use of injections and long and expensive periods of hospitalisation.

When Chinese premier Zhu Rongji came to power in 1998, he promised to have the new medical insurance system established in urban areas by the end of 2000. But numerous reports in the state press this year show the reform has still a long way to go.

Sweeping away the old system has led to two extremes in medical practices nationwide.

In the capital, where medical units operate under the scrutiny of central health administration, hospitals in general do not refuse treatment. But they are burdened with the heavy load of patients' debts.

In May, Beijing Children's Hospital was reported to have 2.9 million yuan (350 U.S. dollars) in unpaid bills.

In the provinces, away from the control of the central health administration, medical practices are unregulated. This means that patients who lack the means are flatly refused treatment, or become trapped in the conflict between disgruntled medical workers and cash-strapped clinics.

Another widely reported case in the press is that of 68-year- old Yu Yinxiu, who was left to die in the Hunan Qianshanhong Hospital while all staffers were on strike to protest unpaid salaries.

After the public outcry generated by Maomao's death, his father wishes that what happen to my child will never happen again.

But the reality is much harsher. At the root of the problem is the absence of the state, and the lack of public funding or control, in a vital social sector.

While this plagues China's health system, it is hard to say there will be no more needless and preventable deaths of children.