China's new health plan targets vulnerable

Abstract

When 18-year-old factory worker Dou Huhai came down with a cold, after a 15-hour shift at a zipper factory on the outskirts of Beijing, he had neither the money nor the time to see a doctor so he just took some medicine. The following day, still drowsy from the medication, he caught his left hand in his punching machine. The machine that snagged Dou's hand crushed two of his fingers. He was taken to the county-town hospital, and then transferred to the Armed Police Hospital, where a doctor told him that it was going to be possible to salvage most of his fingers, but when he discovered that Dou could not pay for the operation, and had no insurance coverage--at least as far as he knew--the doctor performed a simple amputation. Dou's boss paid, but when Dou demanded compensation he was fired. did not have a labour contract, Dou says. Nor do I have the health insurance through my employer. No one would hire you here, if you insisted on having one. Dou comes from a peasant family in Shaoyu Town, Xihe County, in Chinas north-western Gansu Province and is one of Chinas estimated 200 million migrant workers. Health coverage should now improve for people like him. Just nine days after Dou started work in the zipper factory in April 2009, the government announced plans to provide universal access to essential health care to all residents in China by 2020. If fully implemented, the reform will spell the end of the market-based mechanisms that had been gradually introduced since the early 1980s; after 30 years of covering more than 90% of medical expenses for urban residents and providing basic, low-cost healthcare services to the rural population. The fact that Dou did not know if he had insurance coverage comes as no surprise to Wei Wei, the founder of Xiao Xiao Niao, a Beijing-based nongovernmental organization defending the few rights that migrant workers have. He says that migrant workers rarely know if they are insured and that this is partly why there are no reliable statistics on how many are covered. A survey carried out by the China Development Research Foundation back in 2000 revealed that fewer than 3% of migrant workers were covered by health insurance schemes, and those who were covered had only limited access to health-care services. Since then, the situation has improved somewhat. Now over 30 million migrant workers are covered by the Urban Employee Basic Health Insurance Scheme (URBMI), according to the Chinese Medical Insurance Association. As a result of Chinas 1978 economic reform, health-care coverage shrank dramatically. Among the rural population, it dropped to less than 10%. And even in the cities from the late 1970s to mid-1980s, people found themselves suddenly vulnerable as urban medical insurance ceased to cover the dependants of salaried workers and many workers were laid off owing to restructuring of state-owned enterprises in the early 1990s. The amount of health care that consumers had to pay for out of their own pockets rose sharply from just over 20% in 1980 to a high of 60% in 2000. Just as pernicious was the impact of reform on the supply side. Having previously benefited from state funding, hospitals suddenly had to survive on patient fees. Doctors at state-owned hospitals started prescribing medicines and treatment on the basis of their revenue-generating potential--both for themselves and the hospital--rather than for their clinical efficacy, a practice that continues today. [ILLUSTRATION OMITTED] Since 2003, the government has focused on two main types of insurance: the New Rural Cooperative Medical Schemes (NRCMS), which were initiated in 2003 for rural populations; and the URBMI, first piloted in 88 cities in 2007. These schemes are heavily subsidized with the government paying up to 80% of the premiums. According to Dr Lei Haichao, Director of Policy Research at the Ministry of Health, the NRCMS now covers 833 million of the rural population, while URBMI covers 337 million. …