Health vs. Wealth in China

This is a subject of tremendous interest because it’s a key factor in the rural unrest that keeps surfacing to shed an ugly shadow on China’s dazzling economic success. It rasies all sorts of questions, including fundamental issues of how a nation – especially one that aspires to superpower status – deals with its underprivileged citizens whose lives are at risk due to accidents or disease. Will only the wealthy have access to medical care while the poor are left to die?

When Jin Guilian’s family took him to a county hospital in this gritty industrial city after a jarring two-day bus ride during which he drifted in and out of consciousness, the doctors took one look at him and said: “How dare you do this to him? This man could die at any moment.”

The doctors’ next question, though, was about money. How much would the patient’s family of peasants and migrant workers be able to pay – up front – to care for Mr. Jin’s failing heart and a festering arm that had turned black?

The relatives scraped together enough money for four days in the hospital. But when Mr. Jin, 36, failed to improve, they were forced to move him to an unheated and scantily equipped clinic on the outskirts of Fuyang where stray dogs wandered the grimy, unlighted halls.

China’s economic reforms have turned an almost uniformly poor nation into an increasingly prosperous one in the space of a mere generation. But the collapse of socialized medicine and staggering cost increases have opened a yawning gap between health care in the cities and the rural areas, where the former system of free clinics has disintegrated.

That’s just the beginning. It lends credence, via statistics, to the argument that one of Mao’s few successful achievements was socialized medicine, primitive though the “barefoot doctor” system may have been (especially compared to today’s high-tech medical wizardry). The dismantling of this system has been nothing less than catastrophic for the poor – a catastrophe that ranks right up there with China’s contaminated water.

This is just one of several ticking time bombs that the PRC has to deal with. I don’t envy them their task and I sympathize with the difficulty in handling such an immense crisis. But my sympathy only goes so far, because there’s no denying that for years and years they made the crisis worse and allowed it to crescendo to its present level, just like the pollution.

Update: Interesting twist on this story.

The Discussion: 8 Comments

The kind of diseases that were treated well by barefoot doctors are still easy to treat and cheap. So let’s not confuse that with the category of disease you mentioned above.

Barefoot doctors could not have taken care of the case you mentioned above in the quote, so he would have been left to die in Mao’s era as well.
Remember, barefoot doctors were given less training than American paramedics, usually not paid, and often expected to do their work on their own time after putting in full days on the farm. Their biggest success was in being trained to treat, in an assembly-line fashion, widespread diseases that were easily treatable with an injection or two.

True, there were hospitals available for serious cases, but from what I understand, the barefoot doctors were under strong pressure not to refer anyone. Too many referrals meant no more barefoot doctor status.

If anything, the current situation is an indication that something good is happening. Middle class Chinese now have the luxury of being able to exist with chronic disabling diseases. The sick poor have a voice (see above article and countless others), where they didn’t before. Drugs and treatments from abroad are available that just weren’t there before.

There’s no magic wand that you can wave and make expensive treatment available for anyone.

January 13, 2006 @ 9:54 pm | Comment

boo, I’m willing to buy your argument. But I would also say the people were a lot better off with the barefoot doctors than with what they have now (i.e., nothing). And I am not talking about providing expensive treatments, the kind that would cost a fortune any where. I’m talking about basic treatment. At least they had that, and I’ve read praises of this program even from the most anti-CCP reporters like John Pomfret. So I have to give Mao at least some credit for this, painful as it is.

January 13, 2006 @ 10:38 pm | Comment

If your complaint is regarding lack of basic treatment, why are you showcasing very difficult long-term illness as an example?

Besides, this article indicates that it isn’t quite as bleak a picture. The barefoot doctor in this article actually had nurse training (much more than any of Mao’s doctors), and the indication is that there are quite a few of these people around, that the movement is growing, and that the problem is something people are aware of and are addressing.

January 13, 2006 @ 11:42 pm | Comment

Those illnesses were depicted in the article, and I think an infected arm is not so rare and not so difficult to treat (or, if need be, to amputate).

Thanks for the French article on the comeback of the barefot doctors; it’s very good to know. Still, I have seen countless stories of hospitals dumping sick patients on the side of the road because they couldn’t pay their medical bill in full in advance of treatment. I think its pretty common knowledge that the rural poor have been suffering from lack of available medical treatment. It certainly was when i was there, thought that may have changed over the past two years. Maybe things are much better. French himself is obviously not entirely optimistic about it, or he wouldn’t have written in the article cited today, “according to the government’s own estimates, in less than a generation a rural population that once enjoyed universal, if rudimentary, coverage is now 79 percent uninsured.” Doesn’t sound too pbeat to me.

January 14, 2006 @ 12:23 am | Comment

This is one of the touchiest subjects when it comes to medical care. Richard, you often appeal to emotion, and I sympathize, but there’s not a lot the doctors can do.

Given that there aren’t infinte funds for social medical care, what should be done? Just as a five-star hotel would turn people away who can’t afford them, so must hospitals do the same. It would be nice if all doctors worked for charity, but that won’t happen. Even here, the doctors told the family he didn’t have much chance for survival. (Can’t see the full article, so I’m guessing from your extract)

I think in the US, you’d see a similar thing: A terminal patient is brought in, and the doctors ask “wouldn’t it be better for him to be at home?” More likely though, they’ll just put him in a bed in some wing and let him die there. Then go through the insurance for payment. Otherwise, the family could bring him in via the emergency room, and the taxpayers would pay for him to wait and die there. He’d also be taking up a bed that other emergency cases might use — if they fill up and someone more salvagable comes in, the doctors still can’t kick him out. Doctors can be cold-hearted, and they have to be.

I recently saw an article about how China is trying to improve its healthcare system: they want to raise the minimum standards. Too many hospitals are being created that aren’t staffed with good enough doctors. So what does this mean? It means that the supply of doctors and hospitals will be reduced, and it will result in even less medical care being available for the poor.

I really think China’s best hope is to do away with doctor licensing (I’m showing my Milton Friedman colors). Single-doctor clinics can be set up in almost all villages. Like the barefoot doctors, they’ll be able to treat many basic ailments, and know when the patient needs to go to a bigger hospital. With enough doctors, their prices will drop low enough for peasants to afford. Larger hospitals in the city will be more expensive, and better equipped, aiming for mid- to upper-class clients; small clinics in the villages will be much more basic, but affordable.

January 14, 2006 @ 12:31 am | Comment

I’m no believer in opening the floodgates and spending every last cent on earth to save a human life. And maybe in the case of the boy in this article there was nothing to be done. The reporter was using it as an example of how if you can’t pay your bill in advance you can get tossed onto the street or into a primitive “hospital” even worse than the street. My only point was that some level of health care used to be available to people in need, and that what was once available is not available now.

It is a very tough and complex topic. but maybe there can be some creative answers. Like allowing every medical student to reap some bonus by spending a year of his residency practicing in a rural area.

This is not an argument about when to let a patient die. It’s about offering a minimal level of healthcare to all, as just about all civilized societies do. We can’t give everyone an MRI and put them on $100,000-a-year treatments. but we can let them see a doctor, and seek out the most practical solution under the circumstances. Such options were not available to this boy, and to millions of others.

January 14, 2006 @ 2:06 am | Comment

And let’s be quite clear: conscious decisions were taken by the CPC to move to “user pays” healthcare and education policies and do away with the old socialist model. The shift did not happen out of thin air, policymakers made the choice and now vested interests fight to preserve the inequitable and failed system because they have money and they have no regard for those who do not.

January 15, 2006 @ 12:45 am | Comment

People in the countryside don’t have access to the “medical care” that people in the cities have — and that’s a bad thing? In one instance, at least you have a fighting chance. In the other instance, you’ll probably go into the “hospital” with the flu and come out with hepatitis and get so thoroughly raped in the process that your life savings will be gone. (spent on treatments and tests you didn’t need in the first place).

The problem with the medical system in China is so far beyond country vs. city. If they set up these hospitals in rural areas, most people wouldn’t dare to go to them anyway. The solution? Don’t look at me. No clue.

Yes, if you are a millionaire in Shanghai, you can get decent health care — so don’t bring that up.

January 15, 2006 @ 6:10 am | Comment

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