To change traditional medical care services, which are inconvenient and inefficient for both the patients and the doctors, Li, 56, set up the clinic in Wuzhi County in central China's Henan Province along with three other former barefoot doctors.

The small clinic is equipped with basic medical facilities and various medicines, and the doctors in Zhengzhou work round-the-clock in rotation to provide fundamental medical services to local people. In cases of serious and urgent diseases, patients are sent to superior hospitals for better treatment.

More than 2,000 villagers have come to the clinic to receive medical treatment. They spend no more than five yuan each time for the treatment of ordinary symptoms such as colds and gastroenteritis.

Xing Donglin, 75, has managed to get his chronic hypertension under control since he started seeing the doctors every week. In the past, he had to go to the countryside hospital five km away just to get his blood pressure measured, and the treatment fee was much higher.

Li's clinic may be considered a trial case in the local government's effort to reorganize China's outdated rural medical system by introducing the market economy.

Around one third of the county's former barefoot doctors, who also work on farmland, have been organized by local governments to work in the new health care system.

They are allowed to open clinics with their own funds, but all the administrative affairs, medicine purchases and sales, and financial business must be supervised and administrated by local medical authorities.

The state health care authorities have approved the county's invention of the new system and begun to promulgate the experience among other rural areas, where people still face problems seeing doctors.

China created a three-level rural health care system in 1958. The collective economy at that time offered financial support to all the clinics stationed in villages, communes (townships) and counties while the farmers did not need to pay for medical services. During the period barefoot doctors were created to provide health care to people in isolated areas.

The country's three-level system won acknowledgment from international health care organizations for its success in spreading medical services to millions of rural people at a low cost.

But the once prevailing rural medical care system gradually faded in the 1980s, when the rural economic reform took place. Without the financial backup from the collective economy, poor villages could not afford the cost of running clinics, and farmers could not enjoy the welfare of free medical services any longer, said Chen Xiwen, an official from the Development Research Center under the State Council.

Statistics show that more than 700,000 former collectively-sponsored clinics have been transformed to individually-owned ones since 1990. The uncontrolled price increase of medicines and the spread of fake or low-quality medicines, indulged by loose governmental supervision, placed barriers to poor farmers having their diseases cured.

Over 37 percent of Chinese rural people could not afford to go to see doctors, with another 65 percent of sick farmers not having access to hospitals, a 1998 official investigation revealed.

Realizing the incompatible coexistence of the current rural medical care system and the health demands among China's 900 million farmers, more and more rural governments at different levels began to explore various ways, including reforms of investment, personnel management and income distribution systems, to build up a more reasonable medical service system.

The hospital-on-wheels and the chain clinics, which appeared in north China's Shanxi and Hebei provinces respectively, along with other new types of rural hospitals, have become popular among farmers because of their high-quality service and low fees.

A recent national instruction on the reform and development of the rural medical system requires more investment in the field and encourages the development of the newly emerged mechanism.

Under the guideline, China's rural medical reform is expected to enter a new phase of all-round advancement, running on a clear and practical track, analysts predicted, and the dream that all Chinese farmers will no longer fear getting sick and will be able to afford medical fees is expected to come true soon.

(eastday.com.cn 06/27/2001)