A lack of medical insurance and financial difficulties, plus high medical costs, are deterring an increasing number of people from seeking medical help and going to hospital, a recently released survey indicates.

The Third National Health Survey, which was conducted between September and October last year, estimates that 13.83 million people with ailments who needed to be hospitalized in 2003 failed to do so, which is 2.46 million more compared with 1993 and 5.89 million more than 1998.

Even though the number of sick people has been increasing, with a total of 5 billion cases of illness reported in 2003 -- 710 million more than during the second survey in 1998 -- the actual medical consultation rate has been decreasing.

It is estimated that people consulted medical advice 4.8 billion times in 2003, which was 540 million and 580 million times less than during the two previous surveys in 1993 and 1998.

Rao Keqin, director-general of the centre for health statistics and information at the Ministry of Health, attributed the situation to the low number of people who have medical insurance, the rapid increases in medical costs and limited access to healthcare for low-income groups.

The survey indicates the coverage rate of medical insurance in urban areas has been decreasing, while the rate in rural China has been climbing.

Last year, more than 55 per cent of the urban population had medical insurance, which is down dramatically from the 1993 figure. At that time, almost 73 per cent of the urbanities enjoyed some kind of medical subsidies.

Rao says it is because the country's medical reform has kicked in and the market economy has been introduced.

At present, medical care plans differ greatly as only government employees and workers at State enterprises are eligible for government medical care subsidies. For others, some are given medical insurance policies by their employers while some buy medical insurance themselves.

In rural areas, thanks to the co-operative insurance programme which has been running since 2001, the coverage rate of medical care has increased from almost 16 per cent in 1993 to 21 per cent last year.

However in most cases, it is the rural poor who suffer the most as they have to fend for themselves.

As there are almost 768 million people in rural areas, the percentage of the population who are not covered by insurance is huge.

Rao says it is easy to understand that people who are covered by insurance are more willing to seek medical treatment at hospitals.

And conversely, for people who have no insurances, especially the rural poor, being hospitalized will almost certainly create heavy financial burden and leave them in debt.

Medical costs have been rising steadily over the years. The annual outpatient medical cost per person between 1993 and 2003 has increased from 30 yuan (US$3.6) to 66 yuan (US$8).

And the costs for inpatient medical services have also doubled during this period.

When the average income of the country's rural residents was only 2,622 yuan (US$315) last year, the average inpatient hospital costs for a farmer ran as high as 2,236 yuan (US$270).

It means those average households which may have just been beginning to get ahead financially are rapidly dragged back into dire poverty when a family member falls seriously ill.

In 2003, among those patients who were not fully recovered but discharged by a doctor, almost 64 per cent of them left hospital due to the financial difficulties.

Of all the people who have been in Chinese hospitals, more than 43 per cent have discharged themselves without doctors' consent.

Another reason for the increasing number of patients is due to the rise in people's health awareness as society rapidly develops, Rao said.

Urban residents are mainly threatened by chronic diseases such as heart illness and diabetes.

And the rural population is often decimated by chronic diseases and infectious diseases like HIV/AIDS and tuberculosis.

Despite the problems, the survey indicates that great progress has been made in public health, which includes greater awareness of the need to live a healthy life and maternal and children's healthcare.

According to MOH statistics, the infant mortality rate has decreased from 47 per 1,000 to 29 in 2002. And during the same period, the maternal mortality rate has dropped from 77 to 43 per 100,000.

The survey also shows that 38 per cent of women in rural areas give birth at home in 2003, although it was down considerably from 1993's 78 per cent.

In 2003, about 20 per cent of rural residents still had to drink unsanitary water. Ten years ago, the rate was 48 per cent.

Efforts for the mass immunization of children have dropped off in recent years especially at the grassroots level, although the coverage is still regarded as quite good.

According to the survey, 90 per cent of children had been vaccinated against diseases such as polio and the measles. However, 20 per cent of them have not had Hepatitis B shots, despite the central government listing it as a must have in 2002.

The survey sampled 57,023 households, including 193,689 people.

(China Daily December 9, 2004)