Huo Yulan had suffered from hydrocephalus, a brain disease, for decades before she finally agreed to have an operation in the Beipiao County Hospital, Liaoning Province in northeast China last March.

The 51-year-old woman farmer of the Xiafuxiang Village, 22 kilometers away from the county seat of Beipiao, had dragged on with her chronic disease simply because she could not afford the operation cost of nearly 10,000 yuan (US$1,204.8), although Huo's family with an annual income of 3,000 yuan (US$363.8) is considered "well-off" in the village.

"I might still be hesitating if not for the cooperative medical care," says Huo, now free of the abnormal increase in the amount of cerebrospinal fluid in her brain. She used to cope with the pains with some anodyne or medicine for flu she bought from village medics.

But when she caught a cold again last March, the pills didn't work. The helpless Huo thought she was going to die this time, when Beipiao started the program of cooperative medical care in rural areas as a pilot county.

Huo became the first beneficiary of the program and had 3,060 yuan (US$368.7), or one third of her total medical cost reimbursed. Although she still paid 6,000 yuan (US$723) on her own, Huo is grateful that the government footed part of the bill for a farmer for the first time in many years, which almost saved a whole year's income for the family.

"Now that I'm cured, I could work harder after recovery and try to pay back the money I borrowed from relatives as soon as possible," she says.

In fact, the program now under trial run at Beipiao and other counties across the country is part of the effort to re-establish the cooperative medical care system in rural China that collapsed in the early 1980s, following the introduction of the household contract system and the fall of collective economy.

One of the advocates for the restoration of the system is Wang Xianzhen, a 39-year-old doctor of the No.2 Hospital in Chaoyang City which has Beipiao under its jurisdiction, who filed a bill for it at the National People's Congress, China's top legislature, in 2003, when she was first elected deputy to it.

A gynecologist for 16 years, Dr. Wang has seen farmers even poorer than Huo. More than half of Chaoyang's rural population of 2.47 million, 74% of the city's total, cannot afford going to hospital, and half of the 40,000 farmers living below poverty line are impoverished by disease, according to Wang. 

"They are not covered by any medical insurance and their only approach to illness is to endure," says Dr. Wang, "which only aggravates their cases and eventually make them poorer."
Zhu Qingsheng, Vice Minister of Health, estimates that 40 percent to 60 percent of the farmers, or one third of China's total population, couldn't afford medical treatment in hospitals or impoverished by hospitalization. In some poverty-stricken regions, especially in western China, up to 60 percent to 80 percent of the sick die at home as they have no money for the hospital.

The farmers are reluctant to go to hospital mainly because their meager income and the medical cost are disproportionate. In 2003, says Zhu, the per capita annual income for rural Chinese averaged at 2,622 yuan (US$315.9), while the average medical cost for every hospitalization was 2,236 yuan (US$269.4), almost all their entire earnings of the year.

Meanwhile, the township and village clinics, once supported by the state and collective funding to cover most of the rural population, have been on the wane. In Chaoyang, one third of the township clinics supported by the state funding have closed down. Another one third are run in poor condition.

At Wujianfang Clinic, a "decent" one considered by local health officials, most of the equipment are out of date or in need of repair. The B-mode ultrasonic machine shows no blood vessels; the anaesthetizing machine has its wheels tied to it with plastic ropes; and there is no facility to test blood.

"To upgrade the facilities we need around 1 million yuan (US$120,000), while the government allocation is just 50,000 yuan (US$6,024.1) a year," says Wang Dajun, head of the clinic serving a population of 35,000 in the township. Wang, like the other 34 staff members, earns only 300 yuan a month. The low pay can hardly keep the doctors, many of whom have left to run their own clinics.

"Private clinics, which spend less on equipment maintenance and medicine purchase, could survive more easily," says Wang, but he doubts if most of them could be really helpful in curing diseases.

Dr. Wang Xianzhen is not the first NPC deputy to call for the restoration of the cooperative medical care system in rural China. The NPC records indicate that a deputy from Shanxi made a similar proposal as early as in 1994, and to date, it has received 24 bills on the issue, most of which were filed in the past two NPC sessions, including two by Dr. Wang from Chaoyang.

To her pleasure, three months after she submitted her bill in 2003, the Ministry of Health began the piloting of re-setup of cooperative medical care system in rural areas. Till October 2004,the system had been extended to 333 counties in 31 provinces, municipalities or autonomous regions, with 80 million farmers involved.

At Beipiao, a farmer who is willing to take part in the program is to hand in 10 yuan (US$1.2) a year out of his own pocket, while the provincial, municipal and county governments jointly put in another 20 yuan for the farmer. In case he is hospitalized, the farmers could have part of the expense reimbursed, at a rate of 15percent to 55 percent, depending on the cost of medical expenses incurred.

Li Shuyang, head of the Beipiao Health Bureau, says the farmers' response is satisfactory. "Currently, 360,000 farmers, or91.8 percent of the farming population in the county, have joined the program."

In just three months, 143 farmers in Beipiao have received a total reimbursement of 460,000 yuan (US$55,421.7). Liu Yajun, a doctor with the Beipiao County Hospital who treated Huo Yulan, is glad to see more patients are coming from the countryside.

"At this season in previous years, my department of chirurgery had just a dozen inpatients, most of whose cases aggravated by delay. Now our inpatients have more than doubled."

Also delighted at the change, Li Shuyang plans to enhance the 28 state-funded township and village clinics with the new system. Under the system, the patient who spends over 4,000 yuan (US$481.9)in village clinic could enjoy reimbursement, while in county hospitals he has to spend over 6,000 yuan (US$722.9). And the rate of reimbursement is higher in village clinics than that in county hospitals.

Regarding it as an opportunity, Wang Dajun, head of the Wujianfang Clinic, is also concerned over the program's sustainability. "Two million yuan (US$240,000) is everything but a small amount for the Beipiao government," he says, recalling that they had tried four times to promote cooperative medical service from the late 1970s to 1990s and all failed.

"But in those times the provincial governments of Liaoning and the municipal government of Chaoyang were not involved," he added, hoping this change could make a difference.

Despite all the problems, says Zhu Qingsheng, the vice minister, the Chinese government is determined to have all farmers involved in the new cooperative medical care by 2010.

(Xinhua News Agency October 3, 2005)