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Health Insurance for China's Rural Poor

06/05/09May 6, 2009

One of the most important challenges China faces is the provision of proper healthcare to its rural population in particular. The government recently launched long-awaited health reforms which are suppose to make services affordable to the whole of the population. They include the building of a clinic in every village over the next three years.

https://p.dw.com/p/LsIz
A day visitor receives advice on her symptoms from nurses in a makeshift office
A day visitor receives advice on her symptoms from nurses in a makeshift officeImage: DW / Bölinger

“This is our examination room," says Wang Ying, who is proud of her “hygiene centre” on the outskirts of Beijing. The white walls are freshly painted and the floor is gleaming.

“Anyone can be examined once a year for free," she says. "The county contributes some of the money, as does the village.”

The hygiene centre is two years old and caters to some thousand people, who receive basic healthcare. Treatment is free but patients have to pay for medicine. The village, near Beijing Airport, is prosperous and profits from local tax revenues. It can invest more in healthcare than most villages in China.

“We have nurses, general practitioners and “barefoot” doctors," explains Wang. "We have had this system since the 1950s. Hospitals delegate the doctors. The “barefoot” doctors help the doctors treat the villagers.”

Back to the Mao days

“Barefoot” doctors date back to the Mao era. The communists introduced a free healthcare system in the 1950s.

However, there were not enough doctors for the hundreds of millions of peasants. The state trained “barefoot” doctors who treated peasants for free.

But this system collapsed with China’s adoption of capitalism. For years, there was no affordable healthcare for the rural population.

But as social tension rises, the leadership in Beijing is becoming increasingly aware of the problems faced by the rural population and migrant workers.

Rural healthcare reform is great success

Herbert Stüker was part of an EU team that advised the Chinese government on healthcare reform. He explains that the “introduction of a rural medical community scheme was quite successful because each family has to pay just 10 yuan (one euro) a year and then receives coverage of up to 3,000 yuan a year.”

“Of course, not everything is covered but it’s a type of coverage which is interesting for the rural population.”

Zhao Lianjiang lives just a few streets away from the hygiene centre. “When our district government told us in 2004 that they wanted to establish a cooperative health insurance scheme we joined in,” he recalls. ”But to be honest, we didn’t believe in it. I thought: ‘Why should I pay so much money now?’ I didn’t think it would do much.“

But his contributions have paid off. His daughter has a kidney disease and needs regular dialysis. Even though Zhao earns more than the average peasant, the treatment is too expensive for him alone. Most of it is paid for by his insurance scheme. The central and provincial governments share the costs not covered by contributions.

According to government estimates, 700 million peasants are already taking part in the scheme. A pension scheme is set to follow. The aim is that each Chinese citizen should have minimal health insurance and a pension scheme by 2020.

Author: Matthias Bölinger/Anne Thomas
Editor:Thomas Bärthlein