Access to Healthcare and the Rural-Urban Discrepancy
Last May 9, an interesting overview about the health care system in the Chinese countryside was published in the Japan Times. Despite the efforts of the Chinese central government, access to health care remains a critical source of inequality between the city and the countryside. Here we focus on the main challenges lying ahead.
Hospitals in the city are often swamped and prohibitively expensive. Under Mao, the investments in health care infrastructure were concentrated on urban hospitals. This remains the case today, as a severe lack of resources and new investment in rural areas suggests that, despite encouragement from the central government, local governments are today still reluctant to invest sectors that may not be immediately profitable. Cutting-edge hospitals are primarily located in cities and are far better equipped than facilities available in the countryside. Yet on the other hand, the decrease of state subsidies after the opening-up of the economy in the 1980s forced hospitals and doctors to search for supplementary or alternative income sources. The general tendency is to often prescribe unnecessary and expensive drugs to patients.
Reducing the cost of access to healthcare has only been partially successful. Healthcare cost still remains a significant barrier that prevents rural people from seeking medical attention and care. In 2003, the government introduced the New Rural Cooperative Medical System (NRCM), a system allowing the rural population to have about 60% of their medical costs covered for an annual contribution of 10 yuan. This plan, however,remains inaccessible and impractical to migrant workers, who have no medical coverage within the city.
There is also a severe lack of medical personnel. Rural areas thus suffer from a double shortage of both infrastructure and personnel. Underdeveloped and unattractive to some, the areas do not attract many doctors, who often prefer to practice in cities. The government has recently announced plans to encourage retired doctors to practice in the countryside, but no further details have been released. Other measures are also being considered, including offering free tuition to medical students in exchange for their service in rural areas upon graduation, or lowering the average exam requirements for students who wish to practice in the countryside.