Tuesday, 27 May 2014

A few fibs about healthcare in China's human rights report

by Michael Woodhead
Don't be too cynical about China's rather self-congratulatory human rights review for 2013. 
 It contains some genuine advances as well as the the usual stuff how much more freedom of speech Chinese citizens enjoy. (The fact that I would not be able to read nor write my blog post or tweet about this report in China because blogspot and Twitter are banned sums it up really). Yes, China has improved human rights if you count lifting citizens out of poverty and providing them with an education and not treating the women like horses. I'll give you that.
But when it comes to the human rights aspects of China's healthcare system, the report is notable for what it leaves out. The report says China has developed a social security system "suitable to China' s current social conditions'. More specifically for health it says that China has established a basic national medical insurance system, that covers than 1.3 billion people, or over 90% of the population. Government subsidies for basic medical insurance for have risen from 40 yuan per person in 2007 to 280 yuan in 2013. It also claims that the reimbursement rate for hospitalisation expenses covered by relevant policies has been raised to around 70%. There are many more figures like this that make it sound as if China now has a functioning health insurance system that covers most of the population. As you will know if you have read many of my previous posts, this simply isn't the case.  The reality is that China's medical insurance scheme coverage of expenses is minimal and fragmented. It's a user pays system and most Chinese people still face high out of pocket expenses for even the most basic hospital treatment. Look at this new report from Guangzhou on the impact of health insurance on the burden of medical fees for Chinese patients. Its conclusion:
"social health insurance participation has a weak negative or even no significant association with the out-of-pocket payments of hospitalized patients. This seems to contradict the principles of social health insurance, which aims to reduce people's out-of-pocket payments and enhance their wellbeing."
Or this study released this week entitled: "The impact of expanded health system reform on governmental contributions and individual co-payments in the new Chinese rural cooperative medical system." It concludes that while co-payments in most rural provinces have been reduced, "a greater financial burden for healthcare persists among persons in the poorest rural regions." The WHO recently reported about the devastating effect that a major illness can have on household impoverishment in China - in other words, low income families are being financially ruined by their medical expenses - they simply can't afford to be sick, and become destitute. And it's not just the low income Chinese who are feeling the healthcare crisis: blogger Zhang Lijia tells of the common experience of middle class urban Chinese:
"The doctor took one cursory look and sent me for an allergy test on an imported machine and then prescribed numerous creams and pills. The total bill was US$800 - more than the average monthly salary in Beijing."
These then are just a few examples of the reality of China's healthcare 'human rights record'. China looks foolish when it publishes reports like this which are so obviously misleading. They have many aspects of their healthcare system of which they can be proud - the good public health services that ensure high vaccination levels and control of infectious diseases such as malaria, for example.
However, if you count universal basic healthcare as a human right China has failed to protect the human rights of its citizens. In this it is in good company - the USA is in much the same boat, as healthcare remains unaffordable for those who cannot get insurance.
Xi Jingping often talks about the 'Chinese Dream' - and that's what this human rights report is when it comes to healthcare - more dream than reality.

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