Sunday, 3 August 2014

Hukou reform: what does it mean for health?

by Michael Woodhead  

The announcement by the Chinese government that it will relax some of the restrictions on the hukou (household registration permit) system will have major implications for the healthcare system.
Access to healthcare in Chinese cities is determined by hukou - if a family or person do not have an urban hukou they are not eligible for social services such as education and health insurance in that city - their hukou only entitles them to health services in the location where their hukou is registered. This means that the millions of migrant workers living in China's cities are denied access to healthcare.
   Actually, it's a bit more complicated than that - rural migrants may be able to attend hospitals, but have to pay full price as their rural-based insurance (if any) will not cover treatment at an urban hospital. With millions of rural migrants locked out of urban schools and hospitals, their demand for education and healthcare has meant that a whole host of 'underground' schools and clinics have sprung up in cities to serve them. As you might expect, the quality of these illegal clinics can be very poor.
   The announcement this week says that the hukou system for some cities will be relaxed to allow rural migrants to switch their hukou to a city. However, the new rules only apply to smaller cities of 1-3 million, not the bigger cities like Beijing, Shanghai and Guangzhou. And as has been pointed out, these changes will not take effect immediately, but will be gradually implemented to create an 'orderly' shift in urbanisation. Furthermore, cities that do not believe they can handle an influx of rural migrants will be entitled to maintain the status quo.
   In theory, the hukou changes will potentially give rural migrants access to urban health services - but this means that urban local governments will face greater demands on their services, and city hospitals will face greater demand. The question is where the extra funding and resources will come from to provide these additional healthcare services. Another cautionary note has come from rural migrants themselves - many have said they will not be willing to relinquish their rural registration because they believe this means they will lose entitlements to land and housing that they may one day want to return to.
   So, to sum up - the hukou changes could potentially fix one of the greatest gaps in Chinese healthcare - the lack of provision of services to the 200 million rural migrant families. The reality, however, is that any change will be a long time coming - and other changes (such as health insurance cover) will be needed too.

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