Mr. Zheng lives in Qingyuan County in the Hebei Province, just 100 miles south from Beijing. He started to feel pain in his legs in 2011, and was diagnosed with massive arterial thrombosis after multiple visits to hospitals in the Hebei Province and Beijing. Doctors there told Mr. Zheng that he had three months to live at most, and recommended amputation of his right leg. The estimated costs, according to Zheng, would be 300,000 to 1 million RMB (approximately 50,000 to 170,000 US Dollars.) Fearing the unaffordable hospital costs, Mr. Zheng decided not to receive treatment and went back home. In April, he reportedly used a fruit knife and a saw to amputate his right leg while biting into a back scratcher to tolerate the pain. His story was published by the media in October and received immediate attention from the public and government agencies.
Further investigation found that Mr. Zheng participates in the New Cooperative Health Insurance Plan for Rural Residents, and the inpatient costs for the surgery could have been partially covered by his insurance. (The annual reimbursement celling was 70,000 RMB, or 12,000 USD for insured Hebei rural residents in 2012.) Journalists also pointed out that the self-amputation story was recounted by Mr. Zheng and his wife and had not been verified by a third party.
Nevertheless, Mr. Zheng’s life changed drastically: the county government and the provincial health bureau stepped in quickly after his story was published. The provincial health bureau sent medical experts from the best local hospital to check on him, and provided him with free surgery to amputate his infected left leg within ten days. The local government offered him health care subsidies given to low-income families. Mr. Zheng also received donations from the public equating to 50,000 USD.
A similar story was recently reported in the Yunnan Province in southwestern China. On October 22, 2013, a post on a famous online forum displayed pictures of an end-stage breast cancer patient lying on the bed in her shabby shelter in a remote village, waiting for death. Again, within three days the local government had sent civil affairs officials for a home visit, escorted the patient to the best county hospital, and promised to cover all healthcare costs that exceeded the healthcare insurance reimbursement ceiling.
These two stories demonstrate the discrepancy between the practical difficulties faced by economically disadvantaged people in accessing health care, and the almost perfect data that the Chinese government publishes as proof of expanding national health insurance. China initiated health care reforms in 2009, aiming to have every citizen covered by one of three national health insurance plans for urban employees, urban residents, and rural residents. Both central and local governments provide subsidies to the funding pool, New Cooperative Plan for Rural Residents, to match the premiums paid by insured individuals. The plan is operated at the county level and the premiums paid plus financial subsidies vary between counties. For example, in Mr. Zheng’s county each individual pays 60 RMB (10 USD) annually, while governments pay a subsidy of 280 RMB (46 USD). Insured individuals are responsible for deductibles and amounts that exceed the maximum reimbursement line.
Undeniably, China has made huge advancement in expanding basic health insurance coverage, especially among rural residents, most of whom were uninsured before the 2009 reforms. According to the Ministry of Health, 99% of rural residents, or 802 million people, are now covered by the New Cooperative Plan. In addition, the government has pledged to reduce patients’ out-of-pocket expenses to 25% of the total cost of health care. The expenses of treating serious diseases, however, may still be too high for rural families, given that the national average annual income of a rural resident in the labor force is less than 1,300 USD.
Mr. Zheng and Ms. Hou were given immediate, free health care services, largely because of media exposure. Their stories follow a typical problem-solving path: governments offer superior health care service packages (often at a very low price or for free) to individuals who successfully publicize their experiences. Yet the media cannot report on every rural patient who places their life in danger by forgoing expensive medical treatment. A more down-to-earth approach needs to be adopted by national policy makers to solve the practical health care issues encountered by economically disadvantaged people in China.
The views reflected in this expert column are those of the individual authors and do not necessarily represent those of the O’Neill Institute for National and Global Health Law or Georgetown University. This blog is solely informational in nature, and not intended as a substitute for competent legal advice from a licensed and retained attorney in your state or country.