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The challenges of health care for rural Chinese

by Cesar Chelala

China’s economy has developed significantly in the past few decades, lifting millions of people out of poverty and improving their health. Despite this progress, however, many health issues remain unresolved.

While the wealthier portion of the Chinese population has benefited from advanced health technologies, many among the poor do not have adequate access to even the most essential services.

It is estimated that approximately 80 percent of health and medical services are concentrated in cities, which means that timely medical care is not available to more than 100 million people in rural areas.

In addition, although almost half of the population lives in rural areas, government expenditures in health tend to heavily favor those living in urban areas.

Although some progress has been made in underdeveloped rural areas, there is still a lack of safe water and sanitation, and there is also widespread under-nutrition, vitamin and mineral deficiencies and indoor air pollution, all of which affect children’s health in particular.

It is estimated that 80 percent of rural households have no access to a sanitary lavatory and 20 percent of rural households lack safe drinking water.

In addition, the government has to address several challenges in health care provision, such as the need to improve quality of services, making the health care system more equitable, reducing costs by improving efficiency, and improving the health insurance system and making it more comprehensive.

It is estimated that China has a highly mobile population of approximately 252 million rural-to-urban migrants, a number that will probably increase in the coming decades. They tend to work in high-risk jobs, such as construction and industries where health and safety are not properly regulated.

These migrant workers have special health needs that have to be met, particularly since they usually do not qualify for public medical insurance, which usually depend on locally based household schemes.

Rural migrants working in the cities constitute a population whose health status and needs are usually not monitored by either the rural or the urban health systems.

Migrants tend to suffer from different diseases than the nonmigrant urban population, among them more communicable diseases, such as sexually transmitted diseases and tuberculosis. In addition, migration is a source of stress and stress-related diseases such as depression, as a result of workers’ isolation and lack of family support.

Doctors and health personnel need to be better prepared to respond to people’s needs. According to the Organization for Economic Cooperation and Development, almost half of the nation’s doctors have no better qualifications than a high school degree. Many rural doctors have less experience and education than their urban counterparts.

The education of rural health care workers needs to be upgraded. They should also receive economic incentives so that their salaries are on an equal basis with urban doctors.

There are still large disparities in access to services and the quality of care available to urban and rural populations as well as between the poor and the more affluent. Many among the poor limit their use of medical services for purely financial reasons, since the cost of treating serious illness can wipe out a family’s life savings.

A great proportion of medical costs are due to unnecessary tests and prescriptions. Chinese hospitals’ reliance on profits from the sale of drugs has led to the overprescribing of unnecessary medication in order to increase profitability and some pharmaceutical companies offer under-the-table inducements for prescribing drugs. The resulting high costs of treatment cause many patients to avoid going to hospitals, even for treatment that might be critical.

By some estimates, by 2035, about 25 percent of China’s population will be aged 60 or older. Medical costs can increase dramatically with age while at the same time the share of individuals who contribute to government revenues will decline.

Although the government has stated that building a “safe, effective, convenient and affordable” health service will not be easy, these are commendable goals.

To achieve them, the government should prioritize the promotion of healthy lifestyles and the prevention of chronic noncommunicable diseases. Health education should be given priority among government-funded interventions.

The Chinese government has taken several actions to improve the health of the population, but although millions of people have benefited, millions are still lagging behind.

The great challenge for China is how to strengthen its health care system to reduce disparities and improve the quality of health care for the majority of the population.

Cesar Chelala, M.D. and Ph.D., is an international public health consultant.