The below was written for a different purpose, after my recent extended period of teaching in Shanghai. It is not a profound economic analysis at all, rather it is a view of the heatlh services. Even there I have omitted stats for lack of time to research them, tho' this will follow.
Purpose was to convey the bitterness of indidivual decision making, that is going on in China. Hari ______________________________________________________________________________________________________________
Health Care In China Today, following privatization of the Health Care System
Astonishingly, there remain some who call themselves Marxist-Leninists, yet who still believe that the China of today is a socialist state. Even if we can agree to leave aside our fundamental differences with them regarding the political character of Mao Ze Dong, this belief of such people is too “far beyond the pale” not to challenge. Alliance can understand at least [without agreeing with], that school of Maoists who say that after Mao, socialism in China disintegrated. We do not agree with the implied lauding of Mao, but this latter formulation at least does recognise that the China post-Mao is not a socialist state. But to say it remains a socialist state now, is untenable.
One does not need to visit China to be aware of the amazing rifts in the social fabric that have been allowed to further accentuate differences between rich and poor. Since Deng Xiaoping proclaimed it was socialist to “Enrich Yourself!” – the green light for all manner of rapacious grabs was given.
We will examine one small area that acts as a litmus indicator of how every-day life for ordinary people has dramatically changed. In the days when the pretence of being ‘socialist’ was far more important than it is now, there was at least a modicum of equality in the health care services. The legacy of the legions of health care workers of Chinese background was astounding. The legacy of foreign workers (those like Dr Norman Bethune and Dr Joshua Horn) who came to China to assist the Liberation forces and the Chinese medical corps, was honourable. What has been done with this legacy? It has been ravaged by “market forces”. A recent article by Geoffrey York, lays out some disturbing facts.
“Public health services have eroded. Medical services have crumbled. Doctors and hospitals generate profit by charging higher fees. And those who cannot afford the fees are left out in the cold. Two-thirds of the population has no health insurance. About 60 to 70 percent of hospital patients are forced to end hospital treatment prematurely because they are unable to pay. A recent UN report found that China’s health system is suffering a ‘profound decline” because of the shift to a profit based system. Because of the commercialization of medicine, health costs have jumped 400% in the past decade. And the medical system has become the top cause of poverty: more than 40% of poor families have fallen into poverty because of high medical costs. In some of the poorest regions, illness and mortality rates are increasing despite the economic prosperity in the rest of the country. Diseases such as TB and Hepatitis B are reappearing, and immunizations are being neglected because they don’t generate a profit. Drug prices are routinely inflated and unnecessary treatments arte often prescribed so that the hospitals can earn income. “ “York G: “In New China, millions can’t afford doctors”; May 17th 2004; Globe and Mail p. A10.
Under the previous era: “Health cooperatives, and barefoot doctors ensured a minimum level of medical care for everyone even in the poor rural areas. Life expectancy rose dramatically and most children were immunized. “It was a public health model for the world, and it achieved some incredible things”, said Lisa Lee, a medical officer in Beijing for the WHO. But as China switched from socialism to free-market capitalism, it decided to privatize most of its health system. “The medical cooperatives have been disbanded and nothing has replaced it” Dr Lee said. “Some very vulnerable and poor segments of the population are being left behind. Critical health services are falling through the gaps.“ Geoffrey York Ibid.
These problems are enormous and naturally affect the most vulnerable and poorest sections the hardest:
“The problems are greatest in rural areas, where 90% of patients must pay cash for health services. Chinese media have reported cases of women dying in childbirth because they couldn’t afford a hospital delivery. But the problem is also hurting people in big cites. Forty percent of urban dwellers have no insurance, and even the insured are often forced to pay most of their medical costs from their own pockets”. York, G Ibid.
Health care workers are naturally disturbed and upset that they are forced to participate in this sham of a heath care system:
“In a recent report to the Chinese parliament, one physician told poignant stories of impoverished patients and their lack of care. “As soon as the diagnosis is completed, the patients ask me how much the treatment will cost”, Wang Chunlan wrote. “When I estimate the cost , many of them say nothing. They just turn around to leave the hospital. And as I watch them leave I feel deeply sad.” York G Ibid.
The individual case histories are poignant.
“Han Fengzhou sat on the edge of his bed, staring vacantly ahead unable to see the see the grimy walls or cement floors or bare neon bulbs of the two room apartment in Beijing where he has spent most of his life. For the past 9 years he has been going blind. A simple cataract operation, costing a few hundred dollars, would have saved his eyesight. But on his meager pension he can’t afford it. …”In the past we never worried about health care because the government took care of it for us” said the 89-year-old retired labourer. “Today if we don’t have money we dare not enter a hospital. We miss the old days of Mao, when we could see a doctor whenever we felt uncomfortable”. York G Ibid.
Costs of medicines are simply exorbitant, making for horrifying effects on decision making by both patients and doctors. This is compounded by the Malthusian policies of the state. So in the context of a one child per family policy, many boys are given maximal therapy and many girls are allowed to die. Thus there is now a life saving therapy for a disease of prematurity known as hyaline membrane disease. Essentially, the preterm lung is devoid of a chemical known as surfactant that enables the lung to stay open and inflated. Surfactant is now able to be instilled into the lung, with consequent life saving effect. There is very good evidence for this now, and it is not a debatable therapy – its imply saves lives and reduces intellectual handicap of survivors. However, each vial of surfactant costs the equivalent of 300 yuan currently [NB. At the time of writing, 1 Canadian dollar = 7 yuan. But of course the dollar value is irrelevant to the purchasing power of the average Chinese family]. A course of treatment requires some 3 vials. Consequently, many babies are simply left without therapy. In some cases the parents take the infant home to die, and is some cases the parents simply abandon the infant to the Reaper in the hospital. I am unable to say which course of inaction is worse for either the baby or for the family.
Preventive Strategies Uprooted by Foreign and Local Corporate Interests
Naturally in the intensified “Enrich Yourself” environment of China today, many other social ills impact on the health of the people. The story of the elimination of schistosomiasis by the Chinese people is well known. In this famous campaign of the year ----, the vector that carries the deadly parasite, a snail, was hunted down in the canals and riverbanks that it leaves. This was a very labour intensive and coordinated effort by the entire peoples. Effectively, it did eliminate schistosomiasis. Yet, the disease is creeping back. But the socialist health care principle of “ First prevention, then cure if necessary” – has been superseded by “No prevention, cure if paid for”.
As Western countries under pressure from the working peoples have adopted largely preventive health care strategies, such as tobacco avoidance, and reduction of dangerous foods – the profits of giant corporations such as Imperial Tobacco and McDonalds foods have been eroded. They have started to recoup their cut revenues by preying on the Chinese population. The fastest growing area for new franchise for McDonald is China – which are opening outlets at the rate of 100 a month since their entry into the Chinese marketplace in 2004. Already the effects of obesity in children can be seen, as Western diets rapidly catch a hold in young children.
