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Disparities Between Rural and Urban Healthcare in China

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When one thinks of a communist country, it’s normal to imagine that the government would take as much action as possible to create equality amongst the people. Of course, there are the leaders and followers, different posts and hierarchies inevitable in any society, but it would seem that a socialist ideology should lead to equal access to services such as education, utilities and healthcare. In the real world, however, healthcare around China is not equally accessible to all. There are big differences in the quality of healthcare services, availability of facilities, technologies, doctors and benefits for people living in rural areas versus their urban counterparts.

Historically, China has used a system known as hukou to separate the social benefits that people receive. The system puts each household in the country into a particular class based on where they live. This was done in order to tightly control the number of rural workers moving to cities. Unsurprisingly, the system, which was created in 1958, is considered by many to be outdated and not able to properly service the population in China's modern society.

China's rapid economic growth over the past decades has driven more and more people to urban parts of the country in search of work and the betterment of their families. In 2010, the average income of families in cities was nearly 3 times as much as rural families. In fact, so many people have moved to China’s cities that there is now a huge "floating population" in China, meaning that people are living somewhere other than where they are registered. This creates problems with regards to healthcare, as local, government subsidized medical programs will only take care of people registered to their particular municipality. If, for example, a poor farmer from the countryside has just moved to the city, he will not be able to receive free healthcare in his new residence, even though he may be seriously in need of such care. The preferential benefits, health and otherwise, provided by urban parts of China are a major reason that people move to cities, but most people find that they cannot change their locality registration status so easily. Only about 13% of this floating population is able to acquire urban status.

Interestingly, there is evidence that rural Chinese who stay in the areas where they are registered are now receiving better health care benefits. The Chinese government’s push in recent years for both urban and rural citizens alike to receive health insurance has actually been rather successful - as of the end of last year, 98% of the rural population now has medical insurance coverage through the New Cooperative Medical Scheme (NCMS). The system has given fee reimbursements to over 1.5 billion people that have received medical care, and nearly 1 billion have received reimbursements for the treatment of serious disease. However, since the current reimbursement rate for rural insurance is 70%, citizens must still pay the remaining 30%, which can be a burden for poor families. A 2009 research paper from professors at Peking University in Beijing found that the impact of the NCMS is limited, as it does not decrease out-of-pocket payments, nor does it improve health status or increase utilization of formal medical services. Future advancements of NCMS and similar programs aim to fully guarantee treatment for 20 serious diseases, such as certain types of cancer. Local governments are even being encouraged to partner with private health insurance providers to develop plans for the state run programs.

Even with the cost of care being covered, the fact remains that the supply of qualified medical professionals in some rural areas is lacking. This need for healthcare workers has even led the Chinese government to encourage retired doctors to re-enter the workforce and assist understaffed hospitals in rural provinces. For urban medical students, free education is being offered in exchange for agreeing to work in the countryside. Plans are also being put in place to increase the number of doctors coming from rural China. Examination standards are being lowered for future medical professionals intending to work in villages, which may further strengthen criticism that the quality of care in rural hospitals is inferior. To address the need for better facilities, health officials have announced that they intend to create new hospitals and primary care centers. Whether or not the government’s promises of health care improvements and advancement bear any fruit, however, remains to be seen. Similar plans for the expansion of rural hospital networks have been in the making for years, but people have seen only sparse improvements.

The new government has recognized the importance of providing healthcare to China's citizens and has taken steps to ensure that every citizen has the opportunity to receive medical insurance coverage if they want. However nice of a policy this is, it still doesn't address the disparity between rural and urban citizens and the discrimination that rural people face when trying to move their family up the socioeconomic ladder and receive the same benefits as city dwellers. The incoming leadership is focusing on growing China's economy forward via urbanization, and these plans are the driving force behind new reforms of the hukou system. Currently there are few specifics on how these reforms will really affect rural Chinese and how quickly change can be expected. For the time being, urban dwellers will have to get by with the system as it exists, and hope for the day when they will have access to the same quality of care as their countrymen in China's cities.

Travis Jones





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