China struggles to cure the violent ills of health system

GUANGZHOU/BEIJING (Reuters) – Beijing is struggling to deal with an increasingly violent flashpoint of social unrest in its healthcare system, as its latest bid to cut costs is failing to ease tensions among millions of people who cannot afford basic treatment.

Violent attacks directed at hospital doctors and other healthcare workers in the form of beatings, threats, kidnappings, verbal abuse and even killings soared in recent years to 17,243 cases in 2010, alarming central policymakers who regard China’s overhaul of its lumbering public healthcare system a top national priority.

Critics say China’s efforts to cut treatment costs in public hospitals and defuse tensions do not go far enough and show little sign of reversing the violence of angry sufferers.

“The government is very worried about violence against doctors, especially when a few doctors and healthcare workers were attacked earlier this year. Some hospitals now have guards guarding them,” said a health official in southern Guangdong province, speaking on condition of anonymity because of the sensitivity of the issue.

“It’s a top priority to stop these things from happening,” said the source, who works in hospital administration.

In July, the ruling Communist Party sought to make treatment more affordable by looking to ban an age-old practice among public hospitals of marking up drugs prices by 15 percent, a practice the government allowed to flourish after it wound back subsidies for public hospitals from the 1950s.

The ban applies to 300 county hospitals under a pilot project. But a patients’ group and senior Chinese health officials say the measure, even if implemented nationwide, does not make medicines substantially more affordable.

Instead, they say Beijing must tackle the far fatter markups enjoyed by drug distributors, a web of middlemen who inflate prices by 40 percent and sometimes by several-fold to levels that are beyond the reach of many ordinary Chinese.

This is a “bigger problem”, said Liao Xinbo, deputy director general for health in southern Guangdong province.

“Nothing is being done to change this,” said Liao, who is about to publish his second book taking a critical look at China’s healthcare reforms.

PAYING THE BILL

One Chinese struggling to meet medical bills is Xu Shiding, who needs weekly injections that each cost more than 1,300 yuan ($210) to control chronic hepatitis C.

The gold miner in China’s northwestern region of Xinjiang has to pay out of his own pocket for one or two injections each month. He has state health insurance, but his cover is limited.

With monthly income of 2,600 yuan, he has been forced to borrow money from his family, he said.

“I have even become a boyfriend of a wealthy married woman,” said Xu, sobbing at times, as he alluded to how he needs his mistress’s financial support to pay for his treatment. Left untreated, such patients may end up with liver cirrhosis and even cancer.

The average cost of a single hospital admission in China is roughly the same as average annual income, a 2008 paper published in The Lancet said. For the lowest fifth of income earners, it is more than twice average annual earnings, the paper said.
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