The China syndrome: rural health care

Editor’s note: While the U.S. health care reform battle rages in Washington, D.C. China has been quietly revamping its own massive health care system — with decidedly mixed results. In this three-part special report, Kathleen E. McLaughlin and photographer Sharron Lovell tracked the effects on both urban and rural residents.

RONGJIANG, China — As their wife and mother lay dying, emaciated and contorted with pain from the final stages of her terminal colon cancer, the Yang family’s last hope arrived in a shiny gold box sent from 1,500 miles away.

They had seen the Chinese herbal medicine advertised on television, with promises to ease pain and rejuvenate health. It only cost about $15, but its failure seems to have broken the family’s final hope that Yang Xuehan might survive. They seemed to believe that if it came from Beijing, it was more potent than any medical treatment available in their tiny, remote village.

After spending their entire life savings and borrowing from all their friends and neighbors to pay for her expensive cancer treatments, the Yang family was desperate for anything that might at least salve her suffering. Her brother-in-law, seated at the end of her bed with the rest of the family gathered around, shook his head sadly and glanced back at the dying 36-year-year-old woman in the bed.

“It just doesn’t work,” Yang Yuanping. “They sent it from Beijing and it didn’t do anything.”

Yang had been through 18 months of testing and treatment since she got sick. With the borrowed funds, her family sent her to the best hospital in the area – a regional treatment center in the larger city of Kaili. After only a few treatments, the doctors sent her back to her village, saying there was simply nothing more they could do for her. Yang died at the end of May, leaving behind a grieving family that includes a 12-year-old daughter and 8-year-old son. “We paid all this money and she never got better,” said Yang’s mother-in-law, diligently massaging her daughter-in-law’s legs to try to ease her pain.This is, of course, a story that could have happened anywhere in the world. Cancer is a killer. Yang might not have been saved by the best of doctors anywhere. But because of gaps in China’s health care system and the massive financial toll her illness took, she leaves behind a family so deeply in debt that her children’s schooling and entire future seems clouded. Her husband earns less than $50 per month as a farmer. He owes others more than $15,000 from the failed medical care.

The family lives in a close-knit tiny village in remote Guizhou province — one of China’s poorest. Like the majority of the other residents, they are ethnic Dong minorities, with traditions, customs and language different from those in the rest of China. Their predicament is all-too-common among China’s estimated 800 million rural residents. Faced with a health care system so fragmented and underfunded, the sick often go bankrupt trying to get better.

China’s government is trying to address the system, and residents in this part of the southern mountains are well aware of a new program to provide basic a basic buy-in health insurance to 200 million Chinese without insurance. It’s part of the government’s $125 billion initial effort to improve facilities and access across the country. In a document released this spring, the State Council pledged to offer “safe, effective, convenient and affordable” treatment to all citizens by 2020. Further stages of the reform are being rolled out gradually. Health care in rural China often offers the worst examples of how the system has broken down. Before the economy moved toward market reforms in the 1980s, China’s health care system was lauded as a model. Today, basic health care is too often inaccessible or unaffordable to the masses. Previous reform efforts, which mainly shifted costs to local governments unwilling to pay up, have been roundly regarded as failures. The cost of rural health care has continued to rise, as government support has declined.

In a local hospital in the larger city of Liping, the director of a crowded street-side clinic said his main directive amid the national health reform effort is to make sure patients are getting appropriate, cost-effective treatment.

“We’re trying to make sure they don’t have to leave their villages when they have minor ailments, or to leave the county if they have a major illness,” said Dr. Lu De.

The basic insurance program unveiled this year has taken off quickly, he said. Wider insurance coverage has encouraged people to visit the doctor before their problems become life-threatening.

“Before, the patients would only come in when they were seriously ill,” Lu said. “Now they come for treatment when they first get sick.”

But for the Yang family, even the new insurance program would not have saved them from permanent debt. Insurance covered about 40 percent of basic costs, but once the price went above a certain level, it was cash out of pocket. For a family that saved pennies for years, little can be done now. They remain deeply in debt to the rest of the village, toiling away and hoping another crisis doesn’t strike.

“We don’t have the money to pay everyone back,” said Yang Xuehan’s mother-in-law.