Beijing (AsiaNews/SCMP) – Ten yuan (€ 1 or US$ 1.20) can make a difference between life and death for Chinese farmers. That is how much it a visit to a doctor would cost, but many rural residents can't even afford shoes. And so they rely on homemade remedies and seek medical care when it is too late.

According to Han Jun, director of the State Council Development Research Centre's Rural Development Institute, 83 per cent of farmers do not go to hospital because of the fees. His data come from a 2003 report that included interviews with more than 1,000 rural households in 118 villages in 25 provinces.

Reticence to spend includes even minor ailments such as a cold—instead, about half of the respondents said they would buy medicine from local stores, with 20 per cent saying they would not take any medication. The result has been that in some provinces up to 82 per cent of farmers died at home without going to a hospital. With just over 20 per cent of rural residents insured one can see why.

In the past people could rely on affordable basic health insurance, but the scheme crumbled at the end of the 1970s. The number of community doctors and assistants per 1,000 rural residents dropped from 1.55 in 1985 to 1.02 last year, according to official figures. Yet, the bed utilisation rate of township health centres is only 37 per cent.

Many rural residents now have difficulty gaining access to basic services such as pregnancy care and immunisation for babies. Hence, 32 per cent of babies in the families interviewed were born at home and in 86 per cent of cases relatives paid for immunisations, the report found.

The average cost for immunisation in the richer eastern provinces was 4.3 yuan, but on average the same services in the poorer western regions cost 9.2 yuan.

In a vicious circle, illnesses have become one of the most important causes of rural poverty, with the sample group showing that 41 per cent of respondents were driven into poverty by sickness and the average cost of treating a serious condition was about 7,000 yuan, far higher than the annual rural family income.

Put plainly, farmers are more vulnerable to more life-threatening illnesses because of poor health care and environmental pollution. Rural areas have been the epicentres of the AIDS epidemic in Henan and a pig-borne disease outbreak in Sichuan.

And as Zhao Genming, of the epidemiology department at Fudan University in Shanghai, points out the prevalence of some conditions appeared to be linked to the level of health services available.

The government is trying to develop a network of rural medical insurance by establishing medical co-operatives, to which farmers would contribute 10 yuan a month and the government 20 yuan per person in western provinces. The scheme would cover farmers for about 3,000 yuan in medical costs.

By June of this year, about 156 million farmers, or 20 per cent of the rural population, were covered by rural medical insurance, according to Lei Haichao, of the Health Ministry's Policy and Regulation Department.

Although useful, many in the medical profession consider such a scheme inadequate to cope with more serious diseases such as Hepatitis B infection whose cost can reach € 6,000 (US$ 7,200) or more.

Researchers say the government should invest directly in building clinics and offering training to doctors, but at least the scheme is a step in the right direction. (PB)