04/08/2009, 00.00
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Health care reform: Beijing promises to include migrants in urban health system

For decades, more than 900 million Chinese have been excluded from effective free medical care. For a few years, rural residents have been given partial reimbursement, but they must pay their own expenses up front, without being certain that they will receive reimbursement. Experts: it is essential to see how rural and migrant people will be treated.

Beijing (AsiaNews/Agencies) - The central government yesterday published its plan to launch health care reform within 3 years, better explaining the guidelines for the project of the State Council made public the day before. But analysts maintain that this document does not explain how the ambitious objectives can be met, in a situation in which two thirds of the population must pay for all treatment.

Beijing is setting ambitious objectives for itself: by 2011, it wants to provide health care to 90% of the population; guarantee all essential medication at affordable prices; establish a network of clinics, in both the cities and rural areas, working together; reform the public hospitals so that they are no longer based on the criterion of profit (treatment is given to those who can pay, or who have insurance to cover the expenses).

Since the health care reform in the 1990's, the situation in the country has become dire. Almost all rural residents, about 910 million people, are without free health care. For a few years, the local authorities have been providing reimbursements for part of essential medical treatment: but the reimbursements are often modest, and the authorities find pretexts to withhold or delay them. Moreover, the reimbursement is commensurate with the costs of the local hospitals, which are much more affordable but less efficient than the ones in the cities. In any case, the migrants are excluded, more than 110 million people living far from their villages of origin.

For this reason, the experts observe that any reform must consider first of all the rural areas and the migrants. The government expects to give migrants the possibility to choose whether to register and receive treatment in their villages of origin, or the cities where they work. University students will also be enrolled in the health care registries in the cities where they are studying.

Gu Xin, an expert at the University of Beijing, tells the South China Morning Post that the town governments could be reluctant to bear the extravagant expenses of guaranteeing millions of migrants the same care that is given to resident citizens. This is also because the draft law does not explain where the municipalities will get the needed funds. Moreover, the migrants frequently "change" their cities according to the availability of jobs, and each city has its own taxes and criteria for medical spending.

The experts say that, in any case, the objectives announced are important: 2,000 new provincial hospitals within 3 years, 29,000 new clinics in smaller cities by 2009, a basic medical center in each village by 2011.

So far, the rural areas have been excluded from the economic miracle, including health care. Now the plan is to pay the university tuition for future doctors who agree to work in rural clinics for at least three years, and to offer 1.9 million continuing education classes for health care workers, in order to improve the quality of service.

But there are some who note that for years Beijing has been promising reforms on behalf of rural residents, and the first results are still awaited.

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