A Dream Yet to Come True: Disparity of Healthcare Access in China

Irene J. Su, RN, MSN


Topics in Advanced Practice Nursing eJournal. 2007;7(3) 

In This Article

The Uninsured and Vulnerable Groups

The Rural Population

The population in the countryside in China is approaching 9 hundred million, roughly 85.17 million of which live in dire poverty, accounting for 9.1% of all rural residents.[13] As previously mentioned, 90% of the rural population does not have any health insurance coverage. Those who live in poverty not only have no access to health insurance but also have very little personal resources to pay for their own healthcare. Preventive medicine is out of reach. When illness strikes, the result is usually devastating. According to media reports, the cost of an average in-patient treatment is equivalent to $270, compared with the average rural annual income of $315.[14]

Ten years ago, the Chinese government proclaimed to re-establish RCMS in the rural area by 2000. However, as of today, this goal has not been realized in most parts of China.

Early in 2007, Xinjing Daily reported a married farmer couple in their 30s from Gongan County, Hubei Province committed suicide by drowning themselves in the river after the husband had been diagnosed of "snail fever, hepatitis B, kidney stone, and jaundice." They left behind them a huge amount of debt and a 12-year-old son who also suffered from hepatitis B.[15]

Migrant Workers

Urban residents are experiencing the same financial barriers to healthcare. Recent years have witnessed an influx of millions of migrant workers to the city from the countryside. These migrant workers are usually poor farmers displaced from their farmland, families, and communities. Employed by private enterprises in low-paid jobs that are temporary or seasonal, they struggle to make ends meet with their lower-than-minimum-wage income.

Their plight is particularly difficult when it comes to healthcare access. According to a recent survey by the National Bureau of Statistics, there are approximately 100 million migrant workers in China. They earn an average of 966 yuan ($120.75) per month. The survey itemizes a migrant worker's average monthly expenses; an average migrant worker spends 463 yuan each month with the following breakdown[16]:

  • 72 yuan on accommodation

  • 235 yuan on food, and

  • 47 yuan on recreation.

Healthcare is not even in the budget.

Urban Dwellers

The laid-off or unemployed urban dwellers are another group of at-risk people. Index Mundi quoted China's unemployment rate from the Central Intelligence Agency World Factbook as follows[17]:

  • 10.10% in 2004,

  • 9.8% in 2005,

  • 9.0% in 2006, and

  • 4.2% thus far in 2007.

These numbers contain the percent of jobless labor force without factoring in substantial underemployment. Healthcare expenditure remains on the lowest agenda of the above groups' priority list until health conditions deteriorate to the point that they can no longer be ignored.

One of the top 10 news stories of the year 2005 by the Chinese Youth Daily reported a story of a 46-year-old woman, You Guoyin, who was sent to the funeral home to be cremated alive after a 3-day hospital stay exhausted the family's financial resources.[18] Hu Xingdou's article published by Guangming Observation cited another story of "the most expensive death in China," where an elderly patient's family was charged RMB 5.5 million yuan (over $700,000 USD) hospital bill when he died after a 67-day hospitalization. Considering an urban resident's average annual income of a mere 8472 yuan ($1033) in 2003,[19] this is an astronomical figure for almost all working families in China.

The problem of healthcare access is evident when health conditions financially devastate the Chinese middle class, triggering a vicious cycle of illness and poverty. In March 2006, Economic Reference publicized a report on Li from Chengdu, Sichuan Province, who dramatically plunged from a successful entrepreneur to a low-income laborer because of the illness of a family member.[20] In a course of 2 years after Mrs. Li's diagnosis of cancer, medical expenses had consumed the Li's entire estate. By the time Mrs. Li succumbed to the terminal disease, the Li family, which used to make over 100,000 RMB yuan a year, had almost nothing left. This incident epitomized the vulnerability of the Chinese middle class.

As market economy moves on, China is on a fast track to becoming a polarized society, in which the current healthcare delivery system satisfies neither the rich nor the poor. While the former complains of the ineffectiveness of the system, the latter is practically being robbed of the most basic healthcare the constitution has promised its citizens.


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