"Brand-name" care

"The characteristic of medicare in China is that it has become both inconvenient and unaffordable," said Li Ling, a professor at the China Center for Economic Research of Peking University, at a symposium last December. She said such a situation was unthinkable in a well-functioning medical system, where expensive health services are always of high quality and convenient while services that people have to queue for are usually inexpensive and even free.

Chen Yude, professor at the School of Public Health of Peking University, pointed out that an important reason for such a situation was that people were rushing to the big, multi-specialty hospitals known for their cutting-edge technology and advanced surgical treatments even for common diseases. Chen said his outpatient surveys in such hospitals in Beijing showed that the most common complaint was upper respiratory tract infection, usually a common cold. As a patient, Chen told Beijing Review, he tried his best to avoid going to The Third Hospital of Peking University, one of the best hospitals in Beijing, despite its proximity to his office. "It is so crowded and I know I will be 'got rid of' in no more than three minutes," said Chen. He said the danger of this "brand-effect" was that patients with a complex disease would not get sufficient time for consultation and check-up.

China embarked on its four-strata national health network in the 1950s. The top three strata comprise comprehensive public hospitals ranked by scale and sophistication of technology while the bottom comprises public clinics at the community level in cities and at the township level in the countryside. Grassroots clinics, amid a market-oriented reform approach and further shrinkage of government subsidies, found themselves short of funds for surgery and development. According to Chen, subsidies have dropped from 30 percent of total medical expenses to around 16 percent. In the process, most people lost confidence in the quality of community medical health.

With the decline of public clinics, private clinics began to mushroom. According to latest figures released by Ministry of Health, China's non-profitable health bodies stand at 134,000 while profitable ones total 152,000. While only the rich can afford to go to private clinics as such treatment is usually not covered by social security, the majority of the urban population has to choose between the overcrowded big hospitals and the crumbling community hospitals. Although the outpatient registration fee for an expert at a big hospital could be more than 25 times that at a community clinic for a similar service, people often choose the former to play it safe.

"The government's new move in medical reform is aimed at trying to dilute the middle level of the system and emphasize the bottom level of grassroots clinics," said Chen. According to the Ministry of Health, by the end of 2005, China had 17,000 community clinics, which is more than a doubling of itself in three years. They serviced 59.4 million outpatients, more than 20 percent of China's urban population.

According to a circular on the development of grassroots clinics issued by the Central Government this August, community clinics have six objectives: disease prevention, health consultation, medical treatment, rehabilitation, health education and family planning.

According to Chen, another important function of the grassroots clinics is to act as a "gatekeeper" of big hospitals, ensuring that critically ill patients can be transferred to big hospitals on time, besides providing quality service for outpatients.

"The development of grassroots clinics is all about making the distribution of medical resources fairer," said Chen, "so that every one can share the achievements of our rapid economic growth."