The right to healthcare cover is about to arrive in China. Starting next week and lasting up until 2010, the Peking government intends to introduce a series of reforms, laws and programmes aimed at guaranteeing basic healthcare cover for all its citizens. The announcement was made just a few weeks before the 17^th congress of the Chinese Communist Party by president Jiabao.

The new healthcare system. The principle on which the new Chinese healthcare programme is based is simple: every citizen will have the right to medical treatment without any form of distinction based on income, place of residence or where they come from. The state will guarantee a free basic package of services in hospitals and casualty departments, improve healthcare facilities in rural areas and attempt to reduce the gap between the services enjoyed by foreign citizens in China and the local population. The first pilot project will begin in September and will involve 79 cities and towns in China, including all provincial capitals. The plan is to cancel the system imposed by the last reform, carried out in 1994, by introducing plans for doctors to return to rural areas, for medicine to be sold at affordable prices and for the hospital structure to be developed both inside and outside urban areas in order to guarantee healthcare to those 800 million Chinese who have not poured into the cities. The pilot project will be studied to decide what improvements have to be made, after which the model will be introduced throughout the country and by 2010 all citizens of the People’s Republic of China will have healthcare cover, although nothing has been said yet about who will be responsible for checking the quality of services offered and what the standards will be.

The problems of the previous system. After two years of discussions, Wen Jiabo has come to the conclusion that it is necessary to take a step back from the reforms of 1994. Among the data analysed during this period was a report by the World Health Organisation (WHO) that criticised the country’s healthcare policies: of the 191 member countries, China was bottom of the list as a result of endemic corruption (Zheng Xiaoyu, who was formerly responsible for the national healthcare programme, was condemned to death for a $790,000 bribe), and inadequate state intervention. State spending by the Peking government on healthcare is only 2 percent of the world total even though it must cover 1.3 billion people, 22% of the world’s inhabitants. Of this figure, 80% is reserved for treating government officials even though there are “only” 8.5 million of them, while half the population of China have never seen a doctor because they don’t have enough money to pay for medical treatment. In 1980, when the state helped to finance healthcare, 37% of the population had medical insurance, but this number had shrunk to less than half (15%) by 2000. Initially the government denied that there was a problem and boasted that it had constructed new hospitals, but since these were only built in cities the result was that those who lived in the countryside faced the additional cost of travelling to the nearest city and paying for accommodation when they wanted to see a doctor. In fact the real victims of the 1994 reforms were inhabitants of rural areas.

The 1994 reforms. Overnight almost half the population of China found themselves without any possibility of having an operation or a medical check-up and getting medicine, never mind being able to buy any. The healthcare cooperatives where basic medical treatment was guaranteed for the payment of one yuan disappeared. All the doctors who worked in decentralised medical structures, particularly those in the countryside, lost their jobs. The state withdrew the funds it had previously provided to subsidise medicine, with the effect that prices increased by 15%. If a Chinese citizen spent 11 yuan ($1.35) per year in 1980 for medical insurance, in 2000, if he had the money to pay, the cost had risen to $50 despite the fact that the Minster of the Economy had increased investment in the sector by 2 points, from 3% to 5% of the GDP. In 1994, Peking ordered all provincial governors to take charge of the healthcare system, cutting subsidies and opening the door to private insurance companies. “A disaster”, as some government officials later admitted. The local authorities didn’t have the money, and at a national level there was no coordination plan. Once again the worst off were the 800 million people who live in the Chinese countryside and the unemployed, who obviously couldn’t take out an insurance policy and were forced to spend all their savings on urgent medical treatment. For government officials and foreign visitors, however, nothing changed, since they either received free medical treatment or were provided with treatment by their own country. In 1981, in an attempt to bolster the healthcare system, Peking forced all workers to pay 10% of their salary in healthcare contributions, but many of them had no money left and in any case there weren’t enough doctors available. In 2003 the Department of Medical Science at Harvard University, in the USA, offered to finance a revision of the system that at the time was about to collapse and to draw up a plan for medical prevention, insurance and basic treatment: Now, however, Jiabao has decided to do it himself and has until 2010 to demonstrate that thanks to his reforms a sixth of the world’s population has acquired healthcare rights.