A long and winding road to recovery - Dialysis Machines Confiscated

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A long and winding road to recovery - Dialysis Machines Confiscated

By Lan Tian, Song Jing and Liang Qiwen (China Daily)
Updated: 2009-04-28 11:00


Tears trickled down Hu Ailing's wrinkled, dark face as Beijing health officials confiscated three dialysis machines. Leaning against the open gate of the courtyard where workers were loading them onto a truck, the devastated 54-year-old could only repeat: "The machines are our kidneys. They are taking away our kidneys."

April 2 was a black day for Anhui-born Hu and nine fellow uremia sufferers who rented the small, dusty yard in Baimiao village in the capital's eastern Tongzhou district. The group thought they had found a way to avoid the extortionate fees at public hospitals for kidney treatment by pooling their cash and buying the second-hand dialysis machines. They were wrong.

For four years, the four men and six women, who all have kidney failure, visited the courtyard at least once every three days to use the equipment, operating the machines manually, which helped to reduce their medical expenses by three quarters.

But on April 2, Tongzhou health bureau decided to confiscate the machines, deeming it an unlicensed medical practice.

Sitting in the shade in the courtyard, an emaciated Wei Qiang, 35, stared blankly through the dust motes as they danced in the sunlight. "I know it's illegal, but what else can we do?" he muttered.

A former fruit vendor from Wangzhuang village in Inner Mongolia, his nephritis developed into uremia 13 years ago, with his family spending 600,000 yuan ($88,000) on medical bills. In the end, he abandoned his young wife and aging parents in search of better and cheaper treatment.

He said kidney dialysis cost more than 500 yuan each time at the public hospital in his hometown, 50 percent of which could be paid for by the rural health insurance, but it only cost 80 yuan each time using their own machines.

Wu Ming, a professor at Peking University's school of public health, said: "Without permission from an authority, the medical practice has many safety risks. But it's understandable patients want to treat themselves at home due to the high medical expense."

With the new medical reform plan, which was announced on April 6 and is aimed at providing fair and affordable services for all 1.3 billion residents by 2020, these kinds of stories could be a thing of the past.

Statistics released by the Ministry of Health (MOH) showed 200 million people were not covered by China's medical insurance network. The plan aims to include them within three years.

However, to make treatment affordable the government must first tackle the profit-seeking public hospital system, a task many analysts have dubbed "mission impossible".

Chi Fulin, a political advisor and president of Hainan-based China Institute for Reform and Development (CIRD), said it would be "one of the most difficult parts", while Li Ling, professor with the national school of development of the Peking University, was quoted by the China Economic Herald as saying: "If the public hospital reform does not succeed, it would be hard to fulfill the other parts of the medical reform."

Even Chen Zhu, the health minister, admitted: "Public hospital problems are where the shoe pinches. It's a key issue for the medical reform."

Since the founding of the People's Republic of China in 1949, the nation has offered free healthcare to its citizens, with the central government financing the construction of hospitals and running costs. But when the country began its economic reforms in the early 1980s, funding dried up and hospitals were urged to seek other avenues for revenue.

This they did through expensive medicine and consultations, with statistics showing that 70 percent of poor rural families in western China were in poverty because of illness.

The State Council set up a medical reform steering group, led by Vice-premier Li Keqiang, in 2006 and, this month, the plan was finally released, promising to restore the welfare nature of public hospitals and tackle four key areas: universal access to basic health insurance, the introduction of an essential medicine system, improved primary health care facilities and equal access to basic public health services.

The reform of public hospitals will focus on management, operation and supervision of systems and government funding, as well as encourage more private medical institutions, especially non-profit clinics.

However, many claim public hospitals have become money-driven due to poor government support. A senior official at one of the country's top public hospitals in Beijing, who asked to remain anonymous, said: "The biggest problem at our hospital is the lack of funding. Public hospitals should be non-profit and patient-oriented, which our hospital has followed all along."

She said a bed in her hospital costs just 25 yuan a day, which is cheaper than the daily parking rate in downtown Beijing, while a patient pays only 10 yuan to register with a medical expert, less than the price of a haircut.

The government's financial aid accounted for only 5-9 percent of the hospital's total income, she said, adding: "I hope the government will improve funding. It's the foundation to maintaining the public welfare nature."

Almost half of the income for China's public hospitals comes from profits on drug sales, according to official statistics. But the medical reform road map states public health facilities will receive more subsidies and be supplied essential medicines with prices regulated by the government. They will be banned from profiting through subscribing expensive medicines.

The State Council has promised authorities at all levels will allocate 850 billion yuan for the plan over the next three years, which includes 331.8 billion yuan from the central government.

"The government should shoulder more responsibility in terms of funding for medical and health fields," said Yu Guangyan, director of Peking University Dental Hospital, during this year's session of the National Committee of the Chinese People's Political Consultative Conference in Beijing. But he doubted funding would be available from local authorities.

Gu Xin, a researcher for the China Society of Economic Reform, is also worried. He said: "Public welfare means patients can pay a low price for medicine and health services, but it means the government must increase its current funding eightfold. I don't think it has enough money to do it."

He said the health system would collapse if public hospitals lowered prices for patients but failed to receive the extra funding.

However, Vice-minister of Finance Wang Jun assured: "I believe the funding will be made in time and in full because we have given full consideration to the financial capacity of local governments when drafting the plan."

He said 280 billion yuan would go to hospitals and health facilities, while the rest will be used mainly to improve the medical insurance system.

Meanwhile, Huang Jiefu, a vice-health minister, said the reform of hospital systems was more important than increasing funding. "The key task is to rationalize the present management and operation system. To optimize medical resource distribution and increase the medical supply, the government should introduce a competition mechanism and lower market access requirements for private medical institutions," he said.

The medical reform plan will see local health bureaus urged to stop operating public hospitals, define the responsibilities and rights of hospital proprietors and administrators, probe the corporate governance structure and refine personnel systems by introducing performance-related pay.

The move was welcomed by Zhu Hengpeng, a researcher for the institute of economics at the Chinese Academy of Social Sciences, who said: "Governments should not be administrators and managers at the same time. If they continue acting as owners of the public hospitals and referees of medical markets, there will be no fairness."

Chi of the CIRD agreed. He said the government must evaluate its relationship with public hospitals or "face many difficulties", while it was vital to give hospitals and doctors "incentives".

In China, 10 percent of hospitals are privately-run enterprises, official statistics show. They have welcomed the reform road map as it will give them equal rights with public facilities when it comes to access requirements, medical insurance policy and scientific research policy.

"It gives our hospital the opportunity to develop, attract more professionals and upgrade our technology," said Ho Gwo-Hao, special assistant to president of Xiamen Chang Gung Hospital. "With equal status, private and public hospitals would offer better services for patients and make progress together through healthy competition."

Established last year, the Xiamen unit is the biggest private hospital in China but limited regulations have forced it to run as a profit-making enterprise, contrary to its non-profit orientation, and does not currently enjoy preferential treatment on sales tax and electric power charges.

Despite the many challenges ahead, there is a promising future for China's public hospital reform, agree officials and experts.

"Medical reform is a worldwide problem. We should take a positive attitude towards the problems and persistently seek solutions," said Zhang Mao, the Party chief at the MOH.

Ling Feng, a chief neurosurgeon at Xuanwu Hospital under the Capital Medical University in Beijing, agreed. "The public hospitals reform will be achieved eventually. But we cannot reach the aim in one move," he said.

After confiscating their dialysis machines, Tongzhou health bureau has offered all 10 of the uremia sufferers in Baimiao temporary, free kidney dialysis in local hospitals while their home provincial or autonomous regional governments work to solve their problems.

But Wei Qiang still dreams of a long-term solution. "We are doomed to die, we are as small as ants," he said. "But we still want to live. I hope the government will help us survive."


http://www.chinadaily.com.cn/china/2009-04/28/content_7723966_3.htm

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The DIY dialysis clinic
von Geoff Dyer

Poor healthcare provision in China is forcing residents to take matters into their own hands

Desperate people seek desperate remedies. The site of the latest scandal to expose the problems in China's health system is a shabby building that looks on to a dilapidated courtyard in a village on the outskirts of Beijing. For the past few years, this has been a makeshift and unlicensed kidney dialysis clinic.

The 17 people who used the clinic all faced the same situation: their basic health insurance did not come close to covering the cost of their dialysis treatment. So they clubbed together, bought some second-hand equipment and, following advice from friends and acquaintances, treated themselves.

Sun Yongqin, a 28-year-old from a rural area of Shanxi province in northern China, started suffering serious kidney problems in 2006. She needed dialysis three times a week but the local government health insurance programme covered only a small portion of the Rmb400 (€43) cost per treatment.

Lack of funds

"These were huge sums of money not covered by the insurance," she says. "My husband and I borrowed money from friends and relatives, but after a few months we had spent all our savings."

She came to the makeshift clinic in Tongzhou, which charged only what was needed to keep it going, in late 2006 and was appalled at first by the dirty conditions. "But I was dying, so what else could I do?"

The clinic eventually attracted the attention of local health officials and this year it was closed down on safety grounds. Ten of the group are still living in the village but the dialysis machinery has been taken away.

Not all the patients are that upset. Wu Yan, a 35-year-old, says the health system in her husband's home town in Hubei province has improved a lot in recent years, the result of increased funding. The couple are applying for insurance offered to low-wage who are registered urban residents.

Optimistic outlook

"If we get that, I will be able to do dialysis twice a week for free, which is good enough," she says.

But outside the cities, the coverage is much less extensive. Ms Sun, who is a registered resident in a rural area of Shanxi province, says she was given 11 free treatments by the Tongzhou authorities when they closed the clinic, but now that they have finished she has been told to go back home and ask for treatment there.

"In my home town, they will pay for only half the treatment cost and that does not cover medicines," she says. "I do not know what I am going to do next."

http://www.ftd.de/karriere_management/business_english/:Business-English-The-DIY-dialysis-clinic/516381.html