Wed, April 08, 2009
BEIJING, April 7 -- Wafts of heavy perspiration fill the air as hurried footsteps and babies' cries echo through the narrow corridor. Doctor Li Zhi lets out a sigh, he knows it will be another trying day at the clinic.
At this time of year, hundreds of patients crowd his medical center in Yijiahe village, Jiangxi province. The facility is run by four general practitioners (GPs), including Li's parents, and is in a region taking part in a pilot rural cooperative medical care system launched in 2005.
The 160-sq-m surgery is stocked with three beds, three computers and medical equipment partly paid for by the government.
"Although we are obviously short-handed, at least the trial is allowing us to run a good facility now," 28-year-old Li told China Daily last month.
Li's parents have been village doctors for more than four decades - Li even remembers being carried on his mother's back as she made her rounds - and his experience has given him an intimate view of the country's medical system from a grassroots level.
It is also why he was eagerly anticipating the latest measures in the countrywide medical reform, which the authorities announced yesterday.
"Nothing much has changed since the previous healthcare reform in the 1990s, with many village doctors still working from their humble homes and lacking adequate medical equipment, medicine and knowledge," said Li, who believes the reforms will bring new hope to 650,000 villages of better healthcare.
China yesterday unveiled a roadmap to healthcare over the next decade after more than 24 months of intense debate and repeated revision, along with a more detailed implementation plan for the next three years. The plan has yet to be published in full but the State Council announced this year an investment plan of 850 billion yuan ($124 billion) for the reform, which will be aimed at "solving pressing problems that have caused strong complaints from the public".
According to the health reform plan draft passed this year by the State Council, the country's cabinet, priority will also be given to a more affordable and accessible healthcare system, allowing citizens to save on medical costs and increase their purchasing power in other areas.
Fees at public hospitals will be a top concern, with a system that tracks the most prescribed medicines to help authorities lower prices for patients, explained Liu Xue'en, a professor with the department of health economics and management at Peking University's Guanghua School of Management, in a recent interview.
Similarly, the government has also pledged to build 2,000 county hospitals and 5,000 township clinics in rural areas in the next three years, extending medical services and making them more affordable.
Health Minister Chen Zhu said on Feb 19 that besides speeding up the construction of medical facilities, the coming healthcare reform plan will also stress the need to train more medical practitioners to meet the rising need for better healthcare.
However, Li stressed that the shortage of medical professionals is one of the most pressing problems the reform must solve.
The situation now is not much different from when his father, now 61, worked with village doctors in his heyday, Li said. A doctors' bag then was equipped with only stethoscopes, thermometer, and blood pressure gauges. They treated their patients the best way they could anytime, anywhere with rudimentary tools, which earned them the nickname "barefoot doctors".
In large cities like Beijing and Shanghai, millions of graduates majoring in medicine are said to be avoiding rural postings, while some even opt to switch careers due to the tight competition in the urban market.
"The market for doctors in Beijing has been saturated for more than a decade," said Dong Shu, 27, a postgraduate from the health science center at Peking University. But despite being wary of a bleak future for the medical profession, she nevertheless felt lucky to get a job at the university's No 3 Hospital this year. "Most of my classmates have to opt for small clinics or try something unrelated to medicine to deal with the cost of living in the city," she added.
But Li in Jiangxi province said what rural areas need are qualified, experienced doctors on the ground, acting as the frontline of the medical system. "Although there are millions of medical students graduating every year, few would like to be village doctors but we need qualified doctors, not fresh graduates," he said.
Countryside doctors must know more than what is taught in medical school, he said, because they handle the healthcare of more than 80 percent of the nation's 900 million farmers.
The four doctors in Li's basic clinic serve about 4,000 families, which means at peak times they are doctor, nurse, pharmacist and cashier all rolled into one. "What we need most are general practitioners. This is a glaring gap in our college medical education," Li said.
He said the government should include GP training in the medical education system and encourage graduates to head for villages as interns, just like the college-educated village leader scheme, which gives students with a chance to get vital experience at the grassroots level.
"This will be an effective way to solve the lack of medical assistants in the countryside and also help medical students acquire more practical knowledge beyond textbooks," Li said.
The moves will also help the large hospitals in the cities, he said, adding: "If the government provide doctors with more training and financial support in rural communities, it will also lighten the pressure from patients heading straight to big hospitals."
Many healthcare experts agree that increasing the number of qualified doctors in villages should be a top priority of the medical reforms.
Professor Liu said about 60 percent of patients visiting large hospitals suffer minor ailments that can be treated easily at smaller facilities and clinics in rural areas.
Zhong Nanshan, a top respiratory scientist and a deputy to the National People's Congress, the country's top legislative body, suggested more capital be pumped into small clinics. Medical graduates should also be given free training at large hospitals before they start their practice at grassroots clinics with "reasonable salaries", he said.
The planned improvements for healthcare will be a massive aid for those in the countryside, like Chen Shuzhen, 72, in Luobei county, Heilongjiang province, who survives on a 150-yuan minimum living allowance from the authorities and traveled to Beijing last month for treatment for a heart condition.
"My county has only one hospital, which is small and lacking in good medical equipment and trained staff. The capital has top-class doctors but the price for services is also high," Chen told China Daily. Her son has already spent more than 10,000 yuan on doctors' fees and her trips to the capital.
"I hope the new healthcare reform allows me to enjoy more affordable medical services in my county," Chen added.
