By Maureen Fan
Washington Post Foreign Service
Thursday, January 10, 2008

BEIJING, Jan. 9 -- On the heels of government pledges to reform China's failing health-care system, a government survey released Wednesday identified medical issues as the No. 1 concern of most citizens.

More than 101,000 households in nearly 5,000 communities and villages surveyed by the National Bureau of Statistics in November identified the cost of health care as their top concern, followed by social morals, security, education and rising unemployment.

The survey underscored the widespread anxiety among Chinese as officials grapple with a growing gap between rich and poor and an antiquated health-care system that has failed to keep up with the demand spurred by the country's economic growth.

The Chinese government spent $8.7 billion on health care last year, a 277 percent increase from 2006, health officials said. Yet routine hospital visits threaten millions of Chinese with bankruptcy.

Urban residents often have access to medical insurance, especially those who work for state-owned enterprises, which traditionally have covered all costs. But most rural residents lack coverage, despite ongoing efforts to provide assistance to the very poor and to extend coverage for common illnesses.

"Going to the hospital is really trouble. They are so crowded you have to get up very early to go register or wait for half a day," said Meng Xianan, a freelance writer in Beijing.

"Right now, the financial assistance offered by my medical insurance is too little and the cost of medicine is so high that poor people can't afford it. I have to really save up in case I have a serious disease and can't pay my hospital bills," she said.

On Monday, Chinese Health Minister Chen Zhu vowed to remove all inequalities and barriers to basic health care by 2020. "Everyone should be entitled to basic medical care. That is the strategic goal for all of China," he said, speaking at a national health conference in Beijing.

Writing in a Communist Party-sponsored ideological journal last week, Chen also warned against allowing market forces to dominate the health-care system. Medical expenses have skyrocketed as China has shed its planned economy and leaned on hospitals to be profitable.

"Eight hundred million farmers cannot afford medical insurance. Before, the reason was China's poor economy. But as China's economy has rapidly developed, health-care coverage hasn't expanded correspondingly," said Wang Yukai, a professor at the China National School of Administration.

"Second, because hospitals have been pushed into a market-oriented system, selling medicine has become a major source of revenue, which causes medical expenses to rise," Wang said.

In Dongguang county in Hebei province, a farmer said all the residents of his village had joined a medical insurance system begun last year. "We all paid 10 yuan [$1.37] for that. I feel safer with it, but I don't know how much it can help us solve our problems," said the man, who gave only his surname, Tian.

"For small diseases, we don't spend a lot of money," Tian said. "What I'm worried about is if I can get enough money back if I have a serious illness. I don't want my family to be impoverished just because we are sick."