A Long Way From Medical Treatment

By Mengyuan Chai / Summer 2020

"You never know which one will come first, accident or tomorrow." A famous slang that I didn't understand until tragedy struck my family. My grandparents and my uncle used to live in a small town which located near the mountain. They liked the idyllic life in the field. It was usual for aged people to feel uncomfortable, so my grandpa did not think this is serious at first. After several days, my uncle noticed that my grandpa kept raising his hands to his temples for a long time. So he took my grandpa to the primary hospital since this town was small. China had a specific classification of the hospital, which they divided all hospitals into three types: primary, secondary, and tertiary hospitals (Zhu). A primary hospital was like a clinic which located in a town or small city. The doctor said my grandpa only had a bad cold after checking my grandpa's tongue and listening to his heartbeat. My uncle asked the doctor to do a full CT test and physical examination. But the doctor said that they did not have the equipment for these tests. He said that they already asked the official health department for the fund to buy the machine, but they needed to go through a lot of checks and departments to get the money. So my uncle took my grandpa home with some medicine for a bad cold. However, my grandpa did not feel better after taking medication. He could not talk clearly and always cough badly. My uncle later told me that my grandpa's tongue stiffened, and he was eager to speak, so he coughed a lot. This sign showed some severe problems. So my uncle decided to take my grandpa back to the capital to do full examination quickly. After the complete test in Beijing, we found out that my grandpa had Alzheimer's disease. This news was grievous for my family. But the doctor mentioned that my grandpa could take some medicine to remit. Although the Alzheimer's disease could not be fully cured, it was possible to slow down the process and decrease risk. The doctor said that we notice the disease timely.

My uncle is upset since he thinks he should react when he first sees my grandpa's action. The medical level in that remote area is deficient. My family is fortunate since my uncle acts fast, and my grandpa does not have some diseases that need treatment immediately. Nevertheless, I am still scared. What if my grandpa has some severe disease, such as Cerebral thrombosis and heart attack? These diseases need immediate medical attention. The hospital supposes to do examinations and treat the patients. However, the primary hospital does not have the ability in that town since it does not have the equipment. This primary hospital is the only place to treat patients in that town. This phenomenon sounds ridiculous. However, this is a typical scene and problem in China. There are many towns in the remote area that only has one primary hospital. These primary hospitals are lack of expert doctors and medical equipment. This fact makes me wonder how patients should get treated in this area. The answer is lurid. They can not get treatment most of the time. If the doctor found out the patient has some severe disease that they cannot treat, the doctor will send them to some secondary or tertiary hospitals. China divides the hospital based on their capacity and ability to cure people. Most of the patients choose to go to urban cities for treatment. The primary hospitals only deal with some cold or allergic symptoms since they can not do the full examination. China has 1.4 billion people, and we do not know what portion of them cannot receive proper medical care. What a pity scene!

We cannot blame the primary hospital since they do not have tools and expert doctors. We also cannot blame the government since they give out the money. So who should we blame on? Who should be responsible for these patients? What if their disease becomes more severe on their way to big cities? Why do hospitals in rural areas not have enough equipment? Don't they have human rights? These are the question we need to consider when we look at the problem of the healthcare system. As society develops, more and more social systems have been established to benefit the public, such as the education system, economic system, and healthcare system. These different social systems help and protect the citizens in different ways. The healthcare system helps people during this period especially, where COVID-19 spreads universally and hurts many people. The government has improved the healthcare system to benefit society. However, some problems appear. The resources in the health system are unevenly distributed between urban and rural areas. We can see this fact on medical equipment and the quality of doctors, where the cities and towns in a remote area do not have enough medical equipment and good doctors. There are two possible reasons for this phenomenon: the government's policy and the doctor's choice. We should all be responsible for the decision we make. In the healthcare system, especially on hospital resources, the government divides resources based on social class and profit, while the doctor considers more about their opportunity and salary, which causes the problem of unevenly distributed resources between metropolis and rural areas.

Before we talk about the cause of this problem, we can first explore the establishment and concept of the Chinese social system. China is a country that is governed by a communist party. However, China is still in the primary stage of unique socialism with Chinese characteristics and trying to fight for a communist country. The ultimate goal is to become a communist country.

Unlike a communist country, a socialist country has a division of class and focuses more on people's contributions and hard work. China has changed some principles of socialism in order to adapt China's national condition. In this special socialism principle, China focuses on "finishing the building of a moderately prosperous society" and "building China into a great modern socialist country that is prosperous, strong, democratic, culturally advanced, harmonious, and beautiful by the middle of the century" ("Backgrounder: Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era"). By following these specific socialism principles, resources are divided based on work, which differs from communist principles. The government will fulfill individuals' needs based on their contribution to society so that hard work and efforts will get more rewards under this special socialism. There are a lot of new millionaires and billionaires that appear in China these years. Since these new millionaires and billionaires contribute more to the country and economy, they always get more benefits and resources. Medical resources are also divided by the work and contribution that an individual provides in society. This socialism principle can be seen as the fundamental reason for the problem of inequality in the healthcare system.

Now that we have examined China's social system, we can consider the history of the healthcare system in China. China develops rapidly in this decade, where most of the Chinese people enter a moderately prosperous society. The establishment of the healthcare system shows China's development since the Healthcare system is one of the most crucial systems in society. The system helps the public on their health problem and protects the public from some infectious diseases in the world. However, the healthcare system in China does not start easily. There are three stages in building the healthcare system. The first stage occurs in 1949, where the Republic of China has established. The government starts to build the system. In this stage, more and more medical institutions are built and cover most of the cities in China, including rural areas. The second stage started in 1984, where the government provides less money for healthcare. This change of fund also leads to an increase in insurance copayment. Moreover, the inequitable distribution of resources appeared in this period, where the rural area lacks medical investment. Since people are dissatisfied with the high medical bill, the healthcare system goes to the third stage. In this stage, which started in the late 1990s, the government adds more funds to the system. They also create a new insurance plan, which covers most of the medical costs ("The Chinese Healthcare System"). We currently live in the third stage, where most people are fully covered in medical care. For example, medical insurance covers all the disease cost by COVID-19 in this current period. We cannot erase all the effort that the government put on healthcare, but this rapid change of system leads to some loopholes. The most critical problem is the inequitable distribution of resources between the modern city and rural areas. This problem first exists in the 1980s, and the government did not focus on it.

Now that we have learned about the healthcare system's history, we can talk about why the government did not take action on solving this problem. Due to the rapid development of economics, some Chinese people become rich, which causes the gap between rich and poor to widen. This gap leads to the division of social class, which divides to the working class, middle class, and upper classes. Also, the government tends to divide the medical resources based on social classes in cities and communities, where higher social classes can have more resources. We can talk about this phenomenon deeply by reading Twohig's writing, "our house is not built equitably. It is stratified along the lines of race and class" (Twohig). There is a line between big cities and the countryside, which implies that the government should focus more on the modern city. The working class is more likely to choose to live in a rural area since its cost is relatively low. And the higher class people, including important members of the government and rich people, usually lives in the metropolis since the living condition is better. Moreover, these elegant upper class wants more types of care, such as monthly or weekly check on their muscle and body. The municipal government in the metropolis have the fund to pay for the medical equipment. To see this, we need to examine the tax system in China. China has a different tax system compared to other countries, which they establish indirect taxation to transfer the tax burdens from high-income people to low-income groups. This transformation benefits the upper class but hurts the working class. These lower-income groups who usually live in rural areas cannot afford the high taxation (Chen). For example, Shanghai, which is a modern city, have a lot of transnational enterprises and billionaires. These company and high-income groups pay more taxes to Shanghai’s government. In other words, the upper class who live in the metropolis have the money to pay tax, and the government can build all the full transportation systems and social constructions, while the rural area cannot. Therefore, more resources will be allocated to these metropolia. The medical resources, including medical equipment and faculty, is limited. So the rural will get fewer resources relatively. This gap and difference finally lead to the uneven distribution of healthcare between metropolis and rural areas.

Another main point that influences the government is profit. Although the Chinese government earmark funds to the healthcare system, they also consider the money they can get when they divide the resources. The Chinese government is not the only one to make this decision. We have learned that “in recent years about an epidemic of hospital closures in poorly served rural areas or the 2019 closure of a major academic safety-net hospital in Philadelphia. These hospitals closed not because they are unneeded, but because they are unprofitable” (Gaffney). I can imagine why the government takes this action since they also need profits for national needs. Most of the Chinese hospitals are public, which means they need healthcare funds from government to operate. Due to the lack of profit in healthcare, the municipal government in these rural areas does not have enough funds to build highly operated hospitals. Why can the government not get profit in this rural area? Chinese people have specific health insurance that covers most of the basic diseases, such as cold and heart disease. However, other medical projects cost more money. For example, the insurance covers the regular check but not the upgrade one, including the check for all the body organs. Most people who live in these remote areas will not choose the upgrade check because this is not cover fully by the insurance. Most of the low-income people do not have enough money to pay for charged item, and “this pandemic will highlight how poverty – and our willingness to let people remain in it – presents a clear and present danger for all of us” (Pilkington). Poverty, as the older people used to say, is the original sin. Since fewer people choose to pay for the charged care, the government has to send this medical equipment to the metropolis. Low-income people cannot afford high-cost care, which leads to less profit and uneven distributions of resources.

The government’s policy is not the only thing that affects the division of medical sources; the doctor, who is part of the resources, also makes their own decision. Doctors are more likely to work in big cities because they think they can get more opportunity in these places, which is a sign of Neoliberalism. When we consider the inequitable distribution of resources through the lens of Neoliberalism, we see that doctors and other medical practitioners focus more on their benefit and interest. There is healthy competition in highly operated hospitals, where doctors compete with each other on research and therapeutic regimens to fight for better opportunities. “Neoliberalism sees competition as the defining characteristic of human relations. It redefines citizens as consumers, whose democratic choices are best exercised by buying and selling, a process that rewards merit and punishes inefficiency”(Monbiot). This evidence suggests that Neoliberalism involves in a Chinese hospital and motivates the faculty to become better. However, there is more opportunity in metropolis compare with rural areas. We have already talked about how the government divides the health resources among cities. Since metropolis has more resources such as medical equipment, doctors can experience more equipment. Another aspect that the doctor needs to consider is their salary because these payments decide their living standards. Most of the doctors work hard. Sometimes they have to be on call twenty-four hours a day, but they are not well treated in China. When we look at Figure 1, we can see that their salaries are relatively low compare to other countries.

And Chinese physicians’ income to GDP (Zhang) rate in 2015 is lower than other countries in 2005. This graph shows the low salaries that Chinese doctors get in average. However, there are differences between rural area and urban area. “Physicians in eastern China, including some developed areas, such as Beijing, Shanghai, and Guangdong, earned more than those in central and western China (p < 0.001). The average annual salaries were US$18,984, US$12,840 and US$13,872 in eastern, central, and western China, respectively” (Zhang). From this data, we can see that there is a big gap between metropolis and other rural areas. Although the living costs

in these two areas are different, the gap between their income is too wide. These medical faculties also need to feed themselves and their family. So it is not hard to imagine what choice they would have made. These difference in opportunities and salaries push doctors from remote areas to urban cities.

All these causes lead to the problem of the medical system. What should we do to solve this problem? The basic and primary idea is to decrease the gap between rich and poor. There is a long way for this to achieve. And we can separate this long journey to a two-step approach. The first approach focus on government. We can understand that the government needs a significant amount of money since the Chinese society is developing in these recent years. As many things are already on the right track, the government can pay less attention to finance and put more effort into benefiting people. They do not need to make money from the health care system, so they could increase the fund for hospital and use more money on healthcare. And government can start policy asking metropolis to help cities in rural areas by helping them build more infrastructure and creating a better medical environment. The government also needs to emphasize on implementation of the program and policy. Another approach is to benefit the doctor and give them what they deserve. Hospitals should give them more salaries and better treatment. Also, they can award doctors who willing to work in rural areas. These awards can focus on providing more opportunities or salaries. We all know that the main problem is the uneven distribution of wealth, and this is a hard problem for not only China but also some developed countries. However, I think we can work together with solidarity to solve this problem and let people living in rural areas like my grandfather have better medical conditions. Without accidents, tomorrow always be a better day.

Works Cited

“Backgrounder: Xi Jinping Thought on Socialism with Chinese Characteristics for a New Era.” Edited by Xiang Bo, Xinhua, 17 Mar. 2018.

Chen, Mingsheng, et al. “Who Pays for Health Care in China? The Case of Heilongjiang Province.” PloS One, Public Library of Science, 1 Oct. 2014.

“The Chinese Healthcare System.” FutureLearn.

Gaffney, Adam. “America's Extreme Neoliberal Healthcare System Is Putting the Country at Risk | Adam Gaffney.” The Guardian, Guardian News and Media, 21 Mar. 2020.

Monbiot, George. “Neoliberalism – the Ideology at the Root of All Our Problems.” The Guardian, Guardian News and Media, 15 Apr. 2016.

Pilkington, Ed. “As 100,000 Die, the Virus Lays Bare America's Brutal Fault Lines – Race, Gender, Poverty and Broken Politics.” The Guardian, Guardian News and Media, 28 May 2020.

Twohig, Niall. “Submission: Justice, Then Peace.” The Triton, 19 June 2020.

Zhang, Chunyu, and Yuanli Liu. “The Salary of Physicians in Chinese Public Tertiary Hospitals: a National Cross-Sectional and Follow-up Study.” BMC Health Services Research, BioMed Central, 24 Aug. 2018.

Zhu, Egui, and Yang Cao. “What Does the Chinese Public Care About with Regard to Primary Care Physicians: Trustworthiness or Competence?” Medicina (Kaunas, Lithuania), MDPI, 9 Aug. 2019.