Poor pay heavy price in China's brutal hospitals

TERESA POOLE

Peking

In the emergency wing of the Peking Children's Hospital, the three-year- old girl's parents were looking desperate. They had arrived from Yi county in central Hebei province, dressed in traditional peasant padded-cotton winter clothes, hoping to find a hospital willing to treat their daughter for leukaemia.

Tears rolled down both parents' cheeks as they explained what had happened. A doctor planned to check whether the girl was strong enough for a bone marrow operation. But even if she was, nothing would be done unless the parents provided a 20,000 yuan (pounds 1,600) deposit, more than 16 times the average peasant's earnings in a year. "We are only lao bai xing [common people]," wept the father. "Where can we find this large amount of money?"

Since they had arrived, the family had been staying on a construction site, where migrant workers from their village are employed, or in very basic hostels. The little girl was so weak she could eat only yogurt. If an operation was the only hope, they would return to their village 60 miles away and try to borrow the money, the parents said.

The Peking Children's Hospital is probably the best of its kind in China. But the scene in the waiting rooms gives some idea of the brutality of China's welfare system, even in one of the country's richest cities.

Human Rights Watch recently focused on the high death rate among orphans and abandoned children across China, often through deliberate neglect. But those horrifying statistics are only one aspect of China's harsh welfare system. It is shocking, but not surprising, that abandoned children are left to die in orphanages, given the way that some sick children who do have parents are dealt with, now that treatment is on a pay-as-you-go basis.

Leukaemia is a disease that many developing countries cannot afford to treat. But on a visit to the hospital waiting rooms there was no difficulty in finding other routine examples of children for whom there is no medical safety net.

A migrant worker from Sichuan who had been living in Peking for several years had brought in his five-year-old son, who was suffering from pneumonia. The father's clothes were ragged. As the child sat slumped on the ground in the corner, a medical orderly was telling the father he must pay 110 yuan (pounds 9) for another dose of medicine. "Otherwise it is too late," she said. The father was in despair: "I do not have a place to live. Where can I get such money?"

In a rare act of compassion, a comfortably-off Peking father who witnessed the scene stepped forward and paid for the boy's injection. The medical orderly sneered. "It is useless," she said. "It can only support the child for a short period. How about tomorrow?" She told the boy's father: "You should find a permanent solution."

These examples illustrate the two-tiered medical system now operating in China. The gaping divide is between city and rural people. The former, attached to danwei (work units), are reimbursed, at least in part, for medical costs by their employers, unless they are unlucky enough to work for a bankrupt enterprise. China's 900 million rural people, by contrast, including millions of migrant workers, usually have to pay for all medical care.

In their case, the former socialist medical system has virtually evaporated, while the new medical insurance schemes that are being tried out cover only a tiny minority.

At the Peking Children's Hospital, administrators said prices were the same for city or rural patients. The hospital works at its limits. The 700 beds are always full and about 5,000 people a day from around the country come for outpatient care. But for the Chinese government to plead lack of resources in this case seems disingenuous. This was a city that spent a fortune in a bid for the 2000 Olympics, and where the party chief is under "investigation" over a pounds 24m corruption scandal.

In China's market economy, everything has a price tag. In the crowded hospital cashiers' room, the mother of a five-year-old boy recovering from a tonsillectomy was queuing to pay the 1,795 yuan (pounds 144) bill for eight days in hospital. The bill was broken down in detail:Medicine 800 yuan; surgery 300 yuan; use of a bed 60 yuan; heating 300 yuan; nursing care 35 yuan; and food 300 yuan. The mother explained that her urban work unit would meet most of the bill for medicines but nothing else, as it was not an emergency.

This week the government organised a briefing to defend the country's human rights record. Amid talk of judicial procedures, and "hostile" Western human rights groups, Liu Hainian, director of the Law Institute at the Chinese Academy of Social Science, admitted that "another important aspect" to human rights in China was the provision of "social insurance". Human rights, he said, consisted of the right to social security as well as political rights. "More effort should be made to improve human rights in China," he said.