posted May 12, 2007 10:25 PM              

· Police to patrol wards as doctors wear hard hats

· Market-oriented system sees poor go untreated

Jonathan Watts in Beijing
Saturday May 12, 2007
The Guardian

Nurses wear hard hats on their rounds after coming under attack from relatives seeking compensation over a patient's death at Shanxia hospital in Shenzhen, southern China.

China unveiled plans yesterday to deploy police in hospital wards and outpatient clinics to protect medical staff from the public, amid growing instances of physical violence meted out by patients furious at charges and dubious treatment.
The government is concerned about increased attacks on doctors, nurses and administrative staff as the healthcare system becomes the focus of resentment about the gap between rich and poor.

According to the China Daily, 5,500 medical workers were injured last year in assaults and protests, causing more than 200m yuan (£13m) damage.

One of the most prominent disputes was sparked in November by reports that an infant in Sichuan province was denied life-saving treatment because his guardians could not afford the £50 fee. According to the Information Centre for Human Rights and Democracy 2,000 demonstrators tore through the Guangan City No 2 People's hospital, smashing equipment and forcing doctors to stop work. About 100 police broke up the crowd, injuring 10 people and detaining five.

Staff at Shanxia hospital in Shenzhen, Guangdong province, started wearing hard hats on their rounds after being harrassed and spat on by relatives seeking compensation for a patient's death.

According to the domestic media, several hospitals have already hired police to patrol wards and maintain order. Health ministry spokesman Mao Qunan told the China Daily that the security services should cooperate with hospitals to "halt the violent trend" and improve service to patients. "Bringing about a harmonious medical service environment is not just down to hospitals," he said. "The police should be more involved in safeguarding hospital staff and the facility itself."

China's healthcare system - once almost free - is now one of the most market-oriented in the world. Since market reforms in 1979 the government's share of healthcare costs has declined from 54% to 17%. According to the World Health Organisation China ranks 188 out of 191 nations in terms of the equality of financial access to health.

For hundreds of millions of poor farmers, all but the most rudimentary care by "barefoot doctors" is unaffordable. A peasant saying has it that a pig must be taken to market every time an ambulance siren wails, a year's work is ruined as soon as you sleep in a hospital bed, and if you are struck with a serious disease, 10 years of savings go up in smoke. In 2004 a report said 75% of rural patients who declined recommended hospital treatment did so because of financial reasons.

With little support from state coffers, medical institutions have to find new ways to generate income. Drug sales account for half of hospital incomes, which has led to widespread accusations of overprescribing. Many ailments are unnecessarily treated with drips - which require hospital stays and monitoring by nurses - rather than pills that could be taken home.

Money also explains why half the babies in Chinese hospitals are now delivered by caesarean section. According to Li Ling, an economics professor at Beijing University's China Centre for Economic Research, hospitals can charge more for caesareans because they are billed as surgical procedures, whereas the fee for natural births is set at a low rate by the government.

"While China is maintaining impressive economic growth, inequality has also reached a disturbing level in the society and this is particularly observable in the area of healthcare," noted Zhao Zhongwei in a recently published paper for the Population and Development Review.

Similar views have been echoed by the WHO, the World Bank, and the Organisation for Economic Cooperation and Development, all of which have called for greater investment in hospitals and public health.

The central government is taking note. Last year it promised an extra £600m for rural healthcare and widened the scope of a new medical insurance scheme that covers more than half of the country's 800 million rural dwellers.

But concerns about inequality persist. James Murray is country director for Plan China, an NGO that provides healthcare support in one of the poorest areas of Shaanxi province. He said China invests only 20% of its medical spending on rural areas although they are home to 70% of the population.

http://www.guardian.co.uk/china/story/0,,2078004,00.html?gusrc=rss&feed=networkfront