News / Asia

China's 'Black Clinics' Thrive as Government Debates Health Reform

An elderly man talks to a girl who was injured after a stampede accident at a primary school, at a hospital in Xiangyang, Hubei province, China, Feb. 27, 2013.An elderly man talks to a girl who was injured after a stampede accident at a primary school, at a hospital in Xiangyang, Hubei province, China, Feb. 27, 2013.
x
An elderly man talks to a girl who was injured after a stampede accident at a primary school, at a hospital in Xiangyang, Hubei province, China, Feb. 27, 2013.
An elderly man talks to a girl who was injured after a stampede accident at a primary school, at a hospital in Xiangyang, Hubei province, China, Feb. 27, 2013.
Reuters
A one-room shack with a single, bare light bulb on a nondescript Beijing side street is 29-year-old Chinese migrant worker Zhang Xuefang's best recourse to medical care.

Not recognized as a Beijing resident, she does not qualify for cheaper health care at government hospitals, and her hometown is too far away to take advantage of medical subsidies there.

Like millions of other migrant workers, Zhang, on whose labor China's economic boom depends, is forced into a seedy and unregulated world of back alley "black clinics" if she falls ill.

The issue highlights the two-tier nature of China's overburdened healthcare system and goes to the heart of a heated debate about how to reform the contentious "hukou" system of household registration, a cornerstone of government policy for decades which essentially legalizes discrimination between urban and rural residents.

The hukou system, which dates to 1958, has split China's 1.3 billion people along urban-rural lines, preventing many of the roughly 800 million Chinese who are registered as rural residents from settling in cities, and enjoying basic urban welfare and services.

China's new government has vowed to change this divisive system with reforms aimed at sharing more equally the bounty of China's economic growth and consumption-led growth.

Newly-appointed Premier Li Keqiang vowed at his debut news conference earlier this month to press ahead with reforms to narrow China's urban-rural gap, including giving migrant labor equal access to medical insurance.

No details have yet been announced, so black clinics will remain the affordable last resort for migrant workers.

"Health care insurance and other social insurances are closely linked to hukou. Providing better social insurance is, I believe, an incentive to reform hukou system," said Zhang Shuo, a senior health specialist with the World Bank's Beijing office.

"China's urbanization will be unprecedented in speed and scale," Zhang explained. "Portable social insurances is key to encourage labor migration, but it will take some time for a country as big as China."

Dark corner of health system

"Black clinics are the dark corner of China's medical system," said Jiao Zhiyong, a professor at Beijing's Capital University of Economics and Business. "Migrant workers are their main patrons largely due to flaws in the health insurance system."

World Bank's Zhang also pointed out that China's health care insurance system is a fragmented one, mostly coordinated within counties. But migrant workers usually have to seek medical treatment outside their home counties.

The Beijing government has shut down about 1,000 black clinics a year since 2010, according to government figures.

Many, however, reopen nearby or at the same place only days after being closed.

While China has never published numbers for how many black clinics exist, every so often state media reports deaths at these unlicensed health centers.

In January, Chinese newspapers reported that a migrant worker from Fujian province died from a cardiac arrest hours after receiving an intravenous drip to relieve her cold symptoms in a black clinic in one of Beijing's gritty outer suburbs.

Migrant worker Zhang has seen the dangers of black clinics close up. On one occasion, out of fear that authorities might be nearing the illegal clinic, Zhang's doctor locked her inside the clinic, still hooked up to an intravenous drip, as he fled.

"We don't want to go to those places, knowing that the substandard hygienic conditions affect us, but we really can't afford big hospitals," said Zhang, who once paid 800 yuan - a quarter of her monthly salary - for treatment of a common cold at a government hospital in Beijing.

China has beefed up spending on health care reform with last year's overall expenditure at 719.9 billion yuan, a 12 percent increase from the previous year. Yet last year's figures from the Ministry of Human Resources and Social Security showed that only about 20 percent of migrant workers have health insurance.

"To build a countrywide health care reimbursement system is our goal, but there is still quite a long way to go," Hu Xiaoyi, vice minister of Ministry of Human Resources and Social Security told reporters this month.

For those who are insured, reimbursement only comes after payment, and often is complicated by bureaucratic red tape, putting families at risk of bankruptcy when major health problems strike.

"Health insurance works locally, but when we go work in other places, only some provide health insurance, which still requires a lot of procedures. And each could take months and still wouldn't come through," Cao Yong, a migrant worker delegate to parliament, told state radio.

You May Like

Multimedia Social Media Documenting, Not Driving, Hong Kong Protests

Unlike in Arab Spring uprisings, pro-democracy protesters in Hong Kong aren't relying on Twitter and Facebook to organize, but social media still plays a role More

Bambari Hospital a Lone Place of Help in Violence-Plagued CAR

Only establishment still functioning in CAR's second city is main hospital More

Featured Videos

Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
The Legacy of Jimmy Carter: The Preacher from Plainsi
X
October 01, 2014 10:45 AM
It is common in the United States to see tourists flock to sites associated with America's presidents. Some are privately owned and others are run by the National Park Service or the National Archives -- but most have helped draw business and people into the towns and cities where they are located. As VOA’s Kane Farabaugh reports, there is one particular presidential hometown that is unique in what it has to offer those who make the trip.
Video

Video The Legacy of Jimmy Carter: The Preacher from Plains

It is common in the United States to see tourists flock to sites associated with America's presidents. Some are privately owned and others are run by the National Park Service or the National Archives -- but most have helped draw business and people into the towns and cities where they are located. As VOA’s Kane Farabaugh reports, there is one particular presidential hometown that is unique in what it has to offer those who make the trip.
Video

Video Hong Kong Protests Draw New Supporters on National Holiday

On the 65th anniversary of the founding of Communist China, Hong Kong protesters are hoping to stage the largest pro-democracy demonstration since the 1989 Tiananmen protests. VOA's Brian Padden visited one of the protest sites mid-day, when the atmosphere was calm and where the supporters were enthusiastic about joining what they are calling the umbrella revolution.
Video

Video India's PM Continues First US Visit

India's prime minister is on his first visit to Washington, to strengthen political and economic ties between the world's oldest and the world biggest democracies. He came to the U.S. capital from New York, the first stop on his five-day visit to the country that denied him an entry visa in the past. From Washington, Zlatica Hoke reports Modi seemed most focused on attracting foreign investment and trade to increase job opportunities for his people.
Video

Video Malaysia Struggles to Stop People Joining Jihad

Malaysian authorities say militant groups like the so-called "Islamic State" have used social media to entice at least three dozen Malaysian Muslims to fight in what they call "jihad" in Syria and Iraq. As Mahi Ramkrishnan reports from Kuala Lumpur, counterterrorism police are deeply worried about what could happen when these militants return home.
Video

Video Could US Have Done More to Stop Rise of Islamic State?

President Obama says airstrikes against Islamic State militants in Syria will likely continue for some time because, in his words, "there is a cancer that has grown for too long." So what if President Obama had acted sooner in Syria to arm more-moderate opponents of both the Islamic State and the Syrian government? VOA State Department Correspondent Scott Stearns reports from the United Nations.
Video

Video Treasure Hunters Seek 'Hidden Treasure' in Central Kenya

Could a cave in a small village in central Kenya be the site of buried treasure? A rumor of riches, left behind by colonialists, has some residents dreaming of wealth, while others see it as a dangerous hoax. VOA's Gabe Joselow has the story.
Video

Video Ebola Patients Find No Treatment at Sierra Leone Holding Center

At a holding facility in Makeni, central Sierra Leone, dozens of sick people sit on the floor in an empty university building. They wait in filthy conditions. It's a 16-hour drive by ambulance to Kailahun Ebola treatment center. Adam Bailes was there and reports on what he says are some of the worst situations he has seen since the beginning of this Ebola outbreak. And he says it appears case numbers may already be far worse than authorities acknowledge.
Video

Video Identifying Bodies Found in Texas Border Region

Thousands of immigrants have died after crossing the border from Mexico into remote areas of the southwestern United States in recent years. Local officials in south Texas alone have found hundreds of unidentified bodies and buried them in mass graves in local cemeteries. Now an anthropologist and her students at Baylor University have been exhuming bodies and looking for clues to identify them. VOA’s Greg Flakus has more from Waco, Texas.
Colonel Steve ‘Spiros’ Pisanos left Greece and came to the U.S. to learn to fly. He flew fighters for the Allies in World War II, narrowly escaping death multiple times.Colonel Steve ‘Spiros’ Pisanos left Greece and came to the U.S. to learn to fly. He flew fighters for the Allies in World War II, narrowly escaping death multiple times.

AppleAndroid