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

    US Leaders Who Served in Vietnam War Look Back and Ahead

    In New York Times opinion piece, Secretary of State John Kerry, Senator John McCain and former Senator Bob Kerrey say as US strengthens relations with Vietnam, it is important to remember lessons learned from war

    Who Are US Allies in Fight Against Islamic State?

    There is little but opportunism keeping coalition together analysts warn — SDFs Arab militias are not united even among themselves, frequently squabble and don’t share Kurds' vision for post-Assad Syria

    Learning Foreign Language Helps US Soldiers Bridge Culture Gap

    Effective interaction with local populations part of everyday curriculum at Monterey, California, Defense Language Institute

    Featured Videos

    Your JavaScript is turned off or you have an old version of Adobe's Flash Player. Get the latest Flash player.
    Vietnamese-American Youth Optimistic About Obama's Visit to Vietnami
    X
    Elizabeth Lee
    May 22, 2016 6:04 AM
    U.S. President Barack Obama's visit to Vietnam later this month comes at a time when Vietnam is seeking stronger ties with the United States. Many Vietnamese Americans, especially the younger generation, are optimistic Obama’s trip will help further reconciliation between the two former foes. Elizabeth Lee has more from the community called "Little Saigon" located south of Los Angeles.
    Video

    Video Vietnamese-American Youth Optimistic About Obama's Visit to Vietnam

    U.S. President Barack Obama's visit to Vietnam later this month comes at a time when Vietnam is seeking stronger ties with the United States. Many Vietnamese Americans, especially the younger generation, are optimistic Obama’s trip will help further reconciliation between the two former foes. Elizabeth Lee has more from the community called "Little Saigon" located south of Los Angeles.
    Video

    Video First-generation, Afghan-American Student Sets Sights on Basketball Glory

    Their parents are immigrants to the United States. They are kids who live between two worlds -- their parents' homeland and the U.S. For many of them, they feel most "American" at school. It can be tricky balancing both worlds. In this report, produced by Beth Mendelson, Arash Arabasadi tells us about one Afghan-American student who seems to be coping -- one shot at a time.
    Video

    Video Newest US Citizens, Writing the Next Great Chapter

    While universities across the United States honor their newest graduates this Friday, many immigrants in downtown Manhattan are celebrating, too. One hundred of them, representing 31 countries across four continents, graduated as U.S. citizens, joining the ranks of 680,000 others every year in New York and cities around the country.
    Video

    Video Vietnam Sees Strong Economic Growth Despite Incomplete Reforms

    Vietnam has transformed its communist economy to become one of the world's fastest-growing nations. While the reforms are incomplete, multinational corporations see a profitable future in Vietnam and have made major investments -- as VOA's Jim Randle reports.
    Video

    Video Qatar Denies World Cup Corruption

    The head of Qatar’s organizing committee for the 2022 World Cup insists his country's bid to host the soccer tournament was completely clean, despite the corruption scandals that have rocked the sport’s governing body, FIFA. Hassan Al-Thawadi also said new laws would offer protection to migrants working on World Cup construction projects. VOA's Henry Ridgwell reports.
    Video

    Video Infrastructure Funding Puts Cambodia on Front Line of International Politics

    When leaders of the world’s seven most developed economies meet in Japan next week, demands for infrastructure investment world wide will be high on the agenda. Japanese Prime Minister Shinzo Abe’s push for “quality infrastructure investment” throughout Asia has been widely viewed as a counter to the rise of Chinese investment flooding into region.
    Video

    Video Democrats Fear Party Unity a Casualty in Clinton-Sanders Battle

    Democratic presidential front-runner Hillary Clinton claimed a narrow victory in Tuesday's Kentucky primary even as rival Bernie Sanders won in Oregon. Tensions between the two campaigns are rising, prompting fears that the party will have a difficult time unifying to face the presumptive Republican nominee, Donald Trump. VOA national correspondent Jim Malone has more from Washington.
    Video

    Video Portrait of a Transgender Marriage: Husband and Wife Navigate New Roles

    As controversy continues in North Carolina over the use of public bathrooms by transgender individuals, personal struggles with gender identity that were once secret are now coming to light. VOA’s Tina Trinh explored the ramifications for one couple as part of trans.formation, a series of stories on transgender issues.
    Video

    Video Amerikan Hero Flips Stereotype of Middle Eastern Character

    An Iranian American comedian is hoping to connect with American audiences through a film that inverts some of Hollywood's stereotypes about Middle Eastern characters. Sama Dizayee reports.
    Video

    Video Budding Young Inventors Tackle City's Problems with 3-D Printing

    Every city has problems, and local officials and politicians are often frustrated by their inability to solve them. But surprising solutions can come from unexpected places. Students in Baltimore. Maryland, took up the challenge to solve problems they identified in their city, and came up with projects and products to make a difference. VOA's June Soh has more on a digital fabrication competition primarily focused on 3-D design and printing. Carol Pearson narrates.

    Special Report

    Adrift The Invisible African Diaspora