Helping migrants key to plan's success
Zhuang Pinghui and Josephine Ma
Rural migrant workers will be given the option of joining the basic medical insurance scheme for urban residents under a new action plan for health care reform for the coming three years.
Reducing the huge gap in the medical services and insurance coverage enjoyed by urban and rural dwellers is one of the key tasks pinpointed by the latest round of health care reform.
The government is working to expand insurance schemes to cover the vast numbers of rural migrants working in cities, which scholars estimate at more than 100 million.
Most rural dwellers are entitled to join the rural medical insurance cooperatives, but these schemes have been criticised for the low level of compensation to policyholders. Outpatient services are not covered by the rural schemes, and many rural migrants find it hard to claim the medical expenses from the rural schemes in their hometowns if they fall sick in cities.
Analysts said the new measures meant well but would not achieve much if no concrete reinforcement measures were in place.
'If I were a migrant worker I would want to join the medical insurance for urban residents because the coverage of the rural schemes back home is too low,' said Gu Xin, a health care reform expert from Peking University who was once consulted on the reform draft.
'But achieving the goal [to cover rural migrants with the urban insurance scheme] involves tackling a lot of difficulties.'
Dr Gu said city governments would be reluctant to spend more to provide the same benefits to rural migrants as to their urban counterparts.
'Where does the extra money come from? I don't think local governments are willing to do that.'
The new measure to allow rural migrants to claim medical expenses for services outside their hometowns was also impractical, Dr Gu said.
Rural migrants tend to move to different cities to work and each of these cities has its own premiums and compensation standards, and settling the bills across cities would be a daunting task.
Meanwhile, the action plan pledges to increase the level of compensation payments to at least six times the average annual income of where a rural resident comes from.
In order to encourage local governments to raise compensation levels for the rural medical co-operative schemes, the action plan restricts the amount of money a local government can keep from the premiums it collects.
Some provinces keep up to one-third of premiums collected in reserve for future use instead of reimbursing farmers for their medical bills.
'The co-operative fund surplus should be controlled within 15 per cent a year in principle and the accumulated surplus should be no more than 25 per cent of the funding that year,' the document says.
A medical insurance expert at Zhejiang University said the reforms were moving in the right direction by encouraging governments to pay policyholders more. But he said more flexibility should be given to local governments instead of imposing a 15 per cent cap on the annual surplus.
Medical services in rural areas, however, are expected to greatly benefit from stipulations that doctors from city hospitals and disease prevention and control centres must spend one year in rural areas before being promoted.
The action plan also pledges to subsidise the university fees for doctors who agree to work in rural clinics for at least three years.
The action plan says the government will build 2,000 county hospitals in three years and finish building 29,000 township clinics this year. It will also upgrade another 5,000 township clinics.
It also set a target to build at least a simple clinic in each village in three years.
The government will offer 1.9 million training sessions for village and township medical clinics and urban community medical institutions over the next three years to improve their quality.