Chinese farmer saws off his own legs as insurance will not cover medical costs

Insurance gaps force horrific decisions in China

PUBLISHED : Monday, 11 November, 2013, 1:43pm
UPDATED : Tuesday, 12 November, 2013, 11:12am

Zheng Yanliang spent much of the last 18 months sitting in a wheelchair in his Hebei farmhouse, a sheet concealing his ruined legs. His mother could not bear to look at the protruding bones.

Early last year, the 47-year-old farmer sought medical help in Baoding and Beijing for a sudden artery blockage affecting his legs. Unable to pay the potential medical bills and told that he might not survive the surgery, Zheng returned home to suffer through the pain.

"We found him painkillers, but they were of no use," said his mother, Yue Fengqin . "His cries and screams of pain could be heard outside the house."

Finally in April of last year, when his family was away, Zheng took a small fruit knife and a saw to his own legs. He chomped down on a towel wrapped around a backscratcher. He cut off his left foot at the ankle and severed his right leg at the thigh.

"Doctors said I only had three months to live," Zheng said. "It's a miracle I survived."

Horror stories like Zheng's keep making the headlines on the mainland, exposing gaps in the country's health safety net, even as authorities trumpet the health care reforms that have provided 95 per cent of the population some basic health insurance.

But many participants find the coverage severely lacking. Zheng, for example, received no help from the New Rural Co-operative Medical Insurance (NRCMI) scheme.

Under the decade-old scheme, farmers pay a small a premium for the government to cover their basic medical needs. This year, the premium in Zheng's home county of Qingyuan was 340 yuan (HK$430) - 60 yuan paid by farmers and 280 yuan paid by the government.

The programme reimburses participants for up to 85 per cent of their inpatient treatment at township hospitals, including 20 major illnesses. Among them are congenital heart disease, terminal kidney illness and some forms of cancer. Zheng's condition was not on the list.

Moreover, reimbursements are capped at 70,000 yuan. And subsidies decline as patients climb through the medical system. Participants receive 75 per cent at the county level, 65 per cent at the city level and 55 per cent at the provincial level.

Insurance experts said it was not realistic to expect that all major illnesses would be covered by basic public insurance.

"The insurance was designed for the government to pay more and farmers only a little to cover basic needs for a huge population," said Lin Wanlong , a professor of economics and management with China Agricultural University. "If such insurance is to cover critical diseases, the premium payment must be significantly increased, to the level of commercial insurance."

Like Zheng, Zhang Xinjian , a 25-year-old brick maker's assistant in Qingyuan county, was filled with despair after he was diagnosed with leukaemia earlier this year. Unable to afford half a million yuan for a bone marrow transplant, he prepared for the worst.

"I don't know about urban people, but for us farmers the only way is to go home and wait for death once we have a serious disease," Zhang said.

He asked township officials about government programmes, but was never told about the NRCMI. He eventually learned of the programme, but only after friends and family raised money to help pay for his treatment at a provincial-level hospital in Shijiazhuang .

Zhang has now spent almost 130,000 yuan, of which 50,000 yuan has been reimbursed. His medication costs 800 yuan a day.

"I don't know what to do after I've taken all the drugs," he said, tears welling in his eyes. "Sometimes I feel like committing suicide, and then I think of my two-year-old daughter, my wife and my mother. I want to be alive for their sake, but how?"

Last year, several government agencies pledged to allocate more NRCMI funds for commercial insurance to cover catastrophic illnesses, but action has yet to materialise.

Professor Zhu Junsheng , of the Capital University of Economics and Business, said improving the efficiency of medical service providers could be an alternative if raising premiums was out of the question.

"So far, the insurance companies have been eager to take the extra market share and have been less concerned about profits," Zhu said. "But the government needs to be cautious, and not kill their motivation with too many requirements."

Zheng has received free treatment at the Baoding No2 People's Hospital since his self-amputation made headlines last month. He was released on Saturday after undergoing surgery to clean his wounds.