In the first of a three-part series, the Post looks at the reasons for rising public anger over health care on the mainland, and examines possible solutions to what leaders see as a recipe for social instability Unless they are among the 130 million urban employees covered by medical insurance, mainland families who need access to decent medical treatment usually sell their assets, borrow money and go to big cities. Even in the big cities with plenty of facilities, getting medical treatment for curable and common diseases can still be a nightmare. Quotas for appointments with reasonably good doctors are always filled early in the morning. Even when a person has access to doctors and can afford the treatment, there is no guarantee for the quality of services. As a result, there are more medical disputes and growing tension between doctors and dissatisfied patients. Last month, a disgruntled patient stabbed a doctor to death in a traditional Chinese medical clinic in Fuzhou . The China Youth Daily reported that some doctors had even hired bodyguards to prevent attacks from angry patients. A State Council official conceded government leaders were alarmed by the rising public anger about health-care provision and fear it may spark social instability. 'Out of all areas, the public is most dissatisfied with the health-care system - that it is expensive and that it's hard to get medical treatment. The problem has the full attention of the senior leadership.' Government sources said the leadership had made assuaging public grievances on health care and education its two key tasks. Another government source said the Ministry of Health started last year to consider plans to rectify mistakes in health-care reform in the past two decades. One key fault, highlighted in a much-publicised State Council Development Research Centre report in July, is the unlimited government-backed marketisation of the past decade. The centre's report - so far the bluntest assessment released to the public - described the past two decades of health-care reform as a failure and called for an overhaul. Many officials and academics agree that much of the problem is rooted in the withdrawal of government funding from the medical sector starting 20 years ago, - when it pushed all hospitals and medical institutes into generating profits to pay for their staff and expenses. Yu Zonghe , deputy chairman of the Chinese Hospital Association said: 'By asking hospitals to make profits to finance expenses, the government is shirking its responsibility.' Medical services have become a pure commercial commodity. Public and private hospitals have been providing services with high profit margins and encouraging patients to undergo unnecessary medical tests to pad out bills. A government policy allowing hospitals to finance their operations by selling medicine at above-market prices has also resulted in rocketing drug bills and the overuse of expensive medication. A Health Ministry official illustrated the situation. 'I once accompanied some World Health Organisation experts to a hospital and they saw a boy on an intravenous drip eating an apple. They asked me why a boy who was able to eat still needed an intravenous drip. 'I did not say anything, but I would have done the same if I were a doctor at that hospital because I would need to charge the patient and pay my expenses.' Ironically, as wasteful procedures have risen the bed use rate in hospitals dropped from 87 per cent in 1985 to 72 per cent last year. Medical facilities have opted to leave beds vacant rather than treat people who cannot afford to foot high bills. While the problems with the health-care service are conspicuous, there is no consensus about remedies. An idea gaining ground within the government is to split medical services into high-end and basic categories. Officials suggest the government should select some hospitals to provide basic medical services and heavily subsidise its cost. The government could then allow the market to freely provide more sophisticated medical procedures. The profit from these services would be used to subsidise basic health care. However, the proposal has many problems - such as how to define basic and high-end services, and how to avoid abuses. There is also strong resistance from hospitals. A hospital president in Nanjing said: 'It would really depend on whether the government would increase funding to hospitals, otherwise it would all be empty talk.' But government officials do not agree. Song Ruilin , deputy director of the public health department at the State Council's legislative affairs office, said increased government funding for health care did not mean all the system's problems could be solved. 'Greater supply will stimulate more demand,' he said, adding that no matter how much the government invested, there would still be a shortage of services. There are also suggestions from within the government that the Ministry of Health should hive off pharmaceutical businesses from hospitals and concentrate on its role as a regulator instead of running medical facilities. A government source said a trial plan to overhaul urban medical services was waiting for State Council approval. Three to five medium-sized cities would be chosen as pilot project centres for the plan in an attempt to offer more efficient and accessible health care. The plan would also involve improving basic services in community hospitals to stop the large influx of patients seeking medical treatment in big cities. But the changes would not mean an increase in government health-care funding to these cities. It is understood that the Development Research Centre is also drafting a report on reforming health-care services. But among the debates and suggestions the issue of quality had been ignored, said assistant professor Zhang Wei , at Peking University's department of health economics and management. 'Quality, efficiency and equity are equally important. If the quality of medical services is not guaranteed, there will remain dissatisfaction and the problems cannot be solved.'