Energy-enhancing eating and a healthy lifestyle as taught in Daoist resorts are becoming ever more important, given the problematic state of China’s health care system. While everyone received free care under Mao, economic development reduced state involvement to the point that, by 2003, only about 30 percent of the population had basic health care.
This number has greatly improved over the years, so that today most Chinese are covered, mainly due to the new rural cooperative medical care initiative. A voluntary system, funded by individual contributions and government subsidies for the poor, it reaches wide swathes of the population, although it continues to be plagued by inadequate funding, staff shortages, and insufficient equipment.
One issue is that while inpatient costs are covered, most outpatient visits are not, which leaves many people still unable to pay for hospital visits. Also, location matters, again referring back to the ubiquitous household registration system. Rural medical care covers 70-80 percent of a visit to the local clinic, but only about 60 at the county hospital, and even less for more specialist services, often located in bigger cities.
In addition, waiting times are long, often lasting hours. One can pay specially to get a prebooked time slot or hire someone to stand in line in one’s stead, but both cost money. Also, physicians are notoriously underpaid and overworked, commonly making less than $800 a month, even in larger cities. One brain surgeon in Tianjin, as Shaun Reid points out, made so little he had to take bribes to pay for basic living expenses.
Given this situation, they often require a “red envelope” filled with private cash to do a proper job. They also tend to overprescribe medicines for percentages from the pharmaceutical industry and recommend unnecessary surgeries to get kickbacks. Typically, they have little time or consideration for patients who they see in rooms filled with dozens of people, affording essentially no privacy or opportunity for calm and quiet conversation.
As a result, lower-income consumers feel helpless and angry at the medical system. Poor people,” Shaun Reid quotes an informant, “in China cannot afford to get sick. We have no insurance and do not trust doctors” (2014, 57). Protests are on the rise. In 2012, for example, the Chinese Hospital Association found that on average each hospital in China had 27.3 violent incidents, up from an average of 20.6 in 2008, bur rising to a total of over 20,000 in the country in 2013. Some of these protests even turn violent. For example, a patient in Harbin stabbed four hospital workers, killing one, because he did not get immediate treatment.
Responding to these protests, the government has cracked down on corruption, notably abuses of medical funds but also on physicians and administrators taking bribes. In addition, it has started a new campaign, Healthy China 2020. By this date, all citizens should have access to high-quality health care while living healthier lives overall. Focusing on urban areas most impacted by Westernization, the state encourages people to eat a more traditional diet and get more exercise—although with pollution on the rise the latter is a double-edged sword.
Read: Burns, Lawton Robert, and Gordon G. Liu, eds. 2017. China’s Health Care System and Reform. Cambridge University Press.