First-aid calls, most popular in Chinese cities, was something new to farmers in Guzhuang Village, Anzhai Township, Quzhou County.
"If I had such illness in the old days, I would have to go a long way to the county hospital," said Gu. "Nowadays, I am treated in the neighborhood in great convenience, saving a lot of money."
Glad of his recovery, Gu was often reminded of an incident 28 years ago. In 1980, his best friend in the village fell ill with the same symptoms. He died on the way to the county hospital.
"We had to send him to the county seat because the village and township had poor medical facilities," said Gu, with bitter hatred.
"For a long period, the township hospital remained shabby. The village clinic existed in name. The medical equipment was simple and outdated. The doctors were actually unqualified."
The rural healthcare system was once a core element of Chinese socialism. After the founding of the People's Republic of China in1949, rural people had access to subsidized health clinics run by "barefoot doctors," who were basically middle-school students trained in first aid.
The primitive service, essentially free, played a role in doubling the country's average life expectancy from 35 years in 1949 to 68 years in 1978.
When China began its economic reform in the early 1980s, the system was dismantled as the country attempted to switch to a market-oriented healthcare system. But the government failed to establish a viable substitute, leaving its large rural population without health insurance.
A national health survey in 2003 revealed about 73 percent of people in rural areas who should have sought medical treatment chose not to do so because of the fear of high costs.
China has a rural population of 737 million, accounting for 56percent of its total population. The per capita net income of farmers reached 4,140 yuan (606 U.S. dollars) in 2007.
The plight of Chinese farmers has provoked national leaders to move to restore rural medical cooperatives and to establish a nationwide safety net of minimal medical insurance.
NEW RURAL COOPERATIVE MEDICAL SYSTEM
About two decades after the old cooperative fund program on medical expense collapsed in the countryside, China launched a new rural cooperative medical care program in 2003 to offer basic healthcare to rural residents who have virtually no medical insurance.
Under the program, a farmer participant pays 10 yuan a year while the state, provincial, municipal and county governments jointly contribute 40 yuan for the cooperative fund.
When rural residents fall seriously ill, the pooled funds cover part of their medical costs. Coverage varies by illness and actual expenses.
The national new-type rural cooperative medical treatment system has gone ahead smoothly from pilot operation to all-round promotion stage, said Chen Zhu, the health minister.
However, some provinces in the central and western parts of the country failed to meet the standard, mainly because individuals in poverty-stricken areas hadn't increased their participation.
To date, the scheme has covered 91 percent of total farmers and 98 percent rural areas through March, said Mao Qun'an of the Ministry of Health.
A total of 42.8 billion yuan was pooled by the fund in 2007, compared with only 4 billion yuan in 2003.
The fund paid out about 59.1 billion yuan over the past five years in reimbursements for 920 million claims.
"The program has helped ease the chronic difficulty faced by Chinese farmers in paying medical charges and significantly improved rural medical services," said Chen Zhu.
"China is working to establish a stable money-raising channel for the fund and efforts will be made to ensure that central and local government subsidies are allocated to the fund quickly and used efficiently," said Chen.
But experts believe there is a long way to go before the cooperative scheme can meet the needs of rural people.
Wu Ming, professor with the medical school of Peking University, said "With an average reimbursement rate for hospital fees only standing at a meager 27.5 percent, the current subsidiesa re still utterly inadequate in dealing with grave and terminal diseases."
HAND FROM INSURERS
A helping hand may come from Chinese insurers who are seeking more business opportunities in the country's rural cooperative medical care system as the value of cooperative funds they managedmore than tripled last year.
In 2007, seven insurance companies were entrusted with the management of 3.66 billion yuan of cooperative medical care funds across the country's rural areas, 233 percent more than in 2006, said the China Insurance Regulatory Commission.
The companies included the country's top three life insurers -- China Life Insurance, Ping An Life Insurance and China Pacific Life Insurance. They provided fund reimbursement, settlement and auditing for medical care schemes that covered 30.17 million ruralChinese last year, an annual growth of 41 percent, said the commission.
Under the schemes, local governments paid management fees to the insurers without drawing money from the cooperative funds. Deficits in fund operation were undertaken by governments and surpluses went to the next year's scheme.
Such a mode boosted the rural insurance business while preventing fraudulent operations and saving government costs, saidthe commission.
It cited the example of China Life Insurance, which promoted life, health and accident insurance businesses in rural areas and raked in more than 200 million yuan of revenue last year.
Farmers can get only about 30 percent of their medical expensesreimbursed under the present system, resulting in a huge potentialdemand for medical insurance products, said the commission.
It urged capable insurance companies to seize the opportunity and develop insurance products supplementary to the rural medical care system.
ASSESS QUALIFICATION
To improve medical skills of township and village doctors, the country devised a personnel exchange scheme. East China's Anhui Province, for example, selects 1,000 experienced doctors annually from city hospitals to work in grassroots hospitals to train rural doctors. The same number of local doctors will go to top city hospitals for training.
China has also moved to assess the qualification of village doctors to improve the quality of the medicare service in the vast rural area.
Village doctors will be evaluated by county-level health bureaux on the basis of their medical techniques, professional ethics and feedback from villagers, according to the regulation on the management of village doctors' profession.
The regulation, posted on the Ministry of Health website, only applies to doctors who had already obtained a medicare license and practiced medical service in villages.
The doctors could continue their profession if they pass the assessment, according to the regulation, adding those who failed the first time could re-apply within six months.
Those who were disqualified for the second time and failed to apply to have them evaluated in time would have their licenses revoked, the regulation said.
The assessment is organized once every two years since a regulation on the village doctors' professional qualification took effect in 2004.
The early regulation required medical practitioners in the countryside to apply for licenses before continuing their practice.
Licensed applicants had to obtain a medicare diploma at or above vocational education, or have been working in grassroots medical institutions for at least 20 years, or qualified in medicare training offered by provincial-level health authorities.
China has about 1.02 million village doctors, accounting for a quarter of the country's medical population. Only 10 percent had qualifications.
COVER ALL
Despite the progress, there are still 9 percent of farmers who have not been covered and have to "endure the ailment and delay the serious disease," as they say themselves.
The government has planned to expand the scheme to cover all rural residents and double the funding level to 100 yuan per capita by the end of 2008, with a split of 20 yuan from the participant and 80 yuan from the governments, Health Minister Chen said.
"As the financing increases, reimbursement plans should be adjusted to ensure that more medical fees can be refunded for farmers to boost the attractiveness of the program," Chen stressed.
China is determined to improve the grassroots healthcare system with a bigger budget, said vice health minister Gao Qiang.
The government will allocate more than 2.7 billion yuan for the development of rural healthcare infrastructure next year, said Zhao Zilin, the Ministry of Health 's financial department director.
The special fund will be used mainly for building hospitals for women and children and hospitals of traditional Chinese medicine as well as health centers.
The average cost for health centers will be 80,000 yuan, 380,000 yuan for hospitals for women and children hospitals, and 1million yuan for Chinese medicine hospitals.
The funding will also provide 21 types of medical equipment, such as B-ultrasonic scanners, sterilizers and ECG monitors.
With good medical equipment, quality doctors and reimbursement of some expenses to ease financial burdens, rural patients are naturally willing to go to hospital when falling ill. In farmer Gu Chaoshan's words, "We have the condition now."
To date, all townships have set up standardized hospitals in Quzhou County, which are equipped with first-aid beds, X-ray facilities. They offer clinic services in traditional Chinese medicine, healthcare, maternity, internal medicine, surgery and paediatric service. Each administrative village has a standardized clinic with college graduate doctors.
Gu was most happy at the new rural cooperative medical care program, as he recently got 1,300 yuan in reimbursement from the local medical insurance authority.
