"As soon as the money dries up, doctors warn, so will the drugs that could save the life of Cui Guangshun’s 7-year-old son, Dejie, in the leukemia unit of Beijing’s Children’s Hospital. Such are the rules of China’s pay-as-you-go health system: cash upfront, or no treatment."

Was it for this that Karl Marx wrote and wrote in Soho, and Mao Dze Dung turned China upside down?

"Mr. Cui’s wife, Yang Devin, traveled more than 300 miles by bus to Beijing from their small farm on the grasslands of Inner Mongolia to be near her only child. For weeks, she camped out on a blue plastic chair in one of the hospital waiting rooms to save money on lodging, like dozens of other parents.

"Back home, her husband pleaded with relatives and village neighbors for more loans to keep the boy’s care going. Most nights, the mother queued in a drab hospital lobby, littered with food wrappings and possessions, to use a touchscreen computer to see how much of the family’s cash was left.

"In the past few weeks, Mr. Cui and Ms. Yang have been forced to accept a terrible reality: Even though their son’s leukemia is considered highly treatable, they may never raise enough money to cure him. The hospital’s estimated fees of $18,500 to complete an initial 6.5-month course of treatment are impossibly high set against the family’s annual income of less than $350. Like two-thirds of China’s population, they don’t have health insurance.

"‘There’s nothing for it,’ Mr. Cui sighed, slumped in the doorway of his red brick home on a recent afternoon. He said he had dug up his potato crop and sold it all. He had threshed his corn and sold most of that, too, leaving barely enough to make the steamed bread that keeps his family going through the winter. ‘I’ll just have to fetch Dejie home to die,’ he said.

"Xie Jing, the chief doctor responsible for Dejie’s ward, defends her hospital’s insistence that patients pay for treatment ahead of time by putting money into a hospital-controlled account. "If the patients have no money to refill the hospital account, we have to stop giving them medical treatment,’ she says. ‘It is a national problem.’

"Health care is an issue vexing the world’s most developed countries, including the US, where people can lose all their savings if they get sick. But in worst-case scenarios people who need urgent care generally receive it. A poor family like Mr. Cui’s would be eligible for Medicaid. Japan and most European countries cover everyone through universal health insurance.

"That’s not the case in China, where patients are routinely denied care if they can not come up with the money to pay for it in advance, even in emergencies."

Pay or Die

"The World Health Organization ranked China fourth from the bottom of 191 countries in terms of the fairness of its medical coverage in a survey issued in 2000. This March, a report from a Chinese cabinet think tank said that unless China overhauls its medical care, ‘it will directly affect economic development, social stability and public support for reform.’

"The crisis in China’s health care is already showing signs of holding the country back. Health costs are one of the main reasons Chinese save as much as 40% of their incomes. That is one of the main reasons they are not spending to consume more goods, as US officials have been hoping amid concern about the big US trade deficit with China. Fewer than one-third of China’s 1.3 billion people have health insurance.

"As recently as the 1970s, China’s health-care network covered just about everybody. Collective farms offered basic treatment and immunization. In cities, health care was a perk of jobs in the government and state factories, which often ran their own clinics and hospitals. But as China embraced free markets, the ‘People’s Communes’ were disbanded in the countryside, and thousands of state factories were shut down or privatized. Starting in the 1980s, hospitals were ordered to turn a profit.

"Today, China has plenty of large hospitals packed with state-of-the-art equipment to compete for paying patients. To maximize revenue, hospital doctors routinely over-prescribe drugs and diagnostic procedures, according to studies by the Chinese government and international bodies like the World Bank. Hospitals sell drugs directly to patients and add a profit margin.

"A World Bank study estimates that drugs account for more than 50% of all Chinese health spending. In the US prescription drugs account for less than 15% of total health spending, according to US government figures. The World Bank says 12% to 37% of Chinese national health expenditures are wasted because of unnecessary drug prescriptions.

"‘Hospitals have become huge corporate profit centers,’ says Chen Bowen, an official with the Society of Community Health Service, a non-profit organization based in Beijing that advises authorities on health reform. Mr. Chen’s research shows that n rural areas, 30% of children who die end their lives at home because their families can’t afford hospital care.

"Dejie first got sick with a cold in late September. For weeks before that, he had been complaining of fatigue and pain in his abdomen. The first doctor to examine him took blood tests but saw nothing suspicious, and prescribed stomach medicine and a cold remedy. By then Dejie had turned a shade of yellow and was too weak to walk to school. A second doctor ran new blood tests but offered no better explanation.

"Mr. Cui brought the boy to a larger hospital in the city of Chengde, five hours away by bus, where another doctor broke the news that he had leukemia. This doctor recommended that they seek treatment in China’s leading children’s hospital in Beijing.

"Mr. Cui recalls that when he heard Dejie had cancer, he stood in the road and sobbed. Dejie lifted his hand and dried his father’s tears. ‘It broke my heart,’ he says. Relatives describe Dejie as a studious boy who prefers staying indoors to playing outside among the chickens and pigs that run around the village. Mr. Cui has hopes his son will make it one day in college. He’s proud of the way Dejie can memorize his school textbooks and boasts that the boy can even recite some passages backwards.

"Mr. Cui knew better than to expect help from the government. He says the head of his village, a collection of 30 dilapidated homes reached by a potholed mud road, turned down his request for a loan, declaring Mr. Cui’s collateral – his house – to be worthless. The local Communist Party secretary wasn’t much help either. ‘People die every day in China,’ Mr. Cui recalls him saying.

"But at the Beijing Children’s Hospital, a doctor put him straight. ‘If you have money the child can live,’ Mr. Cui recalls her saying. ‘If not, he will die.’

"The first round of chemotherapy lasted one month. Doctors warned that if they had to abandon treatment midway through the second round, when the boy’s immune system would be shattered, he could easily fall prey to a life-threatening infection. But they went ahead any way, with no guarantee that the family could raise more cash.

"In China these days, the cost of serious illness quickly becomes a community burden. Of the 30 or so families in Guangming village, a settlement without electricity until 1996, half chipped in with loans that they could ill afford, Mr. Cui says.

"The All China Women’s Federation drummed up support in the area with television appeals, as it often does when somebody falls seriously ill. The stricken boy’s classmates added their savings. Once, on one of Mr. Cui’s visits to Beijing, the long distance bus driver let him aboard free, and the conductor took up a collection among the passengers.

"The strain of health-care costs is so severe it is plunging growing numbers of people back into the poverty from which they so recently escaped. At age 38, Mr. Cui is ruined, his debts of nearly $4,000 already amounting to more than 10 years of income. His relatives and neighbors who lent him money are worse off, too."

– from Economic Reform, February 2006