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At night, Chinese cancer patients haunt the corridors of seedy hotels. Unable to afford a hospital bed, they are forced to choose cheap accommodation while awaiting treatment.

by Zofia Reych

The Chinese healthcare reform, conceived at the beginning of the century, extended the reach of national healthcare insurance from 35% of the population in 2003 to 95% in 2011. But despite numbers suggesting the reform’s success, the system is failing its patients – especially those most in need of medical treatment.

A recent Reuters story revealed the ordeal faced by Chinese cancer patients. Those who cannot afford a hospital bed live in refugee camp-like hotels, awaiting specialist treatment unavailable in their local hospitals. Having travelled hundreds of miles, some of them spend months in a seedy hotel, hoping to be seen by a reputable doctor.

“There’s an imbalance between the big cities and small ones. Good doctors don’t want to work in small places,” explained a man who cares for his wife in one of Beijing’s cancer hotels. By not staying at the hospital the couple manage to save half of the accommodation cost, but they have already been forced into debt.

Despite public insurance reaching over 1.4 billion Chinese, statistics show that 44% of impoverished families have been pushed over the brink of poverty by costs associated with long term illness.

The ill-thought reform

In April 2009, the Chinese government announced a plan to invest USD 124 billion in reviving healthcare provision, a service ruined by privatisation at the end of the previous century. In 2013, spending had reached USD 371 billion and it was already obvious that inefficiency was once again hampering efforts.

Although the primary goal of extending national healthcare insurance to the wider public was reached, only basic services are provided without additional cost to patients. What’s more, in a 2013 survey, 81% of respondents admitted that it was difficult for them to be seen by a doctor. More than half said that it was getting harder and harder to get an appointment.

Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations, believes the reform is failing due to poor allocation of funds. Despite the astronomic spending, the government contributes only 10% of public hospital revenues. Its impact on hospital operations is too insignificant to benefit patients wishing to be treated under national insurance.

Another of the reform’s goals – opening new clinics in rural areas – failed to serve its purpose, as the best doctors flock to big cities, leaving villagers without specialist care.

A recent report from the World Bank warned China that not rethinking and deepening the reforms will soon result in a “high-cost, low-value” health care system. Unfortunately, Beijing’s cancer hotels is proof that this warning comes too late.

Deadly costs

Despite national healthcare insurance extending to a huge proportion of the Chinese public, those who need it the most – poor migrant workers – rarely see its benefits. Travelling from city to city, they are often employed without a contract, and their employers don’t pay the required contributions.

In theory, the recent reform caters for those who fall through the system, but they can only receive free treatment at their place of birth. And in case of the most severe, or rare diseases, high-quality, specialist care is unavailable outside of big cities.

Beijing’s cancer hotels are a direct result of this dire situation. For patients spending hundreds of thousands of yuan on treatment, cutting costs is crucial, even if it means compromising on the quality of care. The budget hotels don’t offer nursing, but they do have communal kitchens where patients can prepare their humble meals.

“For many people, a cancer diagnosis can be financially catastrophic, and push a household into poverty”, says Bernhard Schwartlander, WHO Representative in China.

Tales of the patients awaiting treatment in cancer hotels confirm his words. Although illness is a tragedy in itself, for the poorest Chinese it is only the beginning of their ordeal: they might survive the cancer, but they will be left in debt.

“The hardest part for us is the money. We are farmers, we have already spent over 270,000 yuan (£31,444) since 2013”, revealed one of the budget hotel’s residents.

And, according to WHO data, cancer rates in China are soaring. Every year 2.2 million Chinese patients die of the disease. The numbers could be much lower if the government invested in reducing the social and environmental risks, as well as making hospital beds available to those in need.

Both in cities and in rural areas, medical institutions are under huge strain. Underpaid, overworked doctors are prone to bribery and for many patients bribery is the only way to be seen by a specialist. Those who cannot afford it are left with nothing but frustration, resulting in a rise of verbal abuse and physical attacks on medical staff.

The healthcare price tag is huge not only to individuals: the national medical expenditure in China is growing at 8.4% a year. For now, as observed by World Bank president, Jim Yong Kim, “costs are rising but outcomes are not improving.”