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The China syndrome

What can the U.S. learn from health care reform in the world's most populous country?

A village clinic in Zhaoxing in remote Guangxi province a region populated by the Dong minority. (Sharron Lovell/GlobalPost)

Editor's note: This is the first of a three-part series on China's attempts to reform its sprawling and troubled health care system. Kathleen E. McLaughlin and Sharron Lovell have documented the effects on people across the country, including rural areas and urban centers.

BEIJING — As the United States is once again mired in a debate about health care reform, across the Pacific the world’s largest socialist country is trying to piece together some semblance of universal health care for its 1.3 billion citizens.

China’s health care system was once a model of low-cost, efficient delivery that served hundreds of millions of people. The system began to fall apart in the 1980s with the disbanding of the socialist economy. State-owned companies that had promised cradle-to-grave health care coverage to their employees were privatized. Often, there was nobody to pick up the pieces.

Since 1980, the percentage of personal income Chinese people spend out-of-pocket on health care has doubled. Access is often severely limited in rural areas and even major urban centers struggle with adequate funding and care. In 2006, a survey showed that nearly half of Chinese people refused to see a doctor when they fell ill.

As the system broke down, horror stories began to emerge: patients turned away from hospitals and dying because they couldn’t make large cash deposits, life savings spent on health care that is inappropriate or ineffective.

Earlier this year, China’s central government announced an ambitious, long-term plan to reform its ailing health care system. By shoring up the system, officials say, they can help Chinese citizens feel more financially secure and thus spend more on other items. Increasing domestic consumer spending is a cornerstone of China’s plan to weather the global financial crisis.

But the problem is massive and so, too, will be the solution. The health care reform effort is being rolled out in stages that will continue through 2011, beginning with a basic opt-in insurance program for hundreds of millions of rural residents.

In a groundbreaking study of China’s health care system late last year, the British medical journal, The Lancet, said inequities in the system were among its biggest problems. Still, the report said, China also has a unique opportunity for broad reform.

“With economic boom and growing government revenues, China is unlike other countries challenged by health inequities and can afford the necessary reforms so that economic development goes hand-in-hand with improved health equity,” the journal’s researchers wrote.