{"page":"\u003clink rel=\"stylesheet\" href=\"https://lessonplanet.com/assets/packs/css/resources-c03aa079.css\" /\u003e\n\u003clink rel=\"stylesheet\" href=\"https://lessonplanet.com/assets/packs/css/lp_boclips_stylesheets-517835be.css\" media=\"all\" /\u003e\n\u003cdiv data-title='China struggles with health reforms' data-url='/boclips/videos/5c54bc4ad8eafeecae12b8bb' data-video-url='/boclips/videos/5c54bc4ad8eafeecae12b8bb' id='bo_player_modal'\u003e\n\u003cdiv class='boclips-resource-page modal-dialog panel-container'\u003e\n\u003cdiv class='react-notifications-root'\u003e\u003c/div\u003e\n\u003cdiv class='rp-header'\u003e\n\u003cdiv class='rp-type'\u003e\n\u003ci aria-hidden='true' class='fai fa-regular fa-circle-play'\u003e\u003c/i\u003e\nVideo\n\u003c/div\u003e\n\u003ch1 class='rp-title' id='video-title'\u003e\nChina struggles with health reforms\n\u003c/h1\u003e\n\u003cdiv class='rp-actions'\u003e\n\u003cdiv class='mr-1'\u003e\n\u003ca class=\"btn btn-success\" data-posthog-event=\"Signup: LP Signup Activity\" data-posthog-location=\"body_link_boclips\" data-remote=\"true\" href=\"/subscription/new\"\u003e\u003cspan\u003e\u003cspan\u003eGet Free Access\u003c/span\u003e\u003cspan class=\"\"\u003e for 10 Days\u003c/span\u003e\u003cspan\u003e!\u003c/span\u003e\u003c/span\u003e\u003c/a\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv class='rp-body'\u003e\n\u003cdiv class='rp-info'\u003e\n\u003cdiv aria-label='Hide resource details' class='rp-hide-info' role='button' tabindex='0'\u003e\u0026times;\u003c/div\u003e\n\u003ci aria-label='Expand resource details' class='rp-expand-info fai fa-solid fa-up-right-and-down-left-from-center' role='button' tabindex='0'\u003e\u003c/i\u003e\n\u003ci aria-label='Compress resource details' class='rp-compress-info fai fa-solid fa-down-left-and-up-right-to-center' role='button' tabindex='0'\u003e\u003c/i\u003e\n\u003cdiv class='rp-rating'\u003e\n\u003cspan class='resource-pool'\u003e\n\u003cspan class='pool-label'\u003ePublisher:\u003c/span\u003e\n\u003cspan class='pool-name'\u003e\n\u003cspan class='text'\u003e\u003ca data-publisher-id=\"30356011\" href=\"/search?publisher_ids%5B%5D=30356011\"\u003eCurated Video\u003c/a\u003e\u003c/span\u003e\n\u003c/span\u003e\n\u003c/span\u003e\n\u003c/div\u003e\n\u003cdiv class='rp-description'\u003e\n\u003cspan class='short-description'\u003eAP TelevisionHenan Province, China - 22 Sept, 20091. Mid of bedridden Ji Xiaoyan while hooked up on electrotherapy machine 2. Close Ji Xiaoyan staring up at ceiling 3. Wide of Ji Xiaoyan and her mother operating electrotherapy machine...\u003c/span\u003e\n\u003cspan class='full-description hide'\u003eAP Television\u003cbr/\u003eHenan Province, China - 22 Sept, 2009\u003cbr/\u003e1. Mid of bedridden Ji Xiaoyan while hooked up on electrotherapy machine \u003cbr/\u003e2. Close Ji Xiaoyan staring up at ceiling \u003cbr/\u003e3. Wide of Ji Xiaoyan and her mother operating electrotherapy machine with Ji's high school award certificates in foreground \u003cbr/\u003e4. Close pan of Ji's arms hooked up to machine \u003cbr/\u003e5. Mid of Ji staring listlessly on bed \u003cbr/\u003e6. Mid of calendar on wall \u003cbr/\u003e7. Mid of Ji's mother by her bedside pan down to mother operating electrotherapy machine \u003cbr/\u003e8. Close of Ji's hands and fingers being stretched out by mother \u003cbr/\u003e9. Close of Ji's face expressing discomfort \u003cbr/\u003e10. Wide of Ji's mother performing physiotherapy exercises on Ji \u003cbr/\u003e11. SOUNDBITE (Mandarin): Yang Yunhua, Mother of Ji Xiaoyan (crying): \u003cbr/\u003e\"We asked the doctor how long she would survive, and he said she can't leave the breathing machine at all, so she may not make it home. I asked the nurse to give me a breathing pump because I didn't want my child to suffocate to death while she was still conscious, but she said that the hospital's policy was not to give out breathing pumps unless we pay a deposit of 100 yuan (approx. $15 USD).\"\u003cbr/\u003e12. Mid wide of Ji's uncle operating her makeshift breathing machine, made from an old bicycle,  while Ji's father looks on \u003cbr/\u003e13. Close of Ji's uncle and breathing machine made out of bicycle and washing machine parts \u003cbr/\u003e14. Mid of Ji's father demonstrating how machine was used to help Ji breathe \u003cbr/\u003e15. Mid of breathing machine in operation \u003cbr/\u003e16. Close of uncle pointing at breathing pump \u003cbr/\u003e17. Close spinning bicycle wheel \u003cbr/\u003e18. Mid close of breathing pump \u003cbr/\u003e19. Mid of Ji's father watching programme on television \u003cbr/\u003e20. Close of CCTV programme on television showing Ji Xiaoyan crying while using the bicycle breathing machine \u003cbr/\u003e21. Mid low angle of entire family watching the programme on television \u003cbr/\u003e22. Close of Ji's father holding back tears \u003cbr/\u003e23. Close of Ji's mother wiping her eyes \u003cbr/\u003e24. Close of CCTV programme on television showing Ji's breathing pump \u003cbr/\u003e25. SOUNDBITE (Mandarin): Yang Yunhua, Mother of Ji Xiaoyan (wiping tears): \u003cbr/\u003e\"Not only do we not have the money to pay back the hospital, we don't even have money for our basic living expenses. When we need some household items, we get them on credit from the shop in our village and hopefully pay them back later. To save money we can steam our own buns, and add oil in our rice, we don't even have money for our basic living expenses now.\"\u003cbr/\u003eAP Television \u003cbr/\u003eNingxia Province, China - 13 October, 2009\u003cbr/\u003e26. Wide of bicycles passing village hospital \u003cbr/\u003e27. Close of elderly woman sitting outside hospital \u003cbr/\u003e28. Various elderly man lying on hospital bed with intravenous drip in foreground \u003cbr/\u003e29. Mid of little girl on IV drip \u003cbr/\u003e30. Close of glucose drip bottle \u003cbr/\u003e31. Wide of room with patients on IV drip \u003cbr/\u003e32. Wide of patient Shi Yanzhong being given an IV drip by nurse \u003cbr/\u003e33. Close of Shi Yanzhong tilt down to his hand being injected with needle \u003cbr/\u003e34. SOUNDBITE (Mandarin): Shi Yanzhong, Patient, 45-years-old:\u003cbr/\u003e\"Things have improved now, things are better, our country's new health insurance system is quite adequate.\"\u003cbr/\u003e35. Mid wide of doctors cleaning cut on patient's head in operating theatre \u003cbr/\u003e36. Close of doctor pouring saline on patient's head while another wipes it clean \u003cbr/\u003e37. Mid of patient with surgical equipment in foreground \u003cbr/\u003e38. Close of doctor stitching up head wound \u003cbr/\u003e39. Mid of doctors stitching up patient \u003cbr/\u003e40. Wide of doctors stitching patient with little boy (patient's relative) watching\u003cbr/\u003eAP Television\u003cbr/\u003eBeijing, China - 1 November, 2009\u003cbr/\u003e41. Walking shot of Sarah Barber, Health policy expert with World Health Organisation Office in Beijing \u003cbr/\u003e42. SOUNDBITE (English): Sarah Barber, Health Policy Expert, World Health Organisation Beijing Office:\u003cbr/\u003e\"The public hospitals, for example, have been operating on a system where they rely on the sales of medicines and sales of services, and this is one of the big challenges of the reform in China: how to change the financing system so that you can try something like a pre-payment system or you have a system of for example like capitation, which provides the incentives for health care providers to keep people healthy versus selling medicines or selling services.\"\u003cbr/\u003eAP Television\u003cbr/\u003eNingxia Province, China - 13 October, 2009\u003cbr/\u003e43. Wide of Village doctor Ji Caixia in clinic's medicine dispensary \u003cbr/\u003e44. Close tracking Ji opening box of medicine and taking bottle of pills out \u003cbr/\u003e45. SOUNDBITE (Mandarin): Ji Caixia, Village doctor, 56 years-old:\u003cbr/\u003e\"Work now is very tiring and we're exhausted. Even though we work so hard, we still can't earn enough money now, this is a big headache for me, people in my profession feel like quitting.\"\u003cbr/\u003eAP Television\u003cbr/\u003eHenan Province, China - 22 Sept, 2009\u003cbr/\u003e46. Close tilt up of Ji Xiaoyan being pushed by mother on wheelchair \u003cbr/\u003e47. Close low angle of mother pushing Ji \u003cbr/\u003e48. Wide of Ji's mother helping Ji do exercises in village school playground with young children playing in background \u003cbr/\u003e49. Close of Ji's legs next to wheel chair with children playing in background \u003cbr/\u003e50. Close of Ji doing exercises on chin up bar \u003cbr/\u003e51. Wide of Ji doing exercises next to able bodied children\u003cbr/\u003eChina is overhauling its health care system after years of neglect.\u003cbr/\u003eBut a sprawling hinterland has made it difficult to systematically roll out many reforms, according to the World Health Organization.\u003cbr/\u003eAnd doctors say the reforms are reducing their salaries so much they can no longer afford to work.\u003cbr/\u003e15-year-old Ji Xiaoyan is a living reminder of a system that failed her.\u003cbr/\u003eUnlike other girls her age, who take trips to nearby towns for shopping, Ji is confined to her bed in rural Henan province.\u003cbr/\u003eShe spends her days hooked up to an electro-therapy machine which pumps electric currents into her wasting muscles, in the faint hope of stimulating them back to life.\u003cbr/\u003eWhen the pain becomes too much to bear, Ji shifts her focus to the wall next to her which is filled with her previous high school awards.\u003cbr/\u003eBut since developing a rare spinal cord inflammation last November that nearly paralysed her, she can no longer go to school.\u003cbr/\u003eHer mother, Yang Yunhua, a farmer with little education, struggles to operate the electro-therapy machine while tirelessly performing physiotherapy exercises on her ailing daughter.\u003cbr/\u003eHalf the time, Yang seems unsure if what she is doing is correct, but with little money and little education, this is the best she can offer.\u003cbr/\u003eWhen Ji first contracted her rare illness last winter, she was admitted to hospital and hooked up to a breathing machine.\u003cbr/\u003eBut doctors soon discharged her after her family couldn't pay the bills.\u003cbr/\u003e\"We asked the doctor how long she would survive, and he said she can't leave the breathing machine at all so she may not make it home,\" says Yang wiping her tears.\u003cbr/\u003e\"I asked the nurse to give me a breathing pump because I didn't want my child to suffocate to death while she was still conscious, but she said that the hospital's policy was not to give out breathing pumps unless we pay a deposit of 100 yuan.\"\u003cbr/\u003eIn their desperation, Ji's family assembled a homemade breathing machine in a last ditch attempt to keep her alive.\u003cbr/\u003eMade from bicycle and washing machine spare parts, and driven by a noisy electric motor, the makeshift ventilator pumped air into the teenager's lungs through a washer hose plugged into an incision in her throat.\u003cbr/\u003eThis contraption sustained her for more than a month before media reports about her plight brought public donations and loans for her treatment.\u003cbr/\u003eBut the damage had already been done, her parents chalked up a debt of some 160,000 yuan ($23,400 USD), which they owe to friends and family.\u003cbr/\u003eJi's family barely makes 1,000 yuan ($150 USD) a month on her father's salary as an elementary schoolteacher.\u003cbr/\u003e\"Not only do we not have the money to pay back the hospital, we don't even have money for our basic living expensesďż˝ To save money we can steam our own buns, and add oil in our rice,\" says Yang.\u003cbr/\u003eHealth care used to be universally poor in China, but workers were provided cradle-to-grave medical care while an army of barefoot doctors - rudimentarily trained paramedics - vaccinated children and improved sanitation in the countryside.\u003cbr/\u003eThat all broke down suring the market reforms in the past 20 years, leaving in place a system where being able to pay was all that mattered.\u003cbr/\u003eAfter years of people like the Ji family taking desperate measures to survive, the government is finally trying to fix a severely broken health care system.\u003cbr/\u003eIt has launched a $124 (b)illion effort to address everything from capping prices for medicines to restructuring hospitals.\u003cbr/\u003eThe approaches vary: Shenmu, a northern county, is offering free health care for all its 390,000 residents. \u003cbr/\u003eThe southwestern metropolis of Chongqing is trying to manage urban and rural insurance programmes together to save money.\u003cbr/\u003eIn Ningxia, a small inland region in the impoverished west, farmers now pay 30 yuan a year to join a rural cooperative insurance programme in which they can see a village doctor for 30 common illnesses including the cold, bronchitis and diarrhoea, for only one yuan ($0.15), including medication.\u003cbr/\u003eLike in the U.S., China wants to remake its health system from top to bottom, but the scale of Beijing's challenge is daunting.\u003cbr/\u003eIt's seeking to extend state-subsidised coverage from 70 to 90 percent of all Chinese, providing insurance to an additional 200 million people - about two-thirds of the entire U.S. population.\u003cbr/\u003eThe government is building 2,000 new county hospitals and setting up clinics in each of the nearly 700,000 villages.\u003cbr/\u003e\"Things have improved now, things are better, our country's new health insurance system is quite adequate,\" says Shi Yanzhong who is seeking treatment for a bad flu.\u003cbr/\u003eThe reforms however are fraught with questions on how to effectively use government funds and help poorer regions cough up their 60 percent share of the massive investment.\u003cbr/\u003eAnother problem, experts say, is that while learning by doing is fine, there appears to be little in the way of evaluation of these reform experiments, making it hard to pinpoint what works.\u003cbr/\u003e\"The public hospitals for example have been operating on a system where they rely on the sales of medicines and sales of services and this is one of the big challenges of the reform in China how to change the financing system so that you can try a pre-payment system or you have a system of for example like capitation, which provides the incentives for health care providers to keep people healthy versus selling medicines or selling services,\" says Sarah Barber, a Health Policy Expert with the World Health Organisation in Beijing.\u003cbr/\u003eNearly a third of China's poor say that health is the single most important cause of their poverty - either from medical expenses or a debilitating illness, according to the World Health Organisation.\u003cbr/\u003eA national health survey last year found that around 70 percent of people forgo recommended hospitalisation because they can't afford it.\u003cbr/\u003eThe reforms are intended to remedy these ills by increasing government subsidies of insurance premiums for farmers, migrant workers and retirees and gradually raising reimbursements, while improving public health services and basic care.\u003cbr/\u003eLonger term, the government is trying to find ways to cut back on the unnecessary treatments and drug prescriptions that have been blamed for skyrocketing medical fees at public hospitals.\u003cbr/\u003eExperts say lack of coordination has led rural clinics to compete with township and county hospitals for patients while village doctors are leaving their posts because they can't earn enough money under the new policy.\u003cbr/\u003eOne of those doctors, Ji Caixia, 56, is considering quitting her job of 30 years in the rice and corn farming village of Lijiajuan in northern Ningxia.\u003cbr/\u003eWith the new reforms, she can only sell her medicines at a fraction of the profits she used to.\u003cbr/\u003eFurthermore, the number of patients at her clinic has more than doubled since consultation fees for some illnesses is capped at 1 yuan.\u003cbr/\u003e\"Work now is very tiring and we're exhausted. Even though we work so hard, we still can't earn enough money now, this is a big headache for me, people in my profession feel like quitting,\" says Dr Ji.\u003cbr/\u003eChina's health care reforms are of little comfort to Ji Xiaoyan and her family.\u003cbr/\u003eHer unique and debilitating disease is too expensive to treat and is unlikely to qualify for the much needed government subsidies.\u003cbr/\u003eIn the meantime, Ji can only rely on her family and the goodwill of fellow villagers to help her regain some semblance of normality.\u003cbr/\u003e\u003c/span\u003e\n\u003c/div\u003e\n\u003cdiv class='action-container flex justify-between'\u003e\n\u003cbutton aria-expanded='false' aria-label='Read more description' class='rp-full-description' type='button'\u003e\n\u003ci class='fai fa-solid fa-align-left'\u003e\u003c/i\u003e\n\u003cspan id='read_more'\u003eRead More\u003c/span\u003e\n\u003c/button\u003e\n\u003cdiv class='rp-report'\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv 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