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Village doctors suffer in silence despite key role in health care
September 1, 2010, Wednesday
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A study in Hangzhou has found village doctors have low salaries, poor living conditions and little social security and that a 2005 initiative is to blame for their plight, reports Xu Wenwen.
Village doctors in China, aiming to bring health care to rural areas where urban-trained doctors would not settle, are usually farmers who received basic medical and paramedical training and passed certain examinations. Though not medical experts, they are villagers' "angels in white."
It is estimated around 1 million village doctors serve 800 million farmers nationwide. There is considerable turnover among village doctors as they earn little, have poor living conditions and little social security.
A study of village doctors in Hangzhou found that solving the social security problem is essential to resolving the high turnover, deepening health-care reform and ensuring the health of farmers.
A team headed by professor Shao Dexing from the Party School of the CPC Hangzhou Committee conducted the study, which investigated the working and living conditions of village doctors by a questionnaire and interviews in Xiaoshan and Chun'an counties since last September.
"The New Rural Cooperative Medical Care System is the root cause of the poor social security of village doctors," Shao said.
The system was launched in 2005 to overhaul the health-care system and was specifically designed to make medical expenses more affordable for rural residents.
The system offers every rural resident 50 yuan (US$7) annually for medical coverage - 40 yuan is paid by the government, with the rest 10 yuan by the patient.
However, the coverage only applies to town- or county-level clinics and hospitals. By excluding village doctors' clinics, it cuts a major source of their income.
"The problem needs urgent attention," said Shao.
Village doctors have made great efforts to improve the health of their patients, and their low-cost and wide-ranging services have eliminated the shortage of doctors and medicine.
Though village doctors have been transformed from barefoot doctors, it seems they remain "barefoot" today, some insiders said.
Barefoot doctors were the predecessor of village doctors. They acted as a primary health-care provider at the grassroots level, promoting basic hygiene and treating common illnesses. The name was derived from southern farmers, who often work barefoot in the rice paddies.
No allowance
The barefoot doctor system was abolished in 1981 with the end of the commune system of agricultural cooperatives. Since then, barefoot doctors passing a national exam became village doctors, who began charging patients for their services.
Though the title "village doctor" is more formal, these individuals receive neither allocations nor allowances. Therefore, village doctors have been marginalized, especially since the new system encourages patients to go to bigger hospitals, the report said.
The report also finds that village doctors in Hangzhou are aging - more than 60 percent are above 50, while only 22 percent are under 40. "Those aging people need endowment insurance," Shao said.
However, according to the report, nearly 30 percent do not have any insurance while only 13 percent of these doctors have endowment insurance, mostly because of financial difficulties.
Only 11 percent of them have received education at the junior college level or above.
These problems have influenced the development of medical institutions in towns, counties and villages since they are the base of the whole "medical net," the report said.
Since 2006, Zhejiang Province has initiated a project to train more general medical practitioners in rural areas, thus village doctors have a greater opportunity to improve their knowledge and skills.
Nevertheless, those with financial difficulties can hardly attend training at their own expense. Hence, government investment and related policies are necessary.
The report concluded that there are three priorities to ease the plight of village doctors: to provide them with endowment insurance; involve village clinics in the new medical care system and solve barefoot doctors' transformation issues left over from the past.
Professor Shao's team suggested setting up a retirement system for village doctors and providing more financial support for training.
"Village doctors have contributed a lot and are still a valuable part of the health-care system," Shao said. "We need to wipe out their anxieties to keep them.
"And if the truth be told, farmers and other village people prefer to visit clinics nearby rather than rushing to a faraway hospital in town."
Village doctors in China, aiming to bring health care to rural areas where urban-trained doctors would not settle, are usually farmers who received basic medical and paramedical training and passed certain examinations. Though not medical experts, they are villagers' "angels in white."
It is estimated around 1 million village doctors serve 800 million farmers nationwide. There is considerable turnover among village doctors as they earn little, have poor living conditions and little social security.
A study of village doctors in Hangzhou found that solving the social security problem is essential to resolving the high turnover, deepening health-care reform and ensuring the health of farmers.
A team headed by professor Shao Dexing from the Party School of the CPC Hangzhou Committee conducted the study, which investigated the working and living conditions of village doctors by a questionnaire and interviews in Xiaoshan and Chun'an counties since last September.
"The New Rural Cooperative Medical Care System is the root cause of the poor social security of village doctors," Shao said.
The system was launched in 2005 to overhaul the health-care system and was specifically designed to make medical expenses more affordable for rural residents.
The system offers every rural resident 50 yuan (US$7) annually for medical coverage - 40 yuan is paid by the government, with the rest 10 yuan by the patient.
However, the coverage only applies to town- or county-level clinics and hospitals. By excluding village doctors' clinics, it cuts a major source of their income.
"The problem needs urgent attention," said Shao.
Village doctors have made great efforts to improve the health of their patients, and their low-cost and wide-ranging services have eliminated the shortage of doctors and medicine.
Though village doctors have been transformed from barefoot doctors, it seems they remain "barefoot" today, some insiders said.
Barefoot doctors were the predecessor of village doctors. They acted as a primary health-care provider at the grassroots level, promoting basic hygiene and treating common illnesses. The name was derived from southern farmers, who often work barefoot in the rice paddies.
No allowance
The barefoot doctor system was abolished in 1981 with the end of the commune system of agricultural cooperatives. Since then, barefoot doctors passing a national exam became village doctors, who began charging patients for their services.
Though the title "village doctor" is more formal, these individuals receive neither allocations nor allowances. Therefore, village doctors have been marginalized, especially since the new system encourages patients to go to bigger hospitals, the report said.
The report also finds that village doctors in Hangzhou are aging - more than 60 percent are above 50, while only 22 percent are under 40. "Those aging people need endowment insurance," Shao said.
However, according to the report, nearly 30 percent do not have any insurance while only 13 percent of these doctors have endowment insurance, mostly because of financial difficulties.
Only 11 percent of them have received education at the junior college level or above.
These problems have influenced the development of medical institutions in towns, counties and villages since they are the base of the whole "medical net," the report said.
Since 2006, Zhejiang Province has initiated a project to train more general medical practitioners in rural areas, thus village doctors have a greater opportunity to improve their knowledge and skills.
Nevertheless, those with financial difficulties can hardly attend training at their own expense. Hence, government investment and related policies are necessary.
The report concluded that there are three priorities to ease the plight of village doctors: to provide them with endowment insurance; involve village clinics in the new medical care system and solve barefoot doctors' transformation issues left over from the past.
Professor Shao's team suggested setting up a retirement system for village doctors and providing more financial support for training.
"Village doctors have contributed a lot and are still a valuable part of the health-care system," Shao said. "We need to wipe out their anxieties to keep them.
"And if the truth be told, farmers and other village people prefer to visit clinics nearby rather than rushing to a faraway hospital in town."
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