Economic Costs of Serious Illness in Rural Southwest China: Household Coping Strategies and Health Policy Implications
Jian, Li, Human Organization
Today, some 10 million Chinese peasants fall below China's official poverty line annually because of illness. Currently, more than 80 percent of China's rural residents do not have any health insurance, and most of those who do still have to pay up to 90 percent of their medical costs. Despite the grave situation, very little is known about the strategies rural Chinese utilize to cope with the economic costs of illness. In this paper, I examine how households in a rural village in Southwest China contend with economic impacts of serious illness, and I discuss how development agencies can help to alleviate the situation. I first describe the study site and my research methods. Next, drawing on qualitative and quantitative data, I analyze 10 strategies rural households use to cope with the economic costs of serious illness. In the last section, I discuss the implications of this case study for health policy makers and development agencies in China and elsewhere in the developing world.
Key words: coping strategies, rural health, health policy, development, China
Illness plays an essential role in the growing problem of poverty in China. The cost of health care in China has been rising rapidly. Between 1978 and 2004, the average total health expenditure per person increased nearly eight times in China (WHO 2005:19). In 2003, a single inpatient spell cost, on average, about 4,000 Yuan.1 For the poorest fifth of China's rural population, 4,000 Yuan was equivalent to nearly 200 percent of their average annual income per person (World Bank 2005:2). Despite that, more than 80 percent of China's rural residents currently do not have health insurance, and most of those who do still have to pay up to 90 percent of their medical costs (Blumenthal and Hsiao 2005:1167; Liu et al. 2006:1052). Even for the counties covered by the New Rural Cooperative Medical Scheme, the reimbursement rates are as low as 20 to 30 percent of the patient's medical bills (WHO 2005:15). As a result, some 10 million Chinese peasants fall below China's official poverty line annually because of illness (National Development and Reform Commission 2006:19).
Despite this grave situation, very little is known about the strategies rural Chinese households use to cope with the economic costs of illness. Theoretically, coping is a key concept for research on adaptation and health in social sciences (Lazarus 1993:234). Anthropologists have applied their training and expertise to study a variety of coping in different contexts around the world. Alan Howard (1974) studied the ways Hawaiians personally coped with their economic and cultural estrangement. William W. Dressier (1980) looked into the relationship between coping dispositions, social support, and health status, as measured by arterial blood pressure in a town in St. Lucia. Hussein M. Fahim (1983) examined the strategies that Egyptian Nubians used to cope with their resettlement. In St. Vincent, Hymie Rubenstein (1987) analyzed the strategies developed by the Caribbean villagers to cope with poverty. Rebecca Huss-Ashmore, John J. Curry, and Robert K. Hitchcock (1989) scrutinized how agricultural people in Africa cope with the seasonal constraints of food production. Sharon Hutchinson (1996) described how the Nuer in the southern Sudan coped with the fractured modernity of a malformed state and civil wars. Erik Snel and Richard Staring (2001) attempted to understand international migration from developing countries to Europe as a coping strategy of an individual or a household to escape poverty or insecurity. Amitai Touval (2005) analyzed the strategies members of the Louise Otto-Peters Society of Leipzig developed to cope with their common predicament consequent to the collapse of East Germany. Concentrating on their research foci, each of these studies examines a specific aspect of coping and contributes to the anthropological insights of coping in a unique way.
Up until now, however, no systematic studies were conducted to understand how poor households contend with serious illness in rural China. …