On November 21, 21-year-old Zhang Chunming, a Tsinghua student from the School of Civil Engineering, died of intestinal cancer. Between December 2003 and March 2004, Zhang had visited Tsinghua University Hospital at least four times complaining of continual diarrhea.

The school hospital erroneously diagnosed his illness as enteritis and refused his request to transfer hospitals. When Zhang finally went to Peking University Third Hospital on March 14 at his own expense, his illness was diagnosed as terminal intestinal cancer.

The news of Zhang's death shocked Tsinghua's teachers and students. In fact, as early as November 2001, a campus survey conducted by a student organization showed general dissatisfaction with the school hospital. Of 276 interviewees, 42 percent were discontented with the hospital and 16 percent felt extremely dissatisfied. About 41 percent regarded the hospital's medical skills as "relatively poor" and 11 percent as "very poor."

Another student, Xiong Dingzhong, sued Tsinghua University Hospital on June 9 for a misdiagnosis. Xiong claimed that on May 11 the hospital misdiagnosed his chronic appendicitis as acute, and so performed an unnecessary operation on him. He demanded a public apology from the hospital and compensation of 10,000 yuan (US$1,205).

However, Zhang's parents didn't intend to take the school hospital to court. Before leaving for their hometown in Qidong County, Jiangsu Province, they said: "In today's China each family has only one child. It's not easy for us to provide financial support for our son's education at Tsinghua, one of the country's most prestigious universities. We hope that in the future the school hospital will not miss other chances for timely diagnosis and treatment."

Many students questioned why the school hospital had not given Zhang an enteroscopy at the start, generally accepted as an effective approach to detect early signs of intestinal cancer.

Dr. Wu Aiwen of Beijing Tumor Hospital said: "When making a diagnosis, a doctor usually considers the possibility of conventional diseases. If the patient's symptoms last long enough, the doctor turns to think about a tumor. It's not easy to do an enteroscopy, which needs a lot of preparation."

Tsinghua University Hospital explained that as it just introduced the enteroscope, most doctors were not familiar with the new equipment so it was not yet able to offer enteroscopies.

The refusal of Zhang's hospital transfer request became another focus of the debate. Coincidentally, in Xiong's case he also complained that his transfer request had been turned down.

The school hospital stipulates in explicit terms that only with its approval can patients be transferred to its assigned hospital, Peking University Third Hospital. If patients want to be transferred to a different hospital, the application procedure is even more complicated. Those who go to another hospital without prior approval have to pay for their own medical care.

Obviously, the crux of the matter lies in the free medical care system that has been practiced in universities.

According to Beijing Municipal Labor and Social Security Bureau (BMLSSB), for university students living in the capital, the municipal government bears 80 percent of their medical expenses, while students themselves pay the remaining 20 percent, which is refundable either partially or in full depending on their school's financial condition.

In addition, Beijing's college students are eligible for a medical subsidy of 7.5 yuan (US$0.90) every month.

A teacher named Xiang from Tsinghua's School of Civil Engineering confirmed that except for certain treatments, Tsinghua students can normally be reimbursed 100 percent for seeing a doctor.

The reimbursement ratio is 95 percent at Peking University, and around 90 percent at Renmin University of China and Beijing Institute of Technology. But all these Beijing-based universities have made similar prescriptions that those who transfer to another hospital cannot get reimbursement if their request was not approved in advance.

Peking University Hospital said that each year the school has to allocate millions of yuan to help out with students' medical expenses. Naturally, in principle students are required to go to the school-run hospital for minor illnesses.

On the average, in each Beijing-based university there are no less than 10,000 people who enjoy free medical care. Judging by the current standard of each getting a subsidy of 7.5 yuan per month, one ICU patient could easily spend several hundred students' subsidies. Thus universities have had to settle enormous medical expenses.

Students feel equally burdened. Taking Zhang's case as an example, his medical costs totaled 200,000 yuan (US$24,096). Tsinghua paid the bulk of the bill according to the rules; however, Zhang's classmates still had to contribute over 40,000 yuan (US$4,819) to buy imported medicines and injections that are not on the reimbursement list.

Actually, like employees' hospitals in state-owned enterprises, the school-run hospital is a product of the planned economy system, said Professor Sun Dongdong of Peking University's Law School.

In developed countries, with better community public health services available, universities don't usually have their own hospitals, Sun said. If they get ill, students can go directly to the nearest community hospital. "We need to do two things: one is to improve community services; the other is to encourage students to buy insurance."

In fact, Peking University has already begun cooperating with Shanghai-based Taiping Life Insurance Co. Ltd. in an attempt to find a solution.

Last September, Peking University released a circular regarding student insurance, saying that the school entrusted Taiping Life to sell students life and accident insurance.

Two months later, 5,000 students bought insurance, and this November another 8,000 were insured with Taiping Life. During the past year the company paid out 200,000 yuan each for two unexpected deaths.

A clerk named Sun from Taiping Life's Group Insurance Department said that as a supplement to the present free medical care system, insurance can lessen the medical burden of both students and universities.

After the Peking University initiative, the company is also talking to the Central University of Finance and Economics, Central University for Nationalities and the privately run Beijing Renwen University, he said.

(China.org.cn by Shao Da, December 23, 2004)