Seeing a doctor was too expensive for 54-year-old peasant Song Zhiyao, but a rural cooperative medical in 2007 has greatly eased his burden.

Major public health reforms under review would provide even more assistance to Song and millions of other Chinese who have struggled to pay their own medical bills for 20 years.

For half a century, Song has lived in Xijiang Village, Kaili City in Guizhou Province and misses the days of barefoot doctors before the 1980s.

"Villagers only paid a bit for medical service at the small clinic, as the costs were basically covered by the state," he says.

Although the young "doctor" could only handle basics injections, minor illnesses, coughs and minor accidents, Song was largely satisfied. Those were the days when China prided itself on a government-sponsored medical care system providing most with low-cost service.

The climate changed in the 1980s, however, when public health institutions were told to support themselves like profit-making enterprises. Government subsidies were slashed in the period of reform and opening-up.

Running a hospital with market rules was novel to most Chinese. Fees and costs of treatment and drugs soared.

From that time on, Guizhou villager Song and his fellows struggled with rising medical costs. Living in a poverty-stricken county, Song and his wife earned under 10,000 yuan (US$1,463) annually by building houses in the 5,000-person Miao nationality village.

In 2006, Song suffered severe piles and bled heavily for a month. At first, he chose to stay home, refusing treatment.

Like Song, it is common for many Chinese peasants to "expect self-cure in the face of small illnesses and await death in the face of big illness".

Song's worsening condition forced him to visit the doctor, but neither the village clinic nor the county hospital could treat his complex problem.

The medical resources in Guizhou and China's large interior cannot match those of big cities like Beijing, which has more than 50 Class-A hospitals.

Guizhou has only six top hospitals and most are in the capital of Guiyang.

Song went there by bus and train but left immediately after the check-up. "The initial fee was 8,000 yuan for hospitalization, far beyond my capacity."

At that time, two of his children were in secondary schools. He finally had surgery at People's Hospital in Kaili, costing 4,500 for 11 days. "They advised me to stay for 15 days, but I checked out for lack of money." He had to sign a legal waiver, promising not to sue for any problems.

In spring of 2007, Song joined a new rural cooperative medical program. He pays 10 yuan per year, the government pays another 10. If he is hospitalized, up to 80 percent can be covered.

Despite this improvement, China's medical care system is far from adequate. The problem remains soaring medical fees, lack of access to affordable services, poor doctor-patient relationships and low insurance coverage.

The Ministry of Health reports personal spending on medical services has doubled from 21.2 percent in 1980 to 49.3 percent in 2006, but government funding dropped to 18.1 percent from 36.2 percent in 1980.

Thus, medical services, tuition fees and housing are called the "three new mountains" that greatly dampen happiness, since reform and opening-up.

In 1997, the State Council issued a historic decision, defining medicine as a social welfare sector ?? changing the previous concept that it was a type of commercial product.

But the Development Research Center of the State Council, an influential think-tank, concluded in a 2005 report: "Medical reform in the past decade is basically unsuccessful."

This October, a long-awaited health care reform plan was released. It aims to set up a health care system that covers all urban and rural residents by 2020.

Breaking with market-oriented reform over 20 years, the new plan gives the government a dominant role in providing public health and basic medical service.

In drafting the proposal, the government empowered nine domestic and overseas organizations to conduct independent research, including the World Health Organization and Mckinsey Co. But an online survey by sohu.com says 88 percent of respondents were unsatisfied with or barely understood the 10,000-word draft that involved 16 departments.

Liao Xinbo, deputy director of Guangdong Provincial Bureau of Health, says it does not differ greatly from 1997 policy. The crux of the problem, says Bai, is insufficient government funding.

But Gu Xin, a professor of government management from Beijing University, is concerned that the new government-dominated plan would return the public health sector to the planned economy.

Guizhou farmer Song observes: "My only hope," he said, "is that I will not be tormented by serious illness any more."

(Shanghai Daily December 29, 2008)