Falling Through the Cracks of China’s Health-Care System

Millions of Migrant Workers Can’t Pay Their Medical Bills or Tap Insurance Benefits

China says 95% of its 1.34 billion people are covered by medical insurance. That should have included Zhao Guomei, whose struggle with a rare but treatable disease shows how the system is failing for millions of China’s workers.

Doctors in July diagnosed Ms. Zhao with aplastic anemia, a bone marrow condition that put her at high risk of infection. They estimated her treatment would cost at least 400,000 to 500,000 yuan, or roughly $65,000 to $82,000.

Zhao Guomei, 26 years old, struggled to pay for blood 
transfusions that relieved her symptoms. Like many of 
China’s 269 million migrant workers, she didn’t have 
insurance. Zhou Guangsheng

Despite years of work, the 26-year-old waitress couldn’t pay for it. Like many of China’s 269 million migrant workers, she bounced from city to city and job to job after leaving her home village to seek a better life. As a result, her employers—mostly small restaurants and noodle stands—haven’t contributed to her account under China’s medical-insurance system.

Ms. Zhao could have received coverage under a new rural medical-insurance plan, but only if she moved back to her home province of Guizhou, where job prospects for her fiancé were slim. And before she could even apply for reimbursement back home, she would have to pay the 56,000 yuan she owed to the hospital in Wuhan where she had been receiving blood transfusions and other treatment.

In early September, Ms. Zhao left the Wuhan hospital despite her deteriorating condition. “I just feel so tired. I feel like even walking a few steps takes all my strength away,” she said, in a barely audible voice.

“They didn’t kick us out,” said her fiancé, 28-year-old Zhou Guangsheng, who sells bamboo to make ends meet. “We just felt ashamed to stay there without paying them anything.”

When they ran out of money, they borrowed from friends to keep her medication coming. Medication alone was just a stopgap until they could afford treatment that would be more aggressive, her doctors said.

The government has spent about three trillion yuan on health care since 2009. The effort is crucial, many economists say, to turning China’s notoriously frugal savers into consumers by encouraging them to spend instead of socking the money away for medical emergencies.

Still, millions are falling through the cracks, especially migrant workers who drift from China’s villages to work in factories in bigger cities.

“Coverage is fragmented and the administration of it is not desirable,” said Zhang Wei, a health-care expert at Peking University’s Guanghua School of Management. Dr. Zhang said that despite the expansion of insurance coverage, the individual economic burden has increased. “It’s still a management problem,” he said.

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