In Mao’s time, only the urban population benefited from state social benefits. The rural population had to meet all private and social costs from the income that their community generated. If the municipality produced a surplus, it could finance teachers or paramedics, otherwise not. But even this form of financing basic services collapsed completely with the introduction of the reforms, as the municipalities were abolished. Although the increased standard of living compensated for a lot, it was not until recently that the rural population could fall back on a rudimentary social system.
In the cities, the structure of social systems was fundamentally different. On the one hand they wanted to abolish the old system of the state economy, but on the other hand they did not dare to deprive the urban workers of all their privileges. As a result, comprehensive social systems were set up for the urban population.
Since 1997 there has been a basic pension insurance for the urban employees of state-owned companies, which was extended in 2002 to further employees in urban and rural areas. According to official information, the rudimentary old-age pension system for the urban and rural population included 532.7 million people at the end of 2019. There is also a basic health insurance, in which 1,354.4 million people were covered in 2019, and an unemployment insurance, in which 205.4 million people took part.
It is important to note that the 270 million migrant workers are not part of the urban welfare systems. Rather, they are participants in separate social systems for rural areas. There is a separate rudimentary old-age pension system and a rudimentary health insurance system based on voluntary action (New Cooperative Health System).
Although the coverage of rural social insurances has increased significantly, they still cannot serve as a basis for free life planning, as the payments in the event of benefits are significantly lower than those in the urban systems. In rural areas, for example, a pension can only be 50 yuan (US $ 8), which is well below the poverty line set by the World Bank. Rural residents and migrant workers are still dependent on their savings when they visit the doctor.
In addition to the problem of regional disparities, the PR of China is also confronted with demographic problems in the area of pension insurance due to the relatively low retirement age (men 60 years, women 50-55 years). In 2035, 30% of the population of the PRC will be over 60 years old.
According to hyperrestaurant, even if the health system in the PRC even extends to villages in remote regions, medical care in poor rural areas is much worse than in the booming cities of the eastern coastal regions. If complex operations and treatments are possible in Shanghai or Beijing, many health stations in the Chinese hinterland cannot do much more than provide first aid.
It is unattractive for doctors to work in rural areas due to the disparate health financing. Although there were an average of 2.59 doctors per 1,000 residents in China in 2018 (in Germany there were four), in rural areas of China there are only 1.82 doctors, compared to 4.01 doctors in cities.
In 2019, there were 34,000 hospitals (including 4,000 traditional Chinese medicine clinics), 36,000 health stations, 35,000 local health stations and 267,000 outpatient health stations in the PRC. There were a total of 8.92 million hospital beds. In 2017, 5.2% of the gross domestic product (GDP) was spent on healthcare. 95% of the population had access to a water supply and 75% to sanitary facilities.
China’s medical research attaches great importance to genetic engineering. In November 2018, twins were born for the first time whose genome had been modified by genetic engineering.
Despite various problems, it should be noted that the general health situation in China has steadily improved since the beginning of the economic reforms. The decisive factors for this are higher incomes, a better food supply, medical-technical progress and, from the beginning of the 2000’s, the establishment of nationwide rudimentary health insurance systems.
This can be seen, among other things, from the fact that the most common causes of death in China are now the so-called diseases of civilization such as respiratory diseases, cancer, strokes or heart attacks. The most common epidemic diseases are hepatitis (1.2 million new infections per year), tuberculosis (around 800,000 new infections per year), syphilis and dysentery. In 2016, maternal mortality in the PRC was 19.9 per 100,000 births.
According to UNAIDS, there are 1.25 million people in China who have been infected with HIV or suffered from AIDS. A large group of those affected were former blood donors from rural areas who became infected in the 1990’s through contaminated, unclean blood samples. The most common mode of transmission is now sexual intercourse.
Meanwhile, the consequences of the rapid economic growth and their environmental influences are playing an increasingly important role for the health situation in the People’s Republic of China. For example, the WHO estimates that there were around 1.2 million premature deaths from air pollution in China in 2010. In many cities, air pollution is a dozen times more than the WHO recommended upper limit. The food safety is a growing problem.
In the area of disease control, the PR China intensified its efforts following the brief SARS epidemic in 2003. There are now 3,481 disease control centers across the country. The greatest risk here is from a potential outbreak of the dangerous form of bird flu.