Shu Min, a resident of China's eastern city of Nanjing, thinks the nation's public hospitals are running out of money and are doing everything they can to increase the co-pays charged directly to patients.
"A doctor told me, the more problems a patient has, the better. So the hospital could benefit more by taking whatever highest insurance amount that the patient can claim," she told VOA Mandarin in an interview. "This is so ridiculous!"
Shu Min's father has been diagnosed with mild Alzheimer's disease and suffered a fracture in a fall a few years ago, requiring long-term hospitalization for rehabilitation.
In a phone interview, Shu Min said some hospitals recommended that her father be admitted as a patient seeking treatment for Alzheimer's instead of rehabilitation because the health insurance program pays $3,000 (22,000 yuan) for Alzheimer's patients, compared with $1,100 (8,000 yuan) for rehabilitation.
She said the public hospitals have also raised co-pay amounts in recent years. One of the medications her father uses most is no longer covered by health insurance, and the family had to switch medications, even though a doctor said that the original medication was more effective.
There are also fewer items covered by medical insurance. For example, two years ago, rehabilitation exercise was provided twice a day, but now it is provided once a day. Physical therapy has also been cut from twice to once a day.
"I became very nervous over the past three years because every January, doctors would tell me there's a new policy. Since last year, policy changes have become more frequent. This doesn't give patients or hospitals any time to adapt," Shu Min said. "I've been living in anxiety and serious insecurity."
Insurance dropouts
Unlike Shu Min, who still has medical insurance, millions of Chinese citizens have dropped out of the state scheme.
In 2022, China had 1.34 billion people enrolled in state-subsidized basic health insurance, according to statistics released by the National Healthcare Security Administration, but that was 17.05 million fewer than in 2021.
Wang Chaoqun, an associate professor at Central China Normal University in Wuhan, argues in a research article on health insurance that several factors have led people to withdraw from the insurance program. These include steadily rising premiums, reduced benefits, improved health among middle-aged residents, and a failure of the insurance plan to address some major illnesses.
On Weibo, China's widely used but censored social media platform, a thread titled "20 million people dropping out of health insurance" attracted heated debates and discussions.
"More and more people choose not to buy any health insurance," said one user under the handle "QQQ." A user called "Jacqekaby" responded, "Exactly. So many friends are going this way, it's just too expensive."
Dong Siqi, director of the International Affairs Department of a policy research organization known as Taiwan Thinktank, said the cost of health insurance in China today is 38 times higher than it was 20 years ago, while the average income for migrant workers has risen by only 24%. The continued rise in premiums may put pressure on some people, especially those in rural areas that have more family members.
"The proportion of health insurance paid by the government is still much higher than that by individuals, so the fact that so many people have withdrawn from the scheme reveals a distrust of the social security system," Dong told VOA Mandarin in a phone interview.
The COVID-19 pandemic affected the operations of many businesses, which are no longer able to pay into health insurance for their employees, Dong said. "Local governments have become less capable of providing health care coverage due to financial downturn. So people's out-of-pocket payments are higher, and they prefer to keep the cash for other expense."
Yang Lixiong, a professor in the School of Labor and Human Resources at China's Renmin University, said the cost of health insurance is indeed a burden for average rural families.
"It's very difficult for farmers to increase their income, but the medical insurance premium is growing too fast. That's the biggest problem," Yang told China Economic Weekly in a report published December 4.
