One Yuan Doctor's Visit

What can you do with one yuan? 

For the residents of Rulin Village in Huadu District, Guangzhou, Guangdong Province, one yuan is enough to see a doctor. We were puzzled that a doctor's visit could cost almost nothing. With much skepticism, we went to see the local health center in Rulin. 

The center is located in a beautiful area in the northern part of the town of Huashan. By the road in front of the center, there is a sign with striking red letters that says, "Without health for everyone, there can be no moderate prosperity for all." 

Entering the health center, we found Zhong Yuying, a local resident in his seventies, sitting on a bench for patients in the waiting room. He gave the health center a glowing review, saying, "Before, it cost hundreds of yuan to see the doctor, but now it only costs one yuan. We also used to have to go all the way into town, but now that there is this health center, all nine people in my family can come for a consultation or fill a prescription without having to go out of the village. It's so convenient! I feel like life is pretty prosperous." 

One yuan doctor's visits in Huadu District began during rural medical reform trials more than a decade ago. At the time, village residents complained that it was difficult and expensive to get treatment, and it was common for people to just put off minor illnesses, or put up with major ones. In an effort to address problems faced by village residents in accessing medical care, the government of Huadu District conducted surveys and research at a number of locations. Combining these findings with experience from the program of village-run cooperative medical care that had been running since the 1960's in the district's more economically well-off villages, the government made the pioneering policy proposal to provide free medical care to village residents in the form of government procured services. 

In 2008, Huadu District issued a plan for offering free treatment to rural residents at rural health centers. According to the plan, a fee of just one yuan would be charged for making an appointment, with an additional fee of one yuan for patients who need injections. In May 2008, the district selected 16 village health centers where the initiative was launched on a trial basis. The trial was then expanded to 57 administrative villages in June 2009, and finally to all 196 village health centers in the district in September 2010. 

Now more than ten years have gone by, and what was once a fledgling experiment has caught on and expanded into a powerful movement. Huadu District has leveraged the one yuan doctor's visit initiative to jumpstart reform of the primary-level healthcare system, generating a ripple effect that is positively impacting public wellbeing. In Guangdong Province today, the one yuan doctor's visit initiative has become a model example of primary-level healthcare reform. 

The application of the national catalog of essential medicines has further promoted overall reform of the primary-level healthcare system, and changed the attitude among residents of Rulin Village that it was best to go to a big hospital, no matter how minor their ailment. Now that residents are able to see the doctor steps away from their homes and get minor illnesses looked at right away, people are getting major illnesses less frequently and spending less money on doctor's visits. With the network of rural medical and health services growing stronger, feelings of happiness and fulfillment are steadily increasing among ordinary rural residents in Huadu District.

Doctors stationed in Rulin Village, Huadu District, Guangdong Province display the multi-function diagnostic kit they take with them when making their rounds. PHOTO BY QIUSHI REPORTER WANG ZHAOBIN 

How much money can one yuan doctor's visits save for rural residents? 

At the Rulin health center, Dr. Qiu Hua took us through some calculations. "I have a patient with diabetes who comes in for an appointment four times a month. It costs one yuan each time, so that comes out to just four yuan a month. If he sought treatment somewhere outside the village, it would cost at least 200 yuan for the same medicine. For a patient like him with a chronic illness that needs to continue taking medication over the long term, annual savings on medical costs are in the thousands." 

Between January 2010 and the end of April 2020, village residents in Huadu District received medical services on 11.26 million occasions, resulting in direct savings of 188.45 million yuan. The one yuan doctor's visit policy has transformed the habits of village residents in seeking medical advice, made them more health conscious, and generated positive social and economic effects. 

Why not make it totally free to see the doctor? 

The one yuan fee is meant to prevent the overconsumption of medical resources by requiring a payment. According to Ling Jizhong, director of the health center in Huashan Town, Huadu District, "If village residents could go and get medicine for every little problem, they would just end up putting it away at home and not taking it, resulting in a waste of medical resources." 

Cao Yang, director and CPC secretary of the Huadu District Health Bureau, told us, "The district government has formulated a number of measures to complement the one yuan doctor's visit policy, including health education. The most important steps being taken to support the policy are those aimed at making essential medicines free of charge, standardizing facilities and operations, unifying management of institutions in towns and villages, and integrating health services for rural residents." He went on to say that "Huadu District's complete and well-contained basic medical system has allowed for consistent improvement of public health management in the district, and enabled primary-level health institutions in towns and villages to handle chronic diseases effectively." 

Can people get good treatment for just one yuan? 

Ling Jizhong told us, "Our town health center has an outstanding team of family doctors." He explained, "Each team of family doctors is responsible for two or three village-level centers, with doctors of mid- or high-level seniority leading the teams. In this way, medical services and resources are able to reach smaller localities, and residents of these places no longer have to jump through hoops to see a doctor." 

Dr. Ling then explained, "If a village resident feels unwell, they can first visit a village-level health center. If their condition is serious, the team of family doctors that they are signed up with can arrange for their referral to outpatient care, admission to hospital, or transfer to a higher-level hospital." According to our understanding, the Rulin Village health center has been covered by a contracted team of family doctors from the Huashan Town health center since 2014. A total of 1,910 people in the village are signed up with family doctors, with 60.8% of long-term residents and 73% of members of key groups signed up. 

Building better teams of doctors is the key to ensuring that village residents are able to get good treatment. According to Cao Yang, "The best way to standardize the quality of medical services is to see that skills are shared to smaller localities through the movement of professional medical staff. By integrating town and village institutions and assigning highly capable doctors to villages, we can formally organize rural medical practitioners and bring them under unified management. By recruiting talented people and channeling resources to lower levels, we can resolve the previous problem of the majority of rural medical practitioners being people with limited training and uneven levels of proficiency." 

Qiu Hua, who is a member of one of 15 teams of family doctors contracted to provide services in Huashan Town, told us, "Health centers are also providing remote treatment, bringing top quality medical resources from big hospitals to local areas, and actively linking up with the development of medical consortia. This helps make rural medical practitioners confident that they can do a good job." 

In 2016, the one yuan doctor's visit policy was integrated with the medical insurance system for urban and rural residents. Expenses for village residents seeking treatment at village health centers are first reimbursed through medical insurance, with the out-of-pocket portion covered by secondary subsidies from the district government. This has built a stronger mechanism for the sharing of risk between medical insurance and the government. The one yuan doctor's visit policy has helped village residents build awareness that being healthy starts with monitoring and treating minor ailments, and has effectively curbed the problem of certain residents lapsing or relapsing into poverty as a result of illness. The idea that people should seek treatment according to the severity of their problem has truly taken root in Huadu District. 

(Originally appeared in Qiushi Journal, Chinese edition, No. 14, 2020)