Migrants in China often have to work long hours, are underpaid and are hired illegally, not bound by an authorised labour contract. Having to work in hazardous work conditions, sometimes with only a few days off a year, falling ill and requiring medical care can be a nightmare for many of China’s stateless individuals.
“If I get sick or injured, I will just ask my friend to ask her friend for advice,” I was told by a migrant living in Beijing at the time. Financial burdens and long working hours often force these individuals to self-diagnose out of fear of getting fired.
Since Deng’s economic reforms in the 1970s, China’s growth rate has continued to soar, with output legitimacy largely dependent on measurable economic targets. Often the method in which quota-driven projects are assessed is not noted down. Policy implementation, responsibility and funding were decentralisation to local governments, with the assumption that it would speed up efficiency. This process has only allowed those with considerable power, local governments, to exploit those below them through acts of misconduct. Compared to the collectivisation and commune eras under Mao, China’s health care sector is now fully underway to becoming semi-privatised and commercialised; something many of the country’s rural population are completely unfamiliar with.
A major contributor to China’s soaring economic base is its extensive and committed migrant population. Often regarded as the country’s “floating population” due to their transient nature of moving from city to city in search of job opportunities, migrants have been at the forefront of social inequality. Migrants, considered the “losers” society, are continually disadvantaged when it comes to implementation of newer reforms; all believed to decrease the parity between the country’s rural and urban population.
Healthcare for China’s ever-growing population is now an indicator of state performance. Following the SARS Epidemic in 2003, where the central government was criticized by doctors working in a public hospital in Beijing for manipulating health-related information, the party has understood that its legitimacy can not only be based on the interests of its stakeholders. Censorship concerning medical issues could in fact instigate popular protest. Despite the government’s decision to launch a newer set of health care reforms in 2009, that guaranteed universal basic health care coverage for its entire population by 2020, prioritization of future policies have continued to disadvantage migrant workers.
Social discrimination
With the country’s emerging urban class, accessing health care providers is restricted by social discrimination; a newer phenomenon migrants have to face. Often, even with health insurance in urban areas, migrants will be denied access to health providers on the basis that they do not hold an urban registration card. China’s registration policy, or the hukou system, was first implemented under the Maoist era. The policy was implemented to effectively control internal migration particularly from rural to urban areas. It is now used to identify an individual’s original province, and can dictate what benefits a person is entitled to. For many migrants, holding a rural hukou card means being denied basic health care treatment altogether. It can also mean restricted access to education for their children, on top of social discrimination on a day-to-day basis.
In China’s more developed cities including Shanghai and Beijing, efforts have been made by both civil society and the state to rectify these damages. Health insurance pilot programs are unique to Shanghai and Beijing, which offer financial aid to migrants. The central government has also urged companies to commit to risk pooling projects, where every month both the employer and the employee have to put money aside on the off chance those employed need urgent and expensive medical treatment. Health insurance programs are not universal in China. Often they unique to develop cities and managed under local governments.
Low participation
Although ideal in theory, participation rates with these programs are often very low. Awareness among China’s often-illiterate community means many migrants are completely unaware of such opportunities. If given the option, many are also not inclined to take it. “I don’t know where I will be next month,” I was told by a female migrant living in China’s busy Shanghai city. In recent decades, China’s Premier Li Keqiang in particular has reached out and expressed his support for health care reforms. Opportunities for the country’s migrant workers to change their resident card from a rural status to an urban status are becoming common. However many are still reluctant to do so. Potential loss of farming land in their home provinces is a reason for this. As well as this, migrants often choose to migrate to larger cities alone, having to leave children and older family members behind. Changing their hukou status would mean committing to another city, an act that some are just not ready to do.
The Chinese government’s decision to move from a welfare system to a commercialized and semi-privatized healthcare system has had its toll on migrant workers in particular. As one of the main drivers for the country’s overall growth in GDP, there as concerns as to whether the government can continue to neglect a migrant’s basic needs and prioritize elite dominated interests. Whether the party will reach its target by 2020 still remains uncertain. Although one thing is more predictable, without political or legal capacity, migrant workers will be unlikely to see greater accessibility, affordability and equal health care treatment in the near future.
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