Shocks to the System: Taking a Reading of the Health of Health Care

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This is SCIENCE IN THE NEWS in VOA Special English. I'm Faith Lapidus.

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And I'm Pat Bodnar. Recently VOA News had a team of reporters examine some of the problems and issues facing health care systems around the world.

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Our program this week is based on what they found.

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One could argue that a nation's health is only as good as its health care system.

In many developing nations, the poor often go without even the most basic care. Either the cost is too high or the nearest doctor is too far away.

Yet money is not the only thing in short supply. Some nations are dealing with shortages of doctors and other trained medical professionals.

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Efforts to reform public health systems can produce mixed results.

Consider the situation in Thailand. The country has a health care program known as the "thirty baht" plan. Patients pay just thirty baht, or about seventy-five cents, for every medical visit.

The program serves almost eighty percent of the sixty-two million people in Thailand. It offers basic services and even many high-cost operations and treatments. These include treatments for AIDS and cancer.

The thirty baht plan is popular with voters, especially in the countryside. The program helped the Thai Rak Thai party win the general elections in two thousand one. And it was again an important part of the campaign in the last elections in April.

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The thirty baht program marked a major step toward universal health care in Thailand. But now hospitals are the ones feeling the pain. They say the program is breaking them financially.

Public hospitals and many doctors say the plan is based on poor policy. And they say that even though government financing has increased, it has still fallen short.

Hospitals now face big debts. Siriraj Hospital is Thailand's oldest medical school. Today it has debts of about thirteen and one-half million dollars. Other major teaching hospitals have withdrawn from the plan to avoid similar situations.

Critics of the program note that many doctors have left the public health system in Thailand because of rising work pressures. As a result, hospitals often do not have enough doctors to see the increased numbers of patients.

Officials estimate that more than two thousand doctors have resigned from state hospitals over the last four years.

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You are listening to SCIENCE IN THE NEWS in VOA Special English.

We continue now with India, where most poor people are in the care of a struggling public health system.

About two-thirds of all Indians live in villages. Most hospitals, however, are in big cities. The hospitals are crowded. Patients wait in long lines to see specialists. They can wait months for tests or operations.

Many poor people do not have enough money for a stay in the hospital, so they will not even make the trip.

The lack of an effective public health system has led to a successful private system. Highly skilled doctors treat wealthy patients in modern, privately owned hospitals.

India has even developed a medical tourism industry. Patients travel to India to receive services at a much lower cost than they would pay in their own countries.

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The test for India is to put high-quality health services within reach of the majority of its people. Other countries face similar situations.

Pedro Francke is leader of a group of civil organizations in Peru called "Foro Salud," Spanish for Health Forum. The group is fighting to improve the ability of poor Peruvians to receive health care.

Mister Francke tells V.O.A. that about twenty-five percent of Peruvians cannot get health services. He says this is mainly because of economics. People have to pay at public hospitals for medicines and operations. Most people, he says, do not have the resources.

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In the Philippines, the public health system is suffering as doctors and nurses leave for better paying jobs in other countries. Former health secretary Jaime Galvez Tan tells V.O.A. that the situation is near crisis level. Many rural areas are now without trained medical professionals. He says the situation is similar to the nineteen fifties.

Experts estimate that more than one hundred thousand nurses have left the Philippines since nineteen ninety-four. Within the past few years, thousands of doctors have followed.

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South Africa also has a limited number of doctors and nurses. They have to treat a population where almost one-fifth of the adults are living with H.I.V. The AIDS virus hit South Africa with force about ten years ago.

At that time, the nation was beginning to recover from years of racial separation laws. Public services were being expanded to reach all South Africans, black and white.

The spread of H.I.V. and AIDS overloaded the health services. Many health workers left the country. Poor areas in South Africa have been affected the most.

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International health experts estimate that about half of poor farmers in China go without medical care. Most hospitals and medical centers are in large cities hours away from where they live. In addition, the cost of treatment is often too high for them.

In the nineteen seventies, the communist leadership in China launched a campaign to close the health care divide between cities and villages. Health workers who traveled the countryside became known as "barefoot doctors." They provided free medicines and other basic services to villagers.

But free-market reforms and economic development have been a shock to the system. Medical services in China are now provided mostly at hospitals in large cities. A low-cost health insurance plan has been established, but critics say it has reached few people.

Still, a World Health Organization official recently said the government has clearly recognized the need to re-invest in health. In March, Chinese leaders promised to spend thousands of millions of dollars to improve services in the countryside.

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Across the border from China, Russia is taking steps to reform its health care system for the first time in fifteen years. The plan calls for the government to spend more than three thousand million dollars beginning this year.

Some of that is expected to be used for pay increases for doctors and nurses. The money is also to be used to buy new equipment and build eight high-technology medical centers in the countryside.

But critics of the plan say the quality of patient care in Russia will suffer. The plan reportedly calls for the dismissal of tens of thousands of specialists. The Russian government wants more doctors who can treat general medical problems. Russian news reports say many hospitals could be shut down in the next few years.

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Even the world's wealthiest nation has problems with its health care system. Karen Davenport is director of health policy at the Center for American Progress, a research group. She says one of the biggest problems is the situation of uninsured patients. The United States has three hundred million people. An estimated forty-six million do not have health insurance.

Most health services are privately operated. Government programs pay for care only for the poor. Americans are generally offered insurance through their jobs; their employers usually share the costs. But some people work in jobs that do not provide insurance or it costs too much. Health plans also differ in the services they will pay for.

Karen Davenport notes that many of the uninsured delay medical care when they need it. When they finally do seek help, they often require more complex services including emergency care. So the cost is much higher. When hospitals cannot collect on the bills, the result is higher costs for other patients.

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Public opinion research shows that health care reform is a major concern among American voters. Calls for national health insurance have been debated for years. Opponents including the medical and insurance industries say that idea would be worse for the nation's health than the current situation.

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SCIENCE IN THE NEWS was written by Jill Moss and produced by Brianna Blake. I'm Faith Lapidus.

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And I'm Pat Bodnar. Read and listen to our shows at WWW.testbig.com, and find a link to other reports from VOA's health care series. Listen again next week for more news about science in Special English on the Voice of America.