179. Shocks to the System_ Taking a Reading of the Health of Health Care doc

Shocks to the System: Taking a Reading of the Health of Health Care
Written by Jill Moss
12 June 2006
(MUSIC)
VOICE ONE:
This is SCIENCE IN THE NEWS in VOA Special English. I'm Faith Lapidus.
VOICE TWO:
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.
VOICE ONE:
Our program this week is based on what they found.
(MUSIC)
VOICE TWO:
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.
VOICE ONE:
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.
A child with a high body temperature is given
oxygen at a hospital in Bombay (also known as
Mumbai), India
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.
VOICE TWO:
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 Other major teaching hospitals have withdrawn from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.
(MUSIC)
VOICE ONE:
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.
VOICE TWO:
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.
VOICE ONE:
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.
VOICE TWO:
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.
(MUSIC)
VOICE ONE:
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.

A patient is treated for carbon
monoxide poisoning in Jilin
province, China
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.
VOICE TWO:
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.
(MUSIC)
VOICE ONE:
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.
VOICE TWO:
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.
(MUSIC)
VOICE ONE:
SCIENCE IN THE NEWS was written by Jill Moss and produced by Brianna Blake. I'm Faith
Lapidus.
VOICE TWO:
And I'm Pat Bodnar. Read and listen to our shows at voaspecialenglish.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.