China’s Covid patients face medical debt crisis as insurers refuse coverage

Chinese patients suffering from Covid-19 are struggling under mounting medical bills after state-backed health insurance schemes reduced or dropped coverage in response to an unprecedented wave of infections sweeping across the country.

At least 14 Chinese cities and provinces have stopped providing free treatment for coronavirus after Beijing abruptly rolled back its zero-Covid strategy last month, according to local government announcements. For three years, Chinese patients had received subsidised care for the virus.

Hospitals in Shanghai and Guangzhou are instead charging Covid patients with severe cases up to Rmb20,000 ($3,000) — about five months of income for an average urban resident — per day for intensive care, adding fears of onerous medical debt to the risk of infection. Insurance companies have been reluctant to approve Covid-related claims after previously selling tens of millions of low-cost plans as the industry seeks to avoid liability for enormous payouts during an “exit wave” of cases.

China’s health policy has also made it difficult for claimants to establish proof of infection. Health officials have narrowed the definition of Covid deaths and cases, drawing accusations from the World Health Organization last week of underrepresenting the severity of the outbreak.

An official at Taikang Insurance in Beijing, who has received dozens of complaints after declining coverage, said his company was “very strict” about approving claims. “You have [to] gain proof of illness from hospitals which rarely issue the document,” the official said.

This has put considerable stress on low-income patients and exposed inequalities in China’s underfunded healthcare system, according to analysts, as hospitals and fever clinics are overrun with elderly patients.

“China has never made its healthcare system affordable and accessible to everyone,” said Yanzhong Huang, a fellow at the Council on Foreign Relations. “The latest Covid outbreak is making the problem worse.”

Beijing had touted free Covid treatment as a symbol of its success in fighting the pandemic before it rapidly reversed track last month.

Anhui, an eastern province of 64mn people, began requiring residents last week to pay 30 per cent of their bills for pandemic-related clinic visits. Sanhe, a city near Beijing, went further, announcing last month that Covid patients would have to foot up to half of their hospitalisation costs.

This has created a significant financial burden for many patients. Gao Shengli, a 53-year-old farmer in central Henan province, suffered a stroke last week after testing positive for Covid. Two days after he was admitted to a local hospital, he received a bill for Rmb150,000, more than twice his annual household income.

Additional bills ranging from Rmb5,000 to Rmb10,000 have continued to arrive daily, driving his family into despair.

“My father has no health insurance,” said Gao’s son, who declined to be identified further. “The hospital is chasing us for payment every day, and we can’t afford it.”

China’s urban middle class is not faring much better as patients struggle to file Covid insurance claims. Multiple hospitals have refused to issue proof of infection for patients who tested positive unless they also report a lung infection and pass a review by local health authorities.

A doctor at Shanghai No 10 Hospital said staff had been instructed by the city’s health commission to limit Covid diagnoses. “We are advised to label most cases as respiratory infection,” the doctor said.

“The outbreak happened so quickly that authorities didn’t have time to draw up an action plan,” said a Beijing-based adviser to the National Health Commission. “What is certain is that the government can’t afford to treat everyone for free.”

China’s National Healthcare Security Administration said on Saturday that it would fully cover hospitalisation for Covid patients, but continued to exclude complications. Hospitals are also under pressure to reduce medical costs after the national insurance fund was strained by the costs of the sprawling zero-Covid apparatus.

In the eastern city of Hangzhou, Frank Wang, a marketing manager who bought a Covid insurance plan early last year, was refused proof of illness after he developed lung and kidney infections after testing positive for the virus.

“The hospital made it clear that Covid proof is not easy to obtain as the disease diagnosis has been politicised,” said Wang, who paid more than Rmb20,000 for treatment. “That makes patients like me a victim.”

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