Many migrant workers struggle with medical expenses in big cities 　　 　　Twelve days before the lunar New Year in 2004, Wang Jianmin, a migrant worker from northeast China’s Heilongjiang Province, died in the waiting room of the emergency ward at Beijing’s Tongren Hospital.
　　Just before his death, Wang was twice sent to the hospital by ambulance, but doctors refused to treat him, saying his illness was not life threatening and treatment would only begin if he paid the medical fees in advance. Eventually Wang could no longer endure the pain and gave up on life while waiting for money to be raised for his treatment. Although Wang died of asphyxiation, the original cause of his illness is still under investigation.
　　Wang’s story is a typical example of the situation of millions of migrant workers threatened by various diseases. These diseases, combined with the daily hazards of injury whilst on duty, make life for average workers a bit of a lottery.
　　Recently, Hubei Provincial Labor and Social Security Department conducted a free physical examination for migrant workers in Wuhan, the provincial capital, finding that among 14,000 checked, about 40 percent are working in spite of illnesses.
　　
　　Doctors too costly
　　
　　Liu Guitian carefully fills out his remittance slip for 325 yuan ($40) at a local bank each month. His top priority is to send money home.
　　Liu is a farmer from Xinxiang, Henan Province, one of the biggest sources of labor in the country. Since 1999, he has been trying his luck in Beijing with several of his friends. A year-long, hard-earned wage from the farmland was about 1,000 yuan ($807). “We could not even afford children’s tuition fees in tough years,” said Liu.
　　Now he works as a porter in Beijing. “I have to work 12 hours a day for 15 yuan ($1.8), however, the accommodation is provided by the developer, meaning I can save more than 300 yuan ($37) monthly,” he said.
　　Liu lives on site in a temporary structure made of cardboard. Taking up most of the 15-square-meter floor space are six beds, some piled with washbowls, mess tins, bedding and luggage. The room is bitterly cold.
　　According to Liu, most migrants cannot afford the costly medicine and hospitalization when they fall ill. They would rather grin and swallow medicine to help cure common diseases such as a cold.
　　“We can’t afford the time off to see a doctor, as we lose money,” he complained. Liu’s friend Li Changchun from Sichuan Province said many workers buy their own medication at local pharmacies or bring them from home.
　　Medical experts note that poor living conditions and exhausting physical pressure are determined causes of the workers’ illnesses. Migrant workers usually engage in dirty, weary and dangerous work, with comparatively low incomes.
　　Moreover, the workers show little concern for their diet or clean living environment. Over time, physical problems will accumulate and the body’s constitution inevitably sinks into decline, resulting in the high possibility of chronic diseases.
　　
　　By not addressing ailments in a timely fashion, they may become life-threatening, health experts warn.
　　Statistical analysis shows that the health condition for migrant workers in Wuhan is far from optimistic. It was calculated that more than 20 percent of workers are infected with the hepatitis B virus, 8 percent are suffering from fatty livers, 5 percent are sick with gall or kidney stones, while 10 percent are afflicted with cardiovascular diseases, with a high incidence rate of hypertension and coronary heart disease.
　　The situation is even worse for women workers. About 67 percent were suffering from gynecological infections, including hysteromyoma, PID and cervicitis.
　　
　　Doctors on site
　　
　　It is reported that the Ministry of Labor and Social Security has urged its subdivisions at all levels to include migrant workers in medical insurance plans, as long as they are employed in urban areas. Starting from 2005, Beijing Municipal Government launched a stipulation that employers should pay full medical insurance premiums, which will cover injuries caused at work.
　　In fact, most migrant workers ignore their lawful rights when they sign labor contracts with their employers due to ignorance and the great desire to get work. Illegal employment channels are also a factor preventing them from medical security.
　　The constant movement of these laborers presents yet another obstacle, as keeping tabs on where they are in order to pay medical insurance premiums can become an administration nightmare.
　　In many cases, migrant workers visit doctors on site should diseases become serious. At a construction project near Dongsishitiao, Liu Wanjin has set up a small temporary clinic. The two single beds, cupboard and desk make up the basic facilities, geared toward simple treatments.
　　Liu has seen over 100 workers from Henan Province over a two-year period. During this time he has moved about the city to various worksites, making simple diagnoses and treatment for the workers, as well as working to improve their daily hygiene.
　　Liu said he receives several patients each day, many from other nearby construction sites, adding up to an average of 200 each month.
　　“They are attracted by the low cost of treatment,” Liu said. He added that he is able to give workers more exact quantities of medicine, saving them from the cost of buying full boxes in pharmacies, thus cutting costs. He also dispensed with the rigid procedures and costly registration fees necessary at large hospitals.
　　Despite these savings, more than 90 percent of the workers still cannot pay for their medicine immediately. Most request to sign a letter of credit and pay monthly or even annually.
　　What worries Liu more than workers defaulting on the medical fees is his qualification as a doctor. The 56-year-old believes his qualification is legitimate, as he began his career 40 years ago and has extensive diagnosing experience.
　　The only documentation he can provide to prove his identity as a legitimate doctor is a duplicate qualification certificate issued by a local health bureau of Xincai County, Henan Province, in 2004. In Beijing, however, he is not registered with the municipal health bureau as a doctor.
　　Zhao Huaqiong is a retired registered doctor who sold her own property to fund a small private clinic. Her initiative became known in local media as the first privately owned clinic for migrant workers in the country.
　　Business was going well until in 2005 the local health bureau fined her for violation of medical codes after a complaint from the public. Zhao said it was a misunderstanding about her treatment of a patient.
　　She believes her business is being squeezed by nearby hospitals and pharmacies as she was providing a highly competitive service.
　　
　　Social aid
　　
　　In mid-December last year, 12 nongovernmental organizations (NGOs) dedicated to providing assistance to migrant workers initiated a commission for raising medical aid funds.
　　Starting from 2006, migrant workers in Beijing are able to submit application forms for aid, depending on approved identification. Each can apply for 2,000-4,000 yuan ($247-495), and the applicants are required to submit the bills and receipts within a 30-day period to prove how the money was spent. Special requests made by emergency patients will be dealt with separately.
　　Executive director of a non-profit NGO in Beijing, Xing Wenyi, said the first amount of 200,000 yuan ($24,752) is available and additional funds will be raised through charity sales of 2006 calendars to individuals and businesses.
　　Xing said he hoped this initiative would persuade hospitals, insurers and other social resources to offer more medical help to migrants. Government departments have also been urged to improve the social security system for this massive labor force.

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