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Hospital refuses to treat Sars victims too poor to pay bill
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Tuesday, 22 April 2003
Chinas worst fears about the spread of Sars pneumonia began to come true yesterday as state media said patients from a poor region had been turned away from hospital because they could not afford treatment. The reports raised the prospect of the disease spreading unchecked through Chinas vast hinterland, with impoverished sufferers unable to receive proper care and instead returning home to infect others.

Further alarm came yesterday as the authorities announced that the number of cases in Beijing had shot up again - this time by more than 100, tto almost 450 - following the ninefold increase in official numbers they admitted at the weekend. The Chinese mainlands death count from the new virus rose by 13 to 92, plus a total of 94 fatalities in Hong Kong. The number of infections across China was said to have risen by 194, to more than 2,000. Worldwide, 4,000 cases and 217 deaths have been reported. Despite government orders that hospitals must not turn away suspected cases "for any reason", a report carried by the official Xinhua news agency suggested that this had been happening as recently as last week. A hospital in Inner Mongolia - a northern region combining poor rural areas and redundant industry - left seven relatives of a woman who had died from Sars untreated for six hours in an open emergency ward because they could not pay a 2,000-yuan (£155) deposit each.

Universal health care is one of the many branches of the formerly socialist state apparatus that have been stripped away under 25 years of market-oriented economic reforms. Although hospitals are state-controlled, patients without their own or workplace health insurance have to pay cash. The hospital in the regional capital, Hohhot, told a reporter from Xinhua that the seven patients could not be treated because of "the formalities" -meaning money. Later, a staff member told The Telegraph that the family had previously had an argument with the hospital. Twelve of its staff had been infected by the dead woman, he said, and up to 40 cases were now being treated - a statistic that is more than the official figure for all of Inner Mongolia. The hospital was not a specialist epidemic unit and was having difficulty coping, he added.

Last week, the World Health Organisation cited long-term underfunding of public health, including disease surveillance systems, as one of the major defects exposed by the Sars crisis in China. Henk Bekedam, the WHO representative in China, said he was worried about the prospects for containing the disease if it reached poor provinces from relatively wealthier areas, such as Beijing and Guangdong, which are worst affected.

Areas added to the affected list in China yesterday included the northern "rust-belt" provinces of Jilin and Liaoning, and the poor western province of Gansu, which is the home of footballer Paul Gascoignes latest club, Gansu Heavenly Horses. At the weekend, Chinese officials admitted that virtually every aspect of Beijings disease control and surveillance system had broken down. The health minister, Zhang Wenkang, and Beijings mayor, Meng Xuenong, were both sacked over the fiasco.
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