Debt Plagues China’s COVID Patients Amidst Medicine Shortages

China’s recent COVID-19 wave has left patients and their families struggling with medical debt. A Peking University study estimated that as of January 11, 900 million people in China had been infected with COVID-19, and China’s National Health Commission reported on January 5 that there were 1.63 million people currently hospitalized with the virus. The massive wave of infections has been accompanied by an almost complete roll-back of subsidies for those infected, a byproduct of the end of China’s zero-COVID policy. At The Financial Times, Sun Yu, Wang Xueqiao, and Nian Liu reported on the mounting medical debt of COVID-19 patients who are denied free treatment and unable to take advantage of COVID-19 insurance plans due to hospitals’ narrow definition of “confirmed” cases

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 subsidized 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 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.”

[…] “The hospital made it clear that Covid proof is not easy to obtain as the disease diagnosis has been politicized,” said [Frank Wang, a Hangzhou-based marketing manager who bought a Covid insurance plan early last year], who paid more than Rmb20,000 for treatment. “That makes patients like me a victim.” [Source]

Issues with price and proper diagnoses also plague Chinese patients’ access to Paxlovid, the oral antiviral drug produced by the American pharmaceutical company Pfizer. Paxlovid was approved for use in China in February 2022, the first foreign COVID-19 treatment to receive Chinese regulators’ approval. However, negotiations to lower the price of the drug in China have stalled, severely limiting supply of the drug at a time when it is in high demand. Referring to Chinese regulators’ request for a lower price for the medication, Pfizer’s CEO said, “They are the second highest economy in the world and I don’t think that they should pay less than El Salvador.” The state-run Chinese tabloid Global Times attributed the failure of negotiations thus far to U.S. capital forces’ “business expansionism and insistence on maximizing their interests,” and posed the question: “[W]hy don’t [sic] Pfizer drop some pursuit of the profit, and cooperate with China with a little more sincerity?” At the Associated Press, Huizong Wu reported that Chinese authorities’ decision not to include Paxlovid in the national health plan’s list of reimbursable medications was attributable to the breakdown of negotiations

Chinese health care authorities declined to include Pfizer’s COVID-19 treatment drug in a national reimbursement list that would have allowed patients to get it at a cheaper price throughout the country, saying it was too expensive. 

Paxlovid, an oral medicine developed by New York-based drugmaker Pfizer, has been widely sought after in China since the country began phasing out its “zero-COVID” restrictions and a surge of infections started sweeping through the country. Although it is supposed to be prescribed by medical professionals, that hasn’t stopped people from scrambling to purchase it on their own through any means at their disposal — including buying generic Indian versions of the drug through the internet, according to local media reports. 

Health care policymakers can leverage bulk purchases to lower prices in negotiations with pharmaceutical companies that, in turn, can net a steady source of revenue. A drug must be included on the reimbursement list to be covered by the national insurance scheme. China will include two other COVID-19 drugs, the Chinese-made antiviral Azvudine and the Chinese herbal blend medicine Qingfei Paidu Granules, the National Healthcare Security Administration said in a statement Sunday. [Source]

Demand for Paxlovid has created a hugely distorted market for it. China’s elites have begun giving the drug as a gift to curry favor and cement connections. “It is more coveted than Moutai [a pricey liquor sometimes associated with corruption],” a Beijing hospital official told The Financial Times. The shortage has also proved fertile ground for smugglers and scammers. Hong Kong police have intercepted China-bound travelers with thousands of generic versions of Paxlovid, which reportedly sells for an exorbitant markup on the mainland. Chinese social media is rife with scammers who simply trawl social media platforms for posts seeking out Paxlovid, and then demand cash up front for the promise of a drug they will never deliver. Beijing has instructed authorities to “enhance oversight” of the online Paxlovid market as part of a broader crackdown on price gouging, false advertising, and other crimes. 

Delays in access to Paxlovid are proving fatal for some COVID-19 patients. One man told Reuters that his father died on the same day he was prescribed Paxlovid, after experiencing a seven-day delay. Nonetheless, Paxlovid might not be a panacea even if it were abundant, one Hong Kong-based microbiologist told Bloomberg News: “Even if there is enough Paxlovid for China’s large population, a distribution infrastructure to get these pills to patients in time isn’t something that can be set up overnight.”

Death is no respite from debt for many families of COVID-19 victims. China has officially reported 60,000 COVID-related deaths in the past month, but many Chinese citizens believe that figure dramatically undercounts the true death toll; some have cited a rash of celebrity deaths as evidence of this. Reuters has reported that doctors across China have been issued oral instructions not to report COVID-19 as a cause of death on death certificates. Satellite imagery reviewed by The Washington Post reveals that crematoriums and funeral homes across China are busier than ever, with some overwhelmed by the sheer number of dead bodies. One receptionist at a Chongqing funeral home contacted by The Post said, “I have worked here for six years and it has never been this busy,” adding that the freezers for storing bodies are full and the eight incinerators are running 24/7. The rise in deaths has forced funeral parlors to limit mourning ceremonies to mere minutes, and there have also been reports of price gouging. At Bloomberg News, Selina Xu, Daniela Wei, Allen K Wan, and Philip Glamann reported on the exorbitant prices of cremations amidst China’s latest wave of COVID-19 infections

Public notices at [Shanghai’s Longhua Funeral Home] over the weekend explained that the crematorium had received more than 500 corpses on that day, roughly five times more than it typically handles, according to one funeral goer. After hours of waiting, each family was given five-to-10 minutes to mourn in a no-frills ceremony, fighting for space in a cramped room with bodies laying on stretchers, zipped up in yellow body bags.

[…] A whole gray economy has emerged to cater to those who are desperate to bury their loved ones. Everything is an opportunity for profit: scalpers hawk queue numbers to skip lines for cremation, rent out hearses and offer all-in-one packages at exorbitant rates. Some trumpet their connections to workers at various crematories and hospitals.

When Bloomberg News called one such provider named De Shun Xiang in Beijing, an employee said cremation can be arranged within three days at the cost of 68,000 yuan, with same-day service going for 88,000 yuan. Normally it would cost around a few thousand yuan.

[…] “We couldn’t afford to live under lockdown,” wrote a person on Weibo, sharing a view commonly expressed on the social-media platform over the past few weeks. “And now we can’t afford to die.” [Source]


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