Racial Discrimination in Tibet (2000)
Discrimination in Healthcare
Discriminatory Charges
In 1992, it was claimed that "the government provides
free medical care for all Tibetans". In 1998 this had
changed to an assertion that "medical treatment is free
in farming and pastoral areas, and is financed jointly
by personal medical insurance and the state in cities
and towns". In 1999, it was stated that "only women from
minority nationalities in Tibet enjoy free medical service
provided by the state", until finally in 2000 it was again
asserted that all citizens in China enjoy "free medical
services and a labour protection medical care system
at public expense." In reality, China has been shifting
slowly to a system of fee-for-service medicine since the
dissolution of the communes in 1984, and approximately 79%
of the Chinese themselves are now not covered by any kind
of health insurance or benefits.
For the Tibetans, any claims of free or even subsidised
treatment have been negated by refugee testimonies
indicating that both male and female Tibetans are charged
for all medical services across the board, often in a
discriminatory manner. It would seem that Li Peng's vision
of "a healthcare system with Chinese characteristics"
has come true, but to the extent that Tibetans are
discriminated against in terms of access, expenses,
treatment and many other sectors. Even before they start,
Tibetans are economically disadvantaged as a result of
the discrimination practiced in other areas, particularly
employment, and few have the financial resources to cover
the exorbitant charges made for medical services. As one
European doctor who worked in Tibet for several months
put it,
"In theory, health care is free. In practice there
is a charge for each visit and for the brown OPD
(out-patient department) record. Patients are sometimes
charged for services and diagnostic procedures" Many
medicines, particularly those which are more expensive,
must be bought by the patient. This debars many villagers
(for whom cash is not a ready commodity) from receiving
necessary medication."
Nevertheless, the Chinese still claim that basic and
primary treatment remains free for all citizens. According
to a study by experts from the European Union describing
the structure of the healthcare system in "TAR", "the
policy of the health service is provision of free health
care, certainly at the primary levels. Every person is
given a little green booklet which enables him to get free
health care." In practice, many refugees reported that
the green pass did nothing more than serve as a condition
for receiving treatment, and that it carried no financial
benefits. The following four refugees all escaped from
Shigatse Prefecture in "TAR" between 1999 and 2000, yet
questions as to the use and availability of the green
health pass revealed that different regulations were in
force in each of their respective counties, indicating
the degree to which localized policies operate.
Firstly, a 28 year-old man told TCHRD that "In Kyirong
County, to be admitted into a hospital and to buy medicine
you must have a 'green health pass', which you get from
the hospital itself. The pass costs 10 yuan and it quite
difficult to obtain if you are Tibetan, because they tell
us to find Tibetan doctors. Those who don't have a pass but
need treatment in the hospital have to therefore apply to
the county officials for permission to be admitted. Most
of the Chinese in my area don't have this problem because
they are in the army and do not need a green pass to gain
admission."
18 year-old
Dawa Dorje
also escaped from Kyirong County in January 2000 where he
was a farmer. He confirmed that people in his county had
to pay 10 yuan for a green health pass, and that Tibetans
would pay the same fees for treatment and medicine, with
or without the pass. He also added that "although the
Chinese say that healthcare for farmers is free, this is
all lies. Even for the smallest problems we are forced to
pay just like everyone else."
20 year-old
Kalsang
escaped to Nepal in October 1999
and revealed a different set of rules operating in
Rinpung County. "In my region the healthcare was very
limited. There were no clinics in my township, and
the nearest hospital was one day's drive away. To use
this hospital we had to first get a green health pass
from the County authorities, which costs 35 yuan. The
poorest families in our area received a red pass, which
was supposed to entitle them to a 50% discount off their
treatment costs, but when they tried to use it at the
hospital they were told it was invalid. Nobody was given
free treatment at any time."
Lastly, a
33 year-old woman
who escaped to India in January
2000 reported slightly different regulations concerning the
green pass in Shigatse County itself. "Everyone is issued
a green pass free of charge by the head official of the
county, and you need to take this pass to the hospital
to be admitted. If you don't have the pass, the hospital
will tell you to go somewhere else, or they will charge you
double for the treatment and medicine. Some people I know
were issued a red pass because they were very poor. They
were supposed to get everything free with this pass, but
in reality they had to pay the same as everybody else."
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Extortionate Hospital Deposits --> ]
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