Explainer-What We Know About China's Medical Reform Protests

Hundreds of people in the Chinese cities of Wuhan and Dalian protested against medical benefit cuts on Wednesday in the latest display of public discontent after rare nationwide demonstrations last year over strict COVID curbs.

Here is what we know about the protests.

WHAT ARE THE MEDICAL INSURANCE REFORMS?

Beginning Feb. 1, personal medical insurance benefits for Wuhan retirees were slashed from about 5% of the average basic pension to 2.5%, or 83 yuan ($12) per month, according to the Wuhan Healthcare Security Administration.

Under the reforms, mandatory personal accounts will be used to pay for medication, with doctor visits and hospital stays subsidised by a pooled public account made up of employer contributions.

Chinese financial news outlet Caixin reported that the reforms will affect over 300 million urban residents as part of a nationwide restructuring of China's state health insurance system that began in 2020 and aims to shift accumulated savings from personal accounts to public accounts.

In an essay published Thursday that did not refer to the protests, Finance Minister Liu Kun vowed to "deepen the reform of medical insurance payment methods".

WHY ARE THE PROTESTERS MOSTLY ELDERLY?

Wuhan authorities say that "the sick and elderly in particular will benefit more" from the reforms.

But residents complain that the reimbursement threshold for doctor visits is too high, meaning that only those who make frequent appointments seeking expensive treatment would benefit.

Healthy elderly people, they argue, lose out.

"Elderly people often need to buy small quantities of medicine but don't spend much on doctor visits. As a result of the medical reforms, their expenses will increase by a lot," said a Wuhan resident whose neighbours protested, preferring to remain anonymous due to the sensitivity of the matter.

China's underfunded healthcare system faces multiple pressures, from a rapidly ageing population to local government budgets decimated by three years of enforcing COVID restrictions such as centralised quarantines and mass testing.

ARE THESE PROTESTS RELATED TO LAST YEAR'S?

Since mass demonstrations erupted in multiple cities in November over China's heavy COVID restrictions, several smaller-scale protests have erupted over issues ranging from firework bans and unpaid wages to frozen bank deposits.

While protests over such local issues are not unusual, some commentators have said that pent-up frustrations from three years of zero-COVID measures and last year's protests emboldened more ordinary Chinese to speak out, despite pervasive government surveillance and online censorship.

"Clearly the frustrations of life over the past couple of years are now boiling over in a sense, and we see this with health, with restrictions more generally," said Stuart Gietel-Basten, professor of Social Science and Public Policy at the Hong Kong University of Science and Technology.

DO PROTESTS IN CHINA GET RESULTS?

While Beijing did not cite protests as a factor, it suddenly abandoned its zero-COVID curbs soon after the November demonstrations.

"In the rest of the world, we slightly underestimate the extent to which there is popular pressure within China and the extent to which the government can respond to that popular pressure," said Gietel-Basten, adding that the health care system would come under more stress.

WHAT IS THE REACTION ONLINE?

Following initial protests in Wuhan last week, the hashtag "Major adjustment in Wuhan medical reform" was viewed over 100 million times before being blocked.

Most comments were broadly sympathetic, with some thanking Wuhan's "grannies and grandpas" for voicing their concerns.

By Thursday, many of the sympathetic comments and all footage of the protests had been scrubbed from the Twitter-like Weibo.

ARE THESE PROTESTS ISOLATED?

In January, hundreds of retirees in the southern metropolis of Guangzhou protested, according to social media footage, after their personal account benefits were slashed to 160 yuan ($23) from around 482 yuan ($70) in December.

Since January, similar insurance reforms have been rolled out in provinces and regions including Jiangxi, Gansu,Shanxi, Qinghai, Sichuan and Guangxi. While it is uncertain whether there will be further protests elsewhere, the show of dissent in Wuhan has increased awareness of the issue on social media.