NCMS provides reimbursement. But doctors nowadays tend to recommend more expensive medication because it is linked to their income. So what we pay is not necessarily less. Additionally, for serious diseases like my father’s, NCMS only cover 60% of surgery fees. Even after reimbursement, the spending is still catastrophic and sucked up my savings.
Local protectionism further undermined the effect of NCMS. Because NCMS is locally financed, permission from the local government is needed for one to get reimbursed for treatments done elsewhere. And because many local governments, especially in underdeveloped areas, suffered from massive debts, they rely heavily on private capital to provide medical service, which is at best of moderate quality. As private hospitals often collude with local governments to make trans-local reimbursement difficult, it is more difficult and costly—if not impossible—for migrant workers to get quality treatment. When Rizuo’s mother was rushed to a local hospital in 2017, he was faced with the dilemma of whether to stay with the hospital or transfer his mother to a top hospital in the neighbour city, which meant extra 50.000 yuan spending:
rumors of misdiagnosis and mistreatment by that hospital widespread … I cannot risk my mother’s life. Talking to the government is not useful, unless you have guanxi. They all know each other.
Even more acute is the pressure to provide their children with quality education. Murphy (2020) observed that rural migrants’ hope for their children to study out of drudgery increased since 2010 due to the expansion of the labour market, mass compulsory education and higher education. The STER further reinforced this hope. Many migrant drivers lamented how it is increasingly difficult to make a living without higher education as technologies advance. As the hukou system began to relax, many hoped their children could secure a good future in cities through education. A’xiong is among them. Having contributed to his local social security account for 5 years, his children were eligible for compulsory education in Shenzhen. This saved him 20.000 yuan per year, equivalent to 3–4 months of his income. Yet he was still worried that his children might ‘lose at the starting line’, since they were channelled into a minban, privately run, schools where the quality of education was widely believed to be lower, by a point-based system. The system linked access to quality public school education to one’s hukou, employment and housing status, favouring local property owners with formal employment. To better prepare their children for the labour market and future life in the city, A’xiong sent them to extra-curriculum cram schools, which cost over 20.000 yuan per year. In addition, because without local hukou his children were not eligible for high school in Shenzhen, he had further plans to buy a flat and settle down in Dongguan, where it was easier to get local hukou and where housing price was significantly lower. For him, this is worth it,
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Y. ZHOU