Chapter 1158 - Medical Insurance and the Provincial-Harbor Hospital

Commissar Shi Niaoren's cabin occupied the farthest end of the ship from the engine room. The wall facing the machinery was stacked with large bags stuffed with coconut fiber—a token gesture at best, designed to protect the leader should the boiler explode. Whether aboard the 854, the 901, or any other steamship hailed as "the pride of Lingao industry," this roughly reflected how Senate members viewed the state of their vessels' safety. And the facts bore them out.

At the moment, Shi Niaoren sat at the desk in his cabin, leafing through a thick document with a sour expression. Since the voyage began, his mood had been foul—though not because of the seasickness he'd claimed to his accompanying staff. Rather, it was because the volume before him wasn't actually a book but a detailed set of regulations for public medical care for naturalized citizens, handed over by the Civil Affairs Department during his rest stop in Lingao after concluding the previous leg of the tour.

When chatting with Elder physicians of domestic origin, Shi Niaoren would occasionally let slip the phrase "back when I was in the United States." But he never mentioned how his American medical practice had been constrained by insurance bureaucracy. Who would have imagined that, having traveled back over a hundred years before America was even founded, he'd still be dealing with medical insurance—and moreover, an entirely new system of his own making? The thought blackened his mood further.

In the latter half of the previous year, at an expanded Executive Committee meeting, the Finance Department had proposed implementing a monetized settlement system in the health sector. Drug and equipment allocations would no longer be free; all health services would carry specific prices.

This wasn't aimed at the Health Department alone. Fiscal Controller Cheng Dong had raised the idea of implementing monetized accounting across all agencies, enterprises, institutions, factories, and commercial units multiple times. This was merely the pilot implementation—and the Health Department had been chosen to go first.

Commissar Shi had no objections to monetized accounting itself. Without it, the Finance Department couldn't account for currency issuance, economic output, or fiscal expenditure. But what came next blindsided him.

Implementing monetized accounting wasn't particularly difficult—it just meant more paperwork. Previously, the Health Department only needed to requisition supplies and fill out requests. Now, in addition to filing requests, they also had to calculate everything in Trading Vouchers according to a price list. The money calculated was merely recorded in ledgers and processed through De Long Bank. The impact on the Health Department amounted to hiring a few more accountants, cashiers, and clerks.

Elders and naturalized citizens now had additional steps when seeking treatment. Before, they only needed to register. Now they had to fill out triplicate forms listing itemized costs for drugs and treatment, then submit them separately to the Civil Affairs Department and Finance Department. For this purpose, the three hospitals under the Health Department had hired a batch of cashiers.

Then things took an unexpected turn. The Civil Affairs Department subsequently required the Health Department to formulate clinical pathways for common diseases affecting naturalized citizens, to guide the treatment activities of naturalized medical personnel. At the time, the Health Department hadn't thought much of it. Aside from the larger hospitals staffed with Elder physicians, medical care for naturalized citizens—beyond public health education and epidemic prevention—was basically just dealing with trauma and everyday headaches and fevers. The Health Department reorganized the contents of the common disease manual given to naturalized medical personnel from the accelerated training program and submitted it to the Civil Affairs Department.

What they hadn't anticipated was that several months later, the Finance Department and Civil Affairs Department would jointly issue a document based on the submitted clinical pathways, setting cost limits for treatment of naturalized citizens with public medical coverage. Without special circumstances, for patients entering pathway treatment, any costs exceeding the limit due to deviations from the pathway would have to be borne by the medical institution itself; the public medical system would refuse to pay.

The Civil Affairs Department's rationale: modern medicine is built on a foundation of enormous high-tech investment. Based on experience from the original timeline, the growth of medical expenses routinely outpaced economic development and residents' income growth.

Currently, all diagnostic and treatment activities for naturalized military personnel and employees were covered by the public medical system, provided free of charge. Medical care offered to non-employee naturalized citizens in areas under Senate control was also essentially half-sold, half-given. Such was the Senate's political superiority.

But the Civil Affairs Department argued that although the overall medical enterprise remained quite rudimentary, if no restrictions were placed on public medical payments, an empire where technological leaps happened every moment might develop an unwieldy welfare burden too early, affecting long-term governance.

Upon hearing this rationale, Commissar Shi immediately retorted: "Does a starving ghost need to worry about obesity?" He then "candidly exchanged views" and engaged in a "full exchange of opinions" with the relevant personnel from Civil Affairs and their Finance Department colleagues, "enhancing mutual understanding." The talks were "productive," and both sides "fully reserved their positions."

Commissar Shi knew perfectly well that certain figures in Finance had orchestrated this—their goal being nothing more than what they'd been energetically promoting: "perfecting the social insurance system."

Shi Niaoren's position was clear: the Senate's medical activities for naturalized citizens remained primitive—half of common internal medical treatments were, in the Elders' view, essentially placebo therapy—and urgently needed substantial development. Setting economic restrictions on primitive medical activities this early would certainly constrain the development of the Senate's medical enterprise. Medicine was a highly practical science; binding the hands of practice prematurely would only harm the advancement of medical standards.

(End of Chapter)