Blood donors get credits for giving

China's chronic shortage of blood supplies has forced one of its biggest cities to institute a commercial scheme which allows donors to claim "blood credits" if they later require a transfusion.

Launched in Nanjing, the scheme entitles those who give 800ml or more blood to an unlimited free transfusion in the event of medical need. Those giving less than 800ml earn up to three times the amount given. Relatives are entitled to a transfusion equal to the amount the donor has given.

The regulations require anyone receiving a transfusion who has not given blood to pay for it, but a refund can be earned by giving blood within a year. The young and elderly are exempt from these requirements.

Nanjing, capital of the rich Yangtze valley province of Jiangsu, hopes that the scheme will solve a shortfall of blood supplies made worse by efforts to crack down on the widespread practice of selling blood.

A blood donation law which took effect in October 1998 was supposed to ban all blood donations for money. Last year the health ministry said 3m donors had given blood without payment, but there was still a serious shortfall.

Zhang Wenkang, the health minister, said: "Illegal blood transactions exist in some regions and... current screening technology is unable to detect blood tainted with viruses.

Public opinion has been shaken by recent instances of HIV and hepatitis being spread by infected blood. Newspapers have discovered several poor peasant communities who have relied on the sale of blood for years.

Better-off areas are not immune from medical malpractice either. In Zhejiang - like Jiangsu a relatively rich coastal province - the local authorities found in December that disposable needles and blood transfusion supplies were being bought from doctors, rinsed out and then resold to local hospitals.

The blood crisis reflects wider problems in Chinese health provision since the shift to a market economy after the death of Mao Zedong. Underfunded hospitals and doctors regularly over-prescribe to increase their income, and patients may be denied treatment if they cannot pay.

In a recent critique of declining standards, the well-known economists Hu Angang and Meng Qingguo argue that China's health lags considerably behind the targets set when the economic reforms began. While the GDP has risen by 580% in the past 20 years, the provision of hospital beds relative to population size has risen by just 18%.