BEIJING -- After Premier Wen Jiabao's pledge to accelerate the reform of China's ailing rural health system, the issue of affordable healthcare for Chinese people on the wrong side of the wealth divide is back under the spotlight.

In his government work report delivered at the opening of the National People's Congress (NPC), Wen said that the proportion of rural areas covered by the rural cooperative health system would be expanded from 50 percent to 80 percent, following an increase in the amount of publicity being given to farmers' cries for help.

He also said the central government would almost double spending on medical care to 10.1 billion yuan (US$1.3 billion).

But the flaws entrenched in the rural health system are so severe, local governments are finding it difficult to persuade people in the countryside that joining a cooperative health system is the right thing to do.

According to the program, launched in 2003, a participant in the scheme pays 10 yuan (US$1.3) a year, while the state, provincial, municipal and county governments supply another 40 yuan (US$5.2) to the cooperative fund. Contributors are then entitled to discounts, provided by the fund, to cover their medical expenses.

But some farmers regard the ten-yuan fee as another unjust charge and refuse to pay. They are used to dealing with cents in their daily lives, so are reluctant to give away even a small proportion of their hard earned income on a fund that can not provide immediate and tangible gains.

They also fear the money will be pocketed by corrupt local officials and shy away from joining the scheme out of superstition.

"Many of my folks believe that, because they have to be ill to get the money back, participation in the co-op scheme is a bad omen," said Zhang Jiang, a farmer in Qian'an county, Hebei.

Refusal to join the scheme is sometimes met with more aggressive tactics by local officials and the line between choice and obligation becomes blurred.

"Village heads in Hebei province had to visit a family 16 times before they agreed to join the program," said Bai Keming, Party secretary of north China's Hebei province.

The cooperative scheme is still in its infancy and it has already become apparent that the reimbursements provided for the medical costs of its members are insufficient.

Zhang Jiang is a participant in the program. When his wife was struck down with an aneurism, he had to borrow over 120,000 yuan (about US$15,400), 12 times a farmer's annual average income.

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