Yang Yunhua cries as she recounts the ordeal of using a makeshift ventilator made from bicycle and washing machine parts that was driven by a noisy electric motor to keep her daughter alive. For more than a month, Ji, right, was kept alive only by the contraption after doctors took her off a ventilator and discharged her because her family could no longer pay her hospital bills. Similar stories prompted the government to launch a major system rebuilding effort.

JIZHUANGCUN, China — Unable to rely on China's broken health care system, the Ji family was desperate.

Doctors had taken 15-year-old Ji Xiaoyan off a ventilator and discharged her because her family could no longer pay her hospital bills. So an uncle cobbled together a makeshift ventilator from bicycle and washing machine parts, driven by a noisy electric motor. The contraption pumped air into the teenager's lungs through a washer hose plugged into an incision in her throat for more than a month, until the family got donations for treatment.

"I knew my child didn't want to leave this world. We had to save her no matter what," said Yang Yunhua, the girl's mother, a farmer in Henan province. "But we are only poor people."

Such horror stories prompted the government to launch a three-year, $124-billion effort earlier this year to rebuild the crumbling health care system.

China once provided rudimentary but universal care to everyone. But as the country shifted from socialism to a market economy over the past 30 years, health care frayed. Medical costs soared faster than incomes, and treatment today depends on one's ability to pay. Nearly one-third of the poor say health is the most important cause of their poverty.

"People are paying too much out of pocket for their services for their health care. Many are becoming impoverished in the process," said John Langenbrunner, a World Bank health economist in Beijing.

Affordable medical services also could help reduce China's dependence on exports by encouraging people to stop saving so much for potential medical costs — and spend their earnings on consumer goods instead.

The government's goals include:

• Improving health services, in part by building 2,000 county hospitals and 29,000 township hospitals and ensuring each of the country's nearly 700,000 villages has a clinic.

• Expanding state health insurance from 70 to 90 percent of the population, or an additional 200 million people — equivalent to two-thirds of the U.S. population.

• Reducing drug costs by controlling prices for medications deemed essential.

Longer term, the government is seeking ways to cut back on unnecessary treatment and drug prescriptions that are blamed for skyrocketing fees at public hospitals.

The challenges are daunting.

Eight months into the three-year plan, reform remains a work in progress. Sixty percent of the funding is supposed to come from regional governments, and it is unclear how poorer ones will come up with the money.The central government has laid out a broad strategy but left specifics to local officials. The result is a series of experiments. While learning by doing is fine, there appears to be little formal evaluation of these trials, which could make it difficult to pinpoint what works, said Langenbrunner."The challenge for China is to try to evaluate the various kinds of schemes that it is trying and then see which schemes seem to work better and adopt them," said William Hsiao, a China health policy expert at Harvard University.Shenmu County in the north is offering free health care for its 390,000 residents. The southwestern metropolis of Chongqing is trying to manage urban and rural insurance programs together to save money.In Ningxia, an inland region in the impoverished west, farmers now pay $4.40 per year to join a rural cooperative insurance program that allows them to see a village doctor for 30 common illnesses.But it's too early to declare the Ningxia program a success. Hsiao, the Harvard expert, said a lack of coordination means rural clinics are competing with township and county hospitals for patients, while village doctors are quitting because they cannot earn enough under the new policy.In earlier days, workers were provided cradle-to-grave medical care while an army of "barefoot doctors" — rudimentarily trained paramedics — vaccinated children and improved sanitation in the countryside. That all broke down following China's free market reforms.Now many don't seek care until it is too late, while others resort to risky measures. A national health survey last year found about 70 percent of people forgo recommended hospitalization because they cannot afford it.

Ji Xiaoyan, 15, right, lies on a bed near her uncle Ji Junhai, 42, left, and grand uncle Ji Chunxia, 74, in her home in Jizhuangcun in central China's Henan province. For more than a month, Ji was kept alive only by a home made contraption assembled from bicycle and washing machine parts after doctors took her off a ventilator and discharged her because her family could no longer pay her hospital bills.