Traditionally taboo subjects among Chinese, illness and healthcare are surprisingly both great conversation topics in China today. The media is always rife with medical scandals, while the increasing millions who subsist on a diet high in sodium, fat, cigarettes and stress makes it hard to keep the doctor away in China. Brushes with the Chinese medical system therefore become powerful shared experiences.

Even seeking treatment for a common cold in China requires jumping through a series of hoops in the Chinese medical system. Foreigners may grapple with communicating their medical needs in Chinese, confusing queuing systems and understanding peculiar remedies. But to the Chinese, especially the poor, being in need of medical treatment is equivalent to the kiss of death, making even Good Samaritans afraid to lend a hand. This article attempts to demystify the Chinese healthcare system somewhat, using simple economics.

My First Brush with the Chinese Healthcare System

Every foreigner who’s stayed here long enough seems to have a medical story, so here’s mine. On a trip to the local orphanage, we chanced upon a sleeping newborn among the elderly ladies in the nearby nursing home. Following some miscommunication with one of them, who was speech-impaired, we discovered the baby had a bloated abdomen. Born without an opening to its anus and abandoned, he was passed to the kindly old ladies to care for until he succumbed to toxin build-up. On the advice of the nurse among us, the local friend drove to the local pediatric hospital. The rest was the same old story—the 10,000 RMB pre-admission deposit and stern warnings of other possible myriad (expensive) congenital birth defects. Like an angel, a medical intern was assigned to help us navigate the labyrinth of departments, including an ultrasound room littered with disposable wipes. But that did not spare us from a verbally abusive radiographer who wanted two of us to hold the baby upside-down (without protective gear) for an x-ray. After making our rounds of a few departments the baby was admitted to ICU. But to our surprise, the operation was scheduled for the next day.

The Economics of the Chinese Healthcare System

To the outsider, as well as locals, the Chinese healthcare system seems pretty bewildering, until examined under the light of economic theory. Mao’s socialist China had cooperative medical schemes provided through agricultural communes in rural areas and urban work-unit-based health insurance. “Barefoot doctors” administered basic health services, using mostly herbal medicine. After Mao, economics reigned and healthcare was turned over to market forces. Existing medical schemes disappeared with the dissolution of rural cooperatives, leaving the majority of the population uninsured between 1980 to 2000. Even now, participation in social insurance is voluntary and the lack of understanding of one’s coverage can leave one devastated in the event of serious illness.

The original rationale was to make basic care accessible to the masses, cross-subsidised by premium pricing of elective treatments. However, the failure to adequately define the distinction between the necessary and the elective left this demarcation almost entirely to the discretion of healthcare providers. Healthcare quickly also became another commodity, heavily advertised at every turn. Bait-and-switch techniques became the norm – low consultation fees coupled with over-generous prescriptions. Similarly, low basic salaries of practitioners are supplemented by commission from non-standard prescriptions, diagnostics or padded with hongbaos from patients seeking prompt attention. Hospitals are typically understaffed, so doctors are known to display blasé attitudes or even downright rudeness. Patients admitted to hospitals have to bring their own nurses (friends or relatives) and meals. Failure on the part of Shanghai’s emergency services to send an ambulance to the aid of a three-year-old British boy, ultimately resulting in his death (which was widely covered in both local and foreign media), shows that a crisis point has been reached.

A medical intern friend once recounted that he found the pediatric unit most depressing. The initial thought that came to mind was of the helpless parents under the one-child policy being most susceptible to turning violent on pediatricians. But actually, my friend was heartbroken to see parents, unable to afford treatment, carrying their sick children away. Similarly, we later found out the baby in the earlier story had actually been taken to the same hospital by his parents earlier on. Paralyzed by the thought of myriad congenital birth defects in the baby, they carried him away.

Overcrowding is another problem as clinics are practically non-existent or dodgy-looking. Going to a full-scale hospital for a common cold is not hypochondria in China. With demand outstripping supply, improving patient experience is hardly necessary. Hospitals are not obliged to accept appointments, so visiting a doctor always entails a half-day outing. Queue numbers (guahao) cost money and queuing systems are seldom transparent, so jumping queues or entering the doctor’s room without being called is common among locals. My Caucasian friends have also been bumped up the queue for seemingly no reason.

So what will it take to reform China’s healthcare system?

It seems to surprise locals and foreigners alike that the healthcare system in China has actually undergone quite a few reforms post-2000. Admittedly, it is no mean feat to design a healthcare system for 1.3 billion people. Already, past reforms have covered 98% of the rural population with basic health insurance.

Perhaps at the heart of the matter is a trust issue. China’s proportion of spending on healthcare currently exceeds that of Switzerland. Adequate community-level healthcare exists but citizens prefer to join the queue for a well-known physician. The new government has the unenviable task of taking over at a time when faith in authority is at its lowest. Reformation and regaining the people’s trust in the healthcare system, among other areas, could be a tipping point.

To conclude with the same story, thankfully, the ICU staff later decided that the baby should be operated on that night. Subsequently, the local in our group took it upon herself to discreetly enquire about the baby’s previous hospital records. The story has a happy ending, with the baby eventually being reunited with his parents. But that is not the end of the story, as follow-up medical procedures will be needed as he grows. It remains to be seen if the needed reforms in the system will come soon enough.
 

Related links
Take a Number: How to Handle a Chinese Hospital
Violent Doctor-Patient Cases: What’s Wrong with China’s Healthcare System?
Get Covered: A Brief Guide to Expat Health Insurance in China

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Keywords: Chinese healthcare system Chinese medical system