A patient rests as others queue up to enter a hospital in Shanghai© Eugene Hoshiko/AP/Press Association Images
Amid the buzz surrounding China’s plans for economic reform at the Third Plenary Session of the Central Committee last month was an issue close to the hearts of its people—improvements to public healthcare.
Deteriorating patient-doctor relationships have been the focus of intense public debate in China this year and leading up to the Plenum after a string of attacks by patients against doctors, including a fatal stabbing at a hospital in Zhejiang. The attacks revealed a widespread distrust of medics, and frustration about inequalities within a system buckling under the strain of serving 1.3bn people.
In the worst attack, a 33-year old, apparently unhappy with the results of a nose operation, reportedly stabbed three doctors, one of whom died. The incident fuelled a rare protest from hundreds of doctors at the hospital and prompted panic across the medical profession. The case pointed to deep rifts in China’s public healthcare system, which serves the vast majority of China’s population.
Up until 10 years ago, around 80 per cent of the population paid for healthcare fees out of their own pockets; the remainder were covered by insurance either as government or state-institution employees or urban workers of private businesses. In the last four years however, the government has invested over a trillion RMB (£100bn) into healthcare, half of which went towards expanding health insurance to low income and rural populations. Part funded by the government with the rest paid by the individuals, these new schemes boosted insurance coverage to around 95 per cent of the population. But even with increases in government subsidies per person, many of these packages are wide reaching but low quality, and inadequate at meeting the costs of serious or chronic illnesses.
Furthermore, wider access—as well as the country’s ageing population—has increased the burden on the system. China’s healthcare system is centred on hospitals as a first point of call, rather than the GP (general practitioner) in the UK system—patients go directly to the relevant unit within a hospital, or a specialist hospital in large cities. While the latter offer the best healthcare, they are also the most crowded—in an effort to maintain wide access, the government keeps consultation fees low (30p-£1.50) which means that patients from rural areas flood into cities to seek help.
Queues can therefore be incredibly long: Beijing’s Peking University Dental Hospital, the best for dental treatment in the country, sees queues forming from 9pm each evening for the next day’s appointments, which are issued at 7am the following morning. Consultations with doctors are usually shorter than those in the UK, and a lack of privacy is common—there can be more than one patient in the room during each appointment.
As China shifts from battling the illnesses of developing countries to those of the developed world, such as diabetes, heart disease and cancer, treatment prices have on average soared. With rising medical bills, the public has expressed anger at the inequalities of a healthcare system that still benefits the country’s large contingent of civil servants and officials, whose insurance packages see the state footing most or all of the bill for treatment with little or no insurance contributions from the individual. This extends to privileges such as paid-for private hospital rooms for high-ranking officials, while the average patient battles with overnight costs or overcrowded hospital wards bursting at the seams.
As with other public services, corruption in hospitals is widespread and distrust of doctors has reached breaking point. A survey carried out byChina Youth Daily in October showed that 67 per cent of the public did not not trust “doctors’ professional diagnosis and treatment.” In contrast to many countries in the west, where medical professionals enjoy a respected status, doctors in China are poorly paid and overworked—junior doctors in major cities are paid around 3000RMB (£300) per month for the first few years, rising to around 10,000RMB (£1,000) after 10 years. In a survey by the Chinese Medical Doctor Association this year, 95 per cent of doctors expressed discontent with wages while 78 per cent said they did not want their children to go into medicine.
A “red-envelope” culture has therefore become widespread to supplement doctors’ wages: families present doctors with envelopes of cash before a treatment, in hope of receiving a better service. This has further reinforced a suspicious attitude towards the medical profession, particularly from those who simply can’t afford such payments. And inevitably, when a treatment goes wrong, such insecurities may fuel doubts about the diligence and sincerity of doctors. Bribery has also become common in cases of doctors colluding with pharmaceutical representatives to sell drugs. Several major firms have been investigated for bribery offences.
The government—no doubt itching to move away from supporting an increasingly burdensome system—has vowed to root out corruption in the Third Plenum and repeatedly expressed a desire to seek private investment channels in the healthcare system; what form this could take remains unclear.
While huge strides have been made in the last decade to bring healthcare cover to the public, it is clear that change could not come faster for a system struggling to catch up with the country’s rapid development and ageing population. Perhaps most significantly for the government, healthcare has brought China’s huge social inequality and corruption problem into sharp focus—the biggest and most precarious battle that the new government faces in all areas of its administration. With these rising examples of violent discontent from the public, it is vital that the authorities address the underlying issues and establish an overhaul of the system based on a modern, efficient and sustainable model.
