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Barriers in China’s health care system
Xiao He, The Epoch Times
China’s population of 1.3 billion people (1 billion of which are farmers) comprises nearly 20 percent of the world's population, yet China’s total health budget is only 1 percent of the world’s medical spending! Given this disparity in spending, what is the situation facing people requiring medical attention? Those who have been hospitalized know the extent of the barriers to health care in China. The corruption of Chinese society extends into the medical profession that most would consider as being “above” such things.
Scheduling a doctor’s appointment in China is very difficult and as a result, farmers will only go to the hospital for a really critical situation. Scheduling an appointment with a specialist for severe conditions is even more difficult. A visit to a city hospital would probably bankrupt a simple farmer. Patients are not guaranteed an appointment even if all of their worried relatives have lined up in the appointment room since 3:00 or 4:00 a.m. An option that some choose is to find an “appointment peddler” who makes a living by reserving appointments. The standard doctor’s appointment costs several dozen yuan while a specialist can cost several hundred. Desperate patients are often deceived into seeing doctors who, unbeknownst to them, practice medicine without a license. Wealthy patients may pay a large sum for medical care and they might get the proper care to survive a life-threatening condition, whereas, a poor patient will receive phony medicine and probably die as a result.
The problems faced by a patient do not end there. Should a doctor decide to admit the patient to the hospital, the hospital often rejects the request for admission citing a shortage of beds. Upon investigation, one finds that there are still many beds available but they are kept empty to act as a buffer should anyone of importance request any form of emergency treatment. In the event of such a request being refused, the hospital chief would lose his job. Only those with friends or relatives in the system might experience quick hospitalization. Those farmers who lack these connections are thus ineligible for hospitalization and must make a daily trip to the hospital. Imagine what this would be like for someone requiring daily chemotherapy, probably needing to be carried to the hospital by a relative.
Even when one has made it into the hospital the challenges continue. Chinese hospitals lack nurses and as a result the patient’s relatives must act as care-takers. The hospital also does not provide accommodation for care-takers or relatives. This forces these good people to rent a reclining chair from the hospital and for sleeping in the room. Over the long term this is definitely is a test of endurance for the relatives.
Bribery is also commonplace in the Chinese medical system. Patients who need immediate surgery will try to bribe their doctor. Yet the risk of angering the doctor with a clumsy or obvious bribe is just as bad as not offering a bribe. And for a doctor to reject a bribe may be seen as a refusal of treatment which can also bring great trouble. Thus the corrupt environment has affected the medical professionals themselves.
If the patient has survived all of these hurdles and thinks that their hospital discharge will be swift and easy, they are soon sorely disappointed. The hospital regularly orders a great swathe of tests, normally based on the fact that a routine liver test frequently shows problems (the livers of most patients are like this as a result of the medicines they have been required to take during their treatment). In the end, many tests are done and many medications prescribed, all adding to the burden on the patient. Yet this “burden” could also be relieved by the payment of a well-placed bribe to the appropriate doctor. Without the bribe, one can find that the bill will contain some amazing accounting. For instance, 32 hours of intensive care can be accumulated in just one day or 24 bottles of IV treatment can be consumed in one day when it is impossible to consume more than six a day. Patients often find that they are charged for things they simply did not receive. The hospitals use various excuses to explain away the discrepancies including bill consolidation, computer upgrades and clerical errors. Yet the errors always seem to disadvantage the patient and never the hospital.
Early in 2003 the following story was big news. A patient went to the 3rd People’s General Hospital in Anhui Province for therapy for his back pain. The doctor injected medicine into the lower spine of the patient and the patient promptly fainted. The patient woke up paralyzed after a few hours. The hospital and the relatives soon agreed to compensation of 55,000 yuan. Yet the chief of the hospital noticed that rather than being sad about the incident the relatives were very happy and excited and the chief also noticed that when no-one was looking the paralyzed patient was actually moving his legs!! The group admitted to the extortion attempt. The patient had consumed an herbal “paralysis” drug.
The story doesn't end there, however. After a few months, a reporter went back to the hospital to try to find the doctor involved in the case. Yet the reporter was told that the doctor had run away. This was strange. Why should a doctor in a public hospital need to run away? It turns out that the whole orthopedic department had been rented by external personnel, and the fear of the consequences of the paralysis case made the doctor run away. A little more investigation revealed that a number of departments within the hospital were all under external contracts. These contractors pay a monthly fee to the hospital. The hospital will manage any compensation claims to reduce the damage and then the contractor pays the balance of the compensation.
Neither does the hospital stipulate or enforce that contractors must have a valid license to practice. Those doctors without licenses often make their own medicine without supervision or approval from the drug administration. The paralysis fraudsters had also discovered this cover-up and used this to put pressure on the doctor. It’s impossible to calculate the numbers of hospitals conducting such schemes. Only local people know of these strange occurrences in the hospital but they are forced into silence with the threat of indictment for “disturbing the social order.”
In China, 85 percent of all medicine is sold through the hospital system and the prices charged are generally higher than in the pharmacies. If a patient is covered by the public health system the medicine will be particularly expensive (700 yuan for a common cold prescription). This is a result of the doctors and hospitals receiving something like a sales commission on the medicine. The pharmaceutical company, the hospital and the doctor each receive about a third of the profit and this commission is often the doctor’s main source of income. It is also common to see many “hospital supermarkets” where credit on daily necessities can be exchanged for not picking up the prescribed medicine. Farmers do not have access to these preferential benefits and are unable to pay the soaring charges of medicine. They have to put their faith in doctors who have no medical license and phony medicine. It is estimated that nearly 200,000 people die every year as a result of taking phony medicine. They died from poisoning and infections which “antibiotics” had not cured. Most of these medicines are prescribed by the hospital.
Those who have experience of the strange situation in China’s health care feel distress and hatred. When faced with deep and ever-present corruption, it is difficult for people to believe that anyone with a conscience for right and wrong still exists in the world. The government seems to consent to existence and spread of this corruption while it silences those who speak out with the truth. The same goes for Falun Gong practitioners who believe in “Truthfulness, Compassion and Tolerance” who have become the target of oppression in China. Surely this attack on truth is not what we want to pursue?
Translated from the Chinese edition of The Epoch Times
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