Chinese health care is plagued by corruption, fake medicine, bogus doctors and astronomical costs. Problems are particularly bad at rural hospitals and clinics, which are often dirty and short of supplies. Many village "doctors" only have a junior high school education, a few months of vocational medical training, and treat patients with knives and pliers.

Chinese complain of of soaring medical fees, a lack of access to affordable medical services, poor doctor-patient relationship and low medical insurance coverage. The Chinese system is also weighed down by excessive bureaucracy and inefficiency. In August 2010, the New York Times reported on growing violence against doctors in the northeastern city of Shenyang.

There is a big difference in the health care provided to the well off and that provided to the poor. Beijing University People’s Hospital, one of the best in China, has computerized charts, the latest scanners, quality doctors and deluxe suites for the wealthy while clinics in rural areas and poor urban neighborhoods are often understaffed and poor equipped.

According to a 1995 Ministry of Health report, 2.5 million people died after taking the wrong medicine in Chinese hospitals. In some hospitals the infant mortality exceeds 70 percent and the only piece of modern equipment is a karaoke machine. Doctors and staff routinely smoke and spit in the hallway floors. In Chengdu a patient found a spider crawling around in his IV bottle.

In April 2009, it was revealed that 64 people had been infected with hepatitis C after receiving transfusions at a county hospital in Guizhou Province with blood tainted by a single donor who sold his blood between 1998 and 2002.

Patients are advised to avoid transfusions. The blood supply is not safe. Donors are scarce and the system relies on people who sell their blood, Testing practices are often dubious and people are routinely given blood with hepatitis B or C. In Henan Province thousands of people became infected with HIV and AIDS after being given tainted blood. The going price for blood "guaranteed" to be clean is around $400.

In April 2007, one person died and more than 200 became sick after eating food that had been contaminated with rat poison at a restaurant at the Heilongjiang Provincial Hospital of Traditional Medicine. The victims, which included patients and staff, all ate porridge for breakfast. Investigators suspect the water used to make the porridge was contaminated with poison.

In 2007, a group of reporters submitted tea for their urine samples in several hospitals in Hangzhou in rich coastal Zhejiang Province to see what would happen. The result: six out of 10 hospitals concluded reporters had urinal tract infections and five of 10 prescribed expensive medicine.

In October 2008, nine hospital officials were fired from a hospital in Xian after eight babies died there in 11 days from a hospital-acquired infection. The deaths were not revealed for 10 days.

Health Care Costs in China

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Signing papers at the hospital
In modern China the wealthy have access to better health care while the poor are not even admitted to hospitals unless they can fork over money up front and are taken advantage of by bogus doctors and pharmacists that give them fake medicines. When they do receive good care they are bankrupted by the hospital bills because they don’t have insurance.

A WHO-sponsored survey ranked China the forth worst country in the world in its term of fairness in the allocation of its medical resources. According to the report, “Most of the medical needs of society cannot be met because of economic reasons. Poor people cannot even enjoy the most basic health care.” The problem is becoming an important political issue in China, with sharp criticism even coming from the government itself.

In recent years, the government has been offering less free services and trying to get people to pay for more of their medical costs as a way of weaning the masses off the Iron Rice Bowl. In the Mao era the government footed much the bill for health car costs. From 1980 to 2004,the share of health car costs paid for by the cental government fell from 36 percent to 17 percent. In the United States the share of health car costs paid for by the cental government is 44 percent. In other developed countries it is as high as 70 percent

Doctors and hospitals survive off money collected from patients. Pharmacies have become the cash cows for hospitals, providing them with up to 90 percent of revenues are encouraging doctors to overprescribe drugs. Today about 50 percent of health care spending is on drugs compared to around 15 percent in most developed nations.

The WHO believes that the government needs to get back in the health care system in a big way to prevent abuses.

Problems Created by High Health Care Costs

Because the government controls prices for medical services many public hospitals and doctors rely on profits from the sale of drugs and expensive tests and treatments to recover their operating expenses. Patients are routinely forced to take tests, undergo procedures and buy drugs they don’t need by hospitals and doctors anxious to make profits. In many cases these practice are the product of the state’s continued policy of regulating fees for basic services but allowing hospitals ands doctors to collect profits from the sales of drugs, certain operations and high-tech tests.

One person wrote on an Internet chat line that doctors in one clinic delivered 95 percent of the babies by Caesarean section to make more money (regulations prevent clinics from charging high fees for natural births). Nationwide the figure is about 50 percent, with 70 percent not unusual for some regions. Before 1979 only around 10 percent of births were by Caesarian section.

Medical costs have risen sharply---tripling between 1990 to 2004---as people have lost their jobs and their iron rice bowl supports. Often people who can't pay are denied medical care. One study found that in 1993 ten percent of patients in small towns did not seek medical treatment because of the cost. In 1998 the number quadrupled to 42 percent.

The vast majority of Chinese cannot afford to see a doctor. According to study by the United States Census Bureau, 700 million rural Chinese can't afford adequate health care. According to one survey 41 percent of sick peasants refused to get medical care because they couldn't afford it. One Beijing resident told the Washington Post, “We go to clinics for colds, but we don’t trust the doctors because they are all paid by the drug companies and so they over-prescribe. So most Chinese people, if they don’t feel really sick, do home treatments and try to cure themselves.”

Studies have shown that medical costs are the primary reason people fall into dept and poverty in China. The problem is particularly acute in the countryside where people have no health care benefits and have to pay up front for service. An injury or serious illness can mean bankruptcy.

There have been cases of doctors demanding money up front before they perform a C section. The Times of London described one man who paid $288 to have his daughter treated for an ear infection at a Beijing hospital and 6-year-old boy scalded by boiling water who died of his injuries after being turned away from a hospital in Xinjiang because his parents couldn’t afford the $2,700 deposit demanded by the doctors for treatment.

On man with bad heart who underwent two operations to implant stents at a cost of $15,000 told the Washington Post, “I’m retired and have a little pension every months So I cannot afford the treatment fee at all.” He said he was lucky to have children that were able to help him foot the bill. “Without them I don’t think I could have had the operation,” he said.

Health Care Costs and the Poor in China

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In poor areas up to 80 percent of those who need medical help do not seek it because they can’t afford it. Parents tell their children to protect themselves against the cold not because they are particularly worried about their health but because they don’t want to pay for medicine and a doctor if they get sick. One rural resident told the Times of London, “We almost don’t dare go to the hospital. No matter what disease it is, no matter if it’s necessary, doctors are bound to ask you to undergo a complete check up. How can normal people afford that?”

Nearly a third of the poor say that health is the most important cause of their poverty, according to the World Health Organization. “People are paying too much out of pocket for their services for their health care. Many are becoming impoverished in the process,” John Langenbrunner, a World Bank health economist in Beijing, told AP. “The level of dissatisfaction, at the local level, is very high.”[Source: Gillian Wong, AP, Washington Post, November 30, 2009]

Many poor people in need of medical care don't seek care until it is too late, while others resort to risky measures. A national health survey in 2008 found that about 70 percent of people forgo recommended hospitalization because they cannot afford it.

At hospitals peasants have to pay $25 just to be looked at. That is a lot of money for someone who earns $100 or less a month. Hospitals often demand a large deposit before they see peasants or workers with serious injuries. A construction worker with a leg smashed by bulldozer went a hospital and was told his leg needed t be amputated but the hospital would not admit him until be produced $600 in cash.

Villagers often have to borrow from relatives to pay for medical bills. It is not unusual for all the families in village to fork over a healthy chunk of their saving to help pay for the treatment of a very sick child in their village. It is also not unusual for a poor family to go into debt and lose their entire yearly income on one visit to the hospital. One newspaper described a mother seriously ill with cancer who decided not to have a $500 series of cancer chemotherapy treatments so she could pay the $250 fee to send her two children to school.

Many people in rural areas die at home because they can not afford to go to the hospital. According or Farmers Daily, "When poor farmers who absolutely can't afford to see a doctor get sick, all they can do is lie in bed. If they get something serious, they suffer and weaken."

In some places cancer patients are given poor treatment because the hospital doesn’t want to waste time and money on someone who has little money and they feel is going to die anyway. Poor treatments are also given to poor expectant mothers and their babies. In some poor areas, infant morality rates have risen to 72 per 1,000.

In March 2007, the Chinese government announced it would increase subsidies for medical aid in the countryside by around $1.2 billion, almost double the 2006 figure, in part to offset increases in the prices of drugs and medical services

Chinese Patients in Desperate Straights

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Almost one out of every eight Chinese households was racked by catastrophic health expenses in 2011, according to a paper recently published in the medical journal The Lancet. Gillian Wong of AP wrote: “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.” [Source: Gillian Wong, AP, Washington Post, November 30, 2009]

Ji parents ended up spending 160,000 yuan ($23,400) to treat her for a rare neurological disorder that paralyzed her from the neck down. Most of the money came from friends and family to supplement the family's meager savings from farming and the father's 1,000 yuan ($150) monthly salary as an elementary school teacher. “If not for the help from the loans and donations we received, I don't think my daughter would be alive today,” her mother told AP. [Ibid]

Ji has since recovered partial use of her limbs and no longer needs a ventilator to breathe. Her mother massaged her thin arms and legs as part of a daily physiotherapy routine. Scribbled in white chalk all over the living room's concrete walls were the names and phone numbers of people who had helped. [Ibid]

In Beijing, Wei Qiang told AP he and nearly a dozen other migrant workers pooled their money for secondhand kidney dialysis machines and treated themselves in a dirty suburban apartment when they started running out of money for hospital treatment. [Ibid]

Malpractice in China

Malpractice is a serious problem in China. People routinely die from being given the wrong medicine or botched treatment. Newspapers have reported cases of people with toothaches dying from overdoses of anesthesia; prematurely born twins being tossed in the garbage; and women having their ovaries removed when they supposed to be getting an appendectomy. In some places hospitals are called “execution grounds” and doctors are called “wolves in white coats.”

One Chinese man told the Los Angeles Times his son died from an asthma attack after he was taken to a hospital where he was denied medicine, tied up, forced to breath oxygen and then left alone to die while the medical staff left to have lunch. A Chinese woman said her mother died after high volumes of fluid were taken from her body as part of her cancer treatment but no blood serum was given to replenish the lost fluids.

One young man who accidently sat on some scissors went to clinic for treatment. Even the wounds were not that serious, his doctors insisted that he needed surgery. During the botched operation, doctors punctured an artery in his leg and large blood transfusions were necessary to keep him alive.

There are no medical malpractice laws in China. Victims of negligence and poor medical care can sue hospitals and health care agencies but the suits are hard to win. Victims have few legal recourse. Those that try to sue for negligence often face so many obstacles they give up. To successfully sue for malpractice the plaintiff needs support from the local national health bureau, which invariably takes the side of the doctors and the hospitals.

Victims of malpractice are often forced to take the law into their own hands. In 2006 at the Shanxia hospital in Shenzhen, hospital workers hired bat-wielded, helmeted guards to protect them from family members of a man who was brought to the hospital with a fracture and died 17 days later from a heart attack.

Hospital Protests and Hired Thugs in China

Barbara Demick wrote in the Los Angeles Times, Often victims of malpractice or negligence have little recourse “but to protest or petition “an archaic process that involves going to Beijing to file grievances with higher authorities. There have also been numerous nonviolent demonstrations at hospitals, where families “or their representatives “dress themselves in the traditional Chinese mourning color of white and scatter fake paper money, an offering to the deceased in the afterlife.

In one week in August alone, “two major hospital protests were reported in addition to the one in Nanchang. The family of a 29-year-old man who died of stomach cancer in the eastern city of Nanjing picketed the hospital, claiming he hadn't been properly diagnosed and that they were threatened when they questioned his treatment. In a public hospital in Guangdong, in the south, women staged a sit-in, wailing, screaming and refusing to leave, according to news reports.

The month before a man who claimed to be a professional protester in Nanchang gave a newspaper interview in which he said that the local government usually chose to pay to quiet the protesters, "for the sake of social stability." "I always tell my clients, if you start a big disturbance, you'll get a bigger compensation package. If you start a smaller disturbance, you'll get a smaller package. And if you don't do anything, you'll get nothing," the man, identified as 42-year-old Xiao Ming, was quoted as saying.

The Chinese government is getting tougher on hospital protesters. Last week, a court in the northeastern city of Qingdao handed down what was reported to be the first prison sentence in such a case, sending a man to jail for 18 months for staging a riot at a hospital after the death of his father in January.

Hospital Violence in China

n Nanchang, a provincial capital 300 miles southwest of Shanghai, a young doctor reportedly suffered a serious head injury in June 2011 after the family of a deceased patient led a protest that turned violent. In 2010 a doctor and nurse were stabbed to death in the eastern province of Shandong by the son of a man who had died 13 years earlier of liver cancer, while a pediatrician was badly injured jumping from a fifth-floor window to escape relatives of a baby who had died.

Barbara Demick wrote in the Los Angeles Times, “IMedical personnel advocates complain that the more violent incidents are staged by hired thugs, paid by families of the deceased in hopes of winning compensation from the hospitals. Sometimes the protesters are from the same village or are semi-professionals in causing trouble. The Chinese have even coined a word for the paid protesters: yinao, meaning "medical disturbance." [Source: Barbara Demick, Los Angeles Times LA Times August 25, 2011]

"It has become a very sophisticated system for chasing profits. Whenever somebody dies in a hospital, the yinao will get in touch with the family and offer their services in exchange for 30 percent to 40 percent," said Liu Di, who is setting up a social network for medical professionals. Liu said the practice arose in the last few years as hospitals became more commercialized. "You see this mostly in second- or third-tier cities where the legal system is less developed."

Zhang Yuanxin, an Urumqi-based plaintiffs' lawyer, said it was difficult to sue for medical malpractice, even in the most egregious cases, and that tempted people to take matters into their own hands. "This is the direct result of the lack of rule of law and the lack of a well-established social welfare system," Zhang said. "Conflicts like these are inevitable and there will be many more if people can't solve their problems through the law."

Hospital in Nanchang Fends off Angry Mob

Reporting from Beijing, Barbara Demick wrote in the Los Angeles Times, “Friends and relatives of a patient who died on the operating table marched on Nanchang Hospital No. 1 brandishing pitchforks and clubs. About 100 staff members, among them young doctors, prepared for the onslaught by arming themselves with long sticks and cans of mace, while the security guards donned police vests and helmets. What followed was a pitched battle in the lobby atrium with horrified patients gawking from the floors above. Although nobody was seriously injured, the incident brought attention to a wave of violence in Chinese public hospitals. [Source: Barbara Demick, Los Angeles Times LA Times August 25, 2011]

In the incident in Nanchang, hospital staff members learned that a mob of about 100 people was heading their way with crude weapons and took it upon themselves to mount a defense. Photographs and video posted on a local website showed men in white coats, apparently doctors, and T-shirted security guards brandishing what looked like oversize baseball bats.

"A lot of the young doctors and hospital security guards couldn't stand it anymore and decided to pick up sticks and defend themselves," a doctor from another Nanchang hospital, who gave his name as Lao Tang, wrote on his social networking site. "My fellow comrades, we fully support you! Well done!"

Fixing Health Care Problems in China

China is trying to fix its health care system.The government's goals include: 1) Improve health services, in part by building 2,000 county hospitals and 29,000 township hospitals and ensuring that each of the country's nearly 700,000 villages has a clinic; 2) expand 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; 3) reduce drug costs by controlling prices for medications deemed essential; and 4) in the longer term, seek ways to cut back on unnecessary treatment and drug prescriptions that are blamed for skyrocketing fees at public hospitals. [Source: Gillian Wong, AP, Washington Post, November 30, 2009]

The plan also aims to improve health centers in rural and remote areas as well as equalize health services between urban and rural areas, Xinhua reported. Furthermore, the government would begin this year to reform the operations of public hospitals.

“In a country with 1.3 billion people, to achieve the goal of health for all is by no means an easy job,” Chinese Health Minister Chen Zhu wrote in The Lancet, a British medical journal, “However, we are determined to transform these challenges into opportunities.”

Some say the answer to China’s health care problems is private spending and investments. Gordon G. Liu, a professor of economics at Beijing University’s Guanghua School of Management, told the Washington Post that by letting people with money spend more on care would create more incentives for doctors to work harder and attract more talented people into the medical profession. Poor people would benefit as the system as a whole improves. Others say this approach would only widen the gap between the care given the rich and the poor and leave the poor neglected as doctors seek out wealthy patients.

The government has set up a number of pilot programs with some allowing doctors to work at community or for-profit clinics without losing their jobs and others to work at hospitals where doctor salaries and medical fees are fixed and carefully studying the results with cost-benefit analysis.

Liu, who taught at the University of North Carolina, told the Washington Post: “It’s very interesting to see politics in China. Sometimes they are very old-fashion and sometimes so liberal, even more than in the U.S. Thus it said “since you guys are debating, lets do an experiment and see which way works better.” I tell my colleagues that what you’re doing is very consistent with your “scientific development philosophy” rather than being like a dictator telling us what to do like in the past.”

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. Bai Zhongen, chairman of the economics department at Tsinghua University’s School of Economics and Management in Beijing, told the New York Times said the school did a survey in 2007 about the effect of rural health insurance on consumer behavior and found that in government-sponsored health insurance areas, people are spending more. [Source: Edward Wong, New York Times, January 21, 2009]

Health Care Reforms in China

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Health insurance card
Over the past couple of decades China’s subsidized system of socialized medicine has been dismantled and replaced with a privatized system that is expected to pay for itself. Financial responsibility has been handed over to local and provincial governments and hospitals and doctors themselves who have to rely more heavily than they did before on fees collected from patients. In areas where people have money, namely the cities, the health care services are reasonably good, but in rural areas, where people often can’t afford to pay their medical bills, the health care is very poor.

To improve efficiency hospital staffs are being cut, unqualified doctors are being fired and patients are being charged more money. Most hospitals are having a hard time trimming their bloated unqualified staffs even there are laws on the books that require doctors without proper degrees to be transferred to low-level jobs.

In the cities hospitals and doctors are becoming more competitive. At some Shanghai hospitals, patients can chose the doctor who treats them. Posters with the doctor' names, photographs, specialties and resumes are posted on the walls. Popular doctors are awarded with more business while unpopular ones are transferred or laid off.

Responding to criticism about the high cost of medical care the Chinese government is making an effort to reestablish rural medical cooperatives and set limits on what medical facilities can charge for drugs. It has also promised to boost spending in public health, especially in the countryside. One benificiary, retired farmer Shi Xiulan, 56, told AP at at a clinic in the village of Xihu in Ningxia. “It's so convenient. I don't have to travel far to see the doctor, and it's affordable,” She spends 1 yuan for diabetes and high blood pressure medications, instead of the 300 yuan she used to fork out at the county hospital. “Peasants like us usually have no money for medicine.”

China is pumping $124 billion in health care over three years from 2009 to 2011 to bring health coverage to all 1.3 billion Chinese, make health care more affordable and improve the system.

In August 2009, as part of its program to make health care more affordable, the Chinese government issued of list of more than 300 commonly-used medicines to be sold at controlled prices. In April 2009 the government announced plans to build thousands of new hospitals and put a clinic in every village. China also has an ambitious plan to create a community hospital system. To staff such a system its needs 165,000 doctors.

Implementing Health Care Reforms in China

Sixty percent of the funding is supposed to come from regional governments, and it's 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 may make it difficult to pinpoint what works, said Langenbrunner of the World Bank. [Source: Gillian Wong, AP, Washington Post, November 30, 2009]

“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,” William Hsiao, a China health policy expert at Harvard University, told AP. [Ibid]

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 30 yuan ($4.40) a year to join a rural cooperative insurance program that allows them to see a village doctor for 30 common illnesses including colds, bronchitis and diarrhea for only one yuan, including medication. [Ibid]

Among the problems with the system, Hsiao, the Harvard expert, told AP is 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. [Source: Gillian Wong, AP, Washington Post, November 30, 2009]

“I don't feel like doing this anymore,” said Ji Caixia, a 56-year-old doctor in Lijiajuan, a village of rice and corn farms in northern Ningxia, told AP. “Even the farmers can earn about 80 yuan a day when they do work in the city. I can't earn any money. No one will want to do this work since the money is so little.” [Ibid]

Image Sources:

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Yomiuri Shimbun, The Guardian, National Geographic, The New Yorker, Time, Newsweek, Reuters, AP, Lonely Planet Guides, Compton’s Encyclopedia and various books and other publications.

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© 2008 Jeffrey Hays

Last updated November 2012

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