HEALTH CARE PROBLEMS IN CHINA
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. 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.
According to the New Yorker, Health-care costs have risen sharply in recent years, and Chinese patients must navigate a byzantine system of government coverage. Most people have basic insurance, but anything beyond routine care usually requires steep out-of-pocket payments. “The early stages of the coronavirus pandemic brought to light some of the dysfunctions of China’s medical system, including underinvestment in primary-care clinics and overreliance on huge, rigidly bureaucratic urban hospitals. [Source: Jiayang Fan, The New Yorker, March 30, 2020]
Chinese Health Care Overburdened by China’s Huge Population
Siu-wee Lee wrote in the New York Times: China’s health care “system cannot adequately support China’s population of more than one billion people. The major gaps and inequalities threaten to undermine China’s progress, social stability and financial health — creating a serious challenge for President Xi Jinping and the Communist Party.[Source: Siu-wee Lee, New York Times, September 30, 2018]
“The country does not have a functioning primary care system, the first line of defense for illness and injury.China has one general practitioner for every 6,666 people, compared with the international standard of one for every 1,500 to 2,000 people, according to the World Health Organization.
“Hospitals are understaffed and overwhelmed. Specialists are overworked, seeing as many as 200 patients a day. The deficiency in doctors has taken on more urgency as the Chinese government grapples with the mounting health problems of its vast population. Heart disease, strokes, diabetes and chronic lung disease account for 80 percent of deaths in China, according to a World Bank report in 2011.
Mao Qun’an, the spokesman for the National Health and Family Planning Commission, acknowledged that the hospitals could no longer meet the public’s needs. “If you don’t get the grass roots right, then the medical problems in China cannot be solved,” Mr. Mao said. “So what we’re doing now is trying to return to the normal state.”
Inequality of Health Care in China
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. A WHO-sponsored survey ranked China the fourth 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 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. Siu-wee Lee wrote in the New York Times:“While the wealthy have access to the best care in top hospitals with foreign doctors, most people are relegated to overcrowded hospitals. In the countryside, people must rely on village clinics, or travel hundreds of miles to find the closest facility. [Source: Siu-wee Lee, New York Times, September 30, 2018]
According to research published in The Lancet in 2018 China regional disparities for health are among the widest in the world. According to the Financial Times: Just 10 percent of doctors in township healthcare centres, the lowest level of urban provision, have received formal medical training, according to a study in the BMJ in 2018. “China’s relative efficiency in using health resources is decreasing,” it added. State insurance only covers some costs, and coverage varies regionally. Patients in wealthier areas have more generous insurance, intensifying the concentration of medical skills in larger cities because their better insurance means they can afford more expensive treatment. Some patients have no option but to try to fund treatment out of their own pockets. [Source: Tom Hancock and Wang Xueqiao, Financial Times, December 31 2019]
Howard W. French wrote in the New York Times: When Jin Guilian's family took him to a county hospital in this gritty industrial city after a jarring two-day bus ride during which he drifted in and out of consciousness, the doctors took one look at him and said: "How dare you do this to him? This man could die at any moment." The doctors' next question, though, was about money. How much would the patient's family of peasants and migrant workers be able to pay — up front — to care for Mr. Jin's failing heart and a festering arm that had turned black? The relatives scraped together enough money for four days in the hospital. But when Mr. Jin, 36, failed to improve, they were forced to move him to an unheated and scantily equipped clinic on the outskirts of Fuyang where stray dogs wandered the grimy, unlighted halls. In Mr. Jin's case, the best doctors could do was to administer oxygen and an antibiotic drip. But the new locale did have one sure merit: with their savings nearly exhausted, of all the places the Jin family had taken their brother in a 500-mile trek from Guangdong Province, it was the cheapest, costing what for them was still an exorbitant fee of about $15 a day. [Source: Howard W. French, New York Times, January 14, 2006]
Health Care Costs in China
Signing papers at the hospital About 40 percent of China’s healthcare spending is on drugs, a far higher share than in many countries. About a third of healthcare spending falls on individuals. The average cost of a single hospital admission in China is roughly the same as average annual income, a 2008 paper published in The Lancet said. For the lowest fifth of income earners, it is more than twice average annual earnings, the paper said. The WHO believes that the government needs to get back in the health care system in a big way to prevent abuses.
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 central government fell from 36 percent to 17 percent. In the United States the share of health car costs paid for by the central 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.
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.
High Drug Prices in China
According to Reuters: In China's fragmented healthcare sector, a batch of drugs can go through two, even three layers of distributors before ending up at a hospital. It is not uncommon to have a distributor servicing only one hospital. Each distributor takes a cut and pays doctors and advertisers to promote its sales. [Source: Tan Ee Lyn and Hui Li, Reuters, September 16, 2012]
The system dates back to 1950s when Beijing wound back subsidies, allowing hospitals to mark up drug prices to alleviate budget pressure, effectively passing these costs on to patients. Drug distributors then moved into the picture from the 1980s when China opened up its economy, pushing prices even higher.
“Critics say doctors have an incentive to earn commissions on prescribing drugs because by international standards their salaries are low, ranging from 4,000 yuan ($628) to 10,000 yuan ($1,570) a month. "Within this space, salesmen push for sales, offering commissions to doctors if they prescribe more of certain drugs. Prices go up. Hospitals prescribe more expensive drugs because the cuts and the markups from them are higher," said Liao, the Guangdong province health official. "Everyone profits from this big mark-up. Who suffers? The common people. Whoever has to consume the drug suffers."
Problems Created by High Health Care Costs
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.”
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 and doctors to collect profits from the sales of drugs, certain operations and high-tech tests.
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. 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
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 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.
Burden of Health Care Costs on the Poor in China
Howard W. French wrote in the New York Times: “Every year hundreds of millions of rural Chinese face the clash between health and poverty, knowing that if they treat their illnesses they will lack the money needed for marriage, education and, sometimes, food. Even the official Chinese news media are regularly filled with accounts of the desperate choices people are forced to make over health care, of brothers who must draw lots to see whose serious disease will be treated because their family cannot afford to treat both, or of a father who sells a kidney to treat an ill son. "There's basically no safety net at all for medical care in the village I live in," said Yang Yunbiao, a worker with a Chinese independent organization in Fuyang that aids poor sick people. "Our village has a lot of aged people with disease who are unable to get treatment, just staying at home in bed with barely enough to eat. They are shut in and can't work, and their disease and poverty have taken away their dignity." [Source: Howard W. French, New York Times, January 14, 2006]
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. 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.
Chinese Patients in Desperate Straights
Reuters reported: “One Chinese struggling to meet medical bills is Xu Shiding, who needs weekly injections that each cost more than 1,300 yuan ($210) to control chronic hepatitis C. The gold miner in China's northwestern region of Xinjiang has to pay out of his own pocket for one or two injections each month. He has state health insurance, but his cover is limited. With monthly income of 2,600 yuan, he has been forced to borrow money from his family, he said. "I have even become a boyfriend of a wealthy married woman," said Xu, sobbing at times, as he alluded to how he needs his mistress's financial support to pay for his treatment. Left untreated, such patients may end up with liver cirrhosis and even cancer. [Source: Tan Ee Lyn and Hui Li, Reuters, September 16, 2012]
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. 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.
Lack of Health Care Can Shape the Entire Life of Poor Chinese
Howard W. French wrote in the New York Times: “The story of Jin Guilian, the migrant worker with heart problems who was taken home to Anhui Province by his family from Guangdong, 500 miles to the south, displays all of those weaknesses in the public health system and more. Seeking employment, Mr. Jin set out from his village in Anhui, one of eastern China's poorest provinces, when he was in his early 20's. Living with an uncle in Heilongjiang Province in the far northeast, he collapsed one day while hauling wood. He was taken to a hospital but left without treatment for lack of financial means. [Source: Howard W. French, New York Times, January 14, 2006]
“That was the first of several incidents pointing to what doctors eventually diagnosed as congenital heart disease, a condition that has gone untreated. Some doctors have urged his brothers to arrange valve surgery, which they say would cost about $10,000, in a big city like Shanghai. Ever desperate for work, Mr. Jin later made his way to Shantou, a city in Guangdong, not far from Hong Kong. There he got a job working as an orderly in a large hospital for about $6 a day. From those meager earnings, about $30 a month had to be paid to the hospital for the privilege of holding the job.
“It was at the Shantou hospital that Mr. Jin recently fell gravely ill. But as "just a migrant laborer," he said from his bed in the Fuyang clinic, he was denied treatment by his employer of 10 years. "Although I worked there, I knew that I'd have to pay a deposit to get treated," he said. Unable to afford that, he left the hospital for a neighborhood clinic, where he was put on a simple saline drip. He summoned his family, and when they saw him, visibly weak and with his blackened arm, they decided that his chances would be better if he returned home. Asked whether he regretted not having his brother treated earlier, Jin Guixiu, another brother of the patient, grew emotional. "How can I not regret, but what good would that do?" he said. "For villagers the problem is not enough money. This is my brother, and if I had enough money of course I would treat him."
Bad Medicine, Contaminated Transfusions
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 July 2018, hundreds of thousands of children were found to have been injected with faulty vaccines.
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 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.
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.
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.
Last updated September 2022