Is it easy or difficult to see a doctor in China?
By: Zhou Yu
Tags: Policy, China, Health

Novel coronavirus caused a terrible epidemic to sweep the world. In the face of the epidemic situation, we can see that different countries have taken different anti-epidemic measures, and whether it is “external loosening internal tight”, “internal loosening and external tightening” or “Chinese style”, different effects have been achieved and different evaluation has been obtained.

The reason is that the geographical environment, demographic structure, economic situation, government capacity, and health care system of each country are not the same. If the same “anti-epidemic” measures can not be adapted to local conditions, the best results can not be obtained. There is no doubt that under China’s “tight inside and outside” model, the epidemic in this populous country has been suppressed rapidly. This makes many people wonder: how did China, which appeared to be in a hurry at the beginning of the novel coronavirus outbreak, now hand over a “qualified” answer? Is China’s medical ability strong or weak?

How do we see a doctor in China?

If you suffer from the slow access process, old hospital equipment and dull health care workers in welfare countries such as Canada, you may feel efficient and brand new hospitals in China and cheer them up; if you suffer from the high price bills and expensive health care costs of American hospitals, you will also exclaim, “Chinese hospitals are really cheap.”

In short, China is a comprehensive product of the “welfare care” system and the “commercial medical system”. Compared with Canada, China has more and better private hospitals and doctors; compared with the United States, China has more extensive and cheaper social health care, as well as a large number of public hospitals. To some extent, China has the benefits of both systems. (however, as we will mention below, this benefit is clearly costly.)

In China, the experience of medical treatment is relatively free: China has the infrastructure to implement hierarchical health care, but there is no system of compulsory hierarchical health care, which means that you can enjoy the services of family doctors and community doctors, but you can also go directly to the hospital clinic. In addition, China has community hospitals that facilitate the handling of chronic and minor diseases (they also assume the responsibility of pharmacies), as well as a more dense distribution of commercial pharmacies to facilitate the purchase of over-the-counter drugs by residents.

If you don’t bother to go to a hospital, you can also look for free or paid online medical counseling on the developed Internet. Because there are more medical options, the Chinese prefer to visit specialists or experts in specialized hospitals and departments rather than North American residents who usually have to go straight to comprehensive doctors.

If you don’t know what department you should register in, you can ask at the clinic of the Chinese hospital. In fact, most young Chinese no longer specialize in registering in hospitals (which may make you have to wait in line), but “never leave home” with as many as dozens of online services. If you can’t use the Internet, you can also use machine self-registration in the hospital lobby. There are a variety of channels for registration so that Chinese people are less likely to queue up because of registration.

The Chinese can easily make an appointment for registration on Wechat.

Note, however, that the need to register does not mean that you do not have to wait in line to see a doctor. Because many Chinese are willing to choose better hospitals, departments, and experts, some patients face serious queuing problems-for example, if you want to have a test or operation in the best hospital in China, you may have to wait for months. At the same time, if you just want to do the test or surgery and don’t care about hospital rankings, you’re more likely to be able to do it in a day. With regard to the uneven distribution of medical resources in China, we will discuss it below.

Nearly 1.4 billion people in China have taken part in social health insurance. When you see a doctor, in order to get Medicare reimbursement, you need to use a special health care card. If you forget to bring a health care card, depending on the region and the hospital, sometimes patients can provide ID numbers to access the health care system, sometimes it will be difficult. By the way, depending on whether patients use health insurance and the proportion of reimbursement, Chinese doctors tend to recommend very different drugs or treatments. We will also discuss this issue in depth below.

Taken together, the number of public hospitals in China is larger than that of private hospitals, and the size of public hospitals is larger and the number of beds is large. Of course, this is also related to the population of China, where the largest hospital in North America can have two or three thousand beds, which is only the same number of a medium-size hospital in China, and the largest public hospital in China tends to have tens of thousands of beds. The large scale of public hospitals and a large number of medical and nursing staff in public hospitals are one of the guarantees of China’s “anti-epidemic” ability.

As for private hospitals, this is a more complex problem in China. China lacks particularly good and expensive private doctors, and wealthy Chinese do not have the habit of visiting private doctors. However, there is no shortage of excellent and expensive private hospitals and clinics in China. But note that China also has a large number of expensive but poor private hospitals, some of which may even be suspected of breaking the law, such as attracting patients through false advertising. These poor private hospitals are one of the chronic problems of China’s health care system.

On the whole, what is the level of medical care in China?

According to two papers published in the Lancet, we can take a look at the effectiveness of China’s health care system. (《Healthcare Access and Quality Index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990–2015: a novel analysis from the global burden of Disease Study 2015》《Measuring performance on the Healthcare Access and QualityIndex for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016》)

The main objective of medical care is to ensure the safety of the people as much as possible. However, if the safety of life is measured only in terms of life expectancy, the direct impact on life expectancy is more significant than that of the health care system, such as the adequacy of nutrition, the availability of clean water and air, and so on. Therefore, the key index to measure the quality of the health care system should be “disease treatment”, not “disease-free health”.

Based on this logic, the researchers listed 32 diseases that could be fatal but could also be cured at a lower cost, calculated the mortality of patients with these “common diseases” and came up with a comprehensive indicator called “HAQ” (Healthcare Access and Quality Index). The greater the HAQ, the lower the likelihood of death from common diseases, indicating the higher the coverage and level of medical services in the country.

In the recent novel coronavirus epidemic, Italy has had a huge disaster, the mortality rate is even higher than in some less developed areas-and novel coronavirus’s mortality rate in Italy is unusually high, in fact, because of the serious aging of the Italian population, it is blatant that “Italy’s low level of medical care” is clearly unscientific. Although the publication of the paper is fashionable and there is no epidemic in novel coronavirus, HAQ is also in line with this principle-the illness and death of the elderly can not generally be used to prove that the health care system is backward. Therefore, HAQ combined the age structure of the patients and included them in the index calculation.

So, what is China’s ability to “cure diseases”? In 2016, China ranked 47th out of 195 countries and regions. This ranking is, of course, not high. In fact, if 195 countries and regions are divided into 10 grades, China is only at the third level, lower than most developed countries in Europe and the United States (Taiwan Province of China is in the second place).

But taking into account economic capacity, which best reflects the overall level of development of the country, China’s HAQ is very high. In 2016, China’s HAQ ranked 47th, the per capita GDP ranking was only 73rd in the world, and it is not very prominent among developing countries. It can be seen that the level of medical development in China is higher than the overall development level of its country.

The researchers also took into account income and education levels. Combined with these two considerations, the level of health care in China is still significantly better than its income and education. Among countries with similar incomes and education levels, China has the highest level of health care.

In addition, if we look at the problem from the perspective of development, China is still one of the countries with the fastest progress in medical services in the world. In 1990, if divided by 10 grades, China’s HAQ was the third-lowest in the world; 26 years later, China had reached the third level of positive numbers and made rapid progress.

If the level of health care is more rough, according to the World Health Organization, China’s life expectancy ranks 53rd in 2019, while China’s GDP per capita reached the $10000 mark in 2019, but ended up at 72nd place. It can be seen that the “safety of life” of the Chinese people takes precedence over the overall level of development of China.

China still needs development and better medical conditions; but as far as the status quo is concerned, there is no need for the Chinese to worry too much about the level of public health services.

However, there are still problems in medical care in China.

However, the Chinese still face some problems when they see a doctor. Although the absolute medical ability is not very poor, as far as the “medical experience” is concerned, China is far from “perfect”.

This aspect is reflected in the price of medical services. To be fair, the price of medicine in China is still at the level of developing countries, which is not very expensive. Especially compared with countries with extremely expensive medical care, such as the United States, the problem of medical burden in China is not very prominent, both civilian and financial.

China, however, has one thing in common with the United States: there is no universal health care system. This means that before the Chinese go to the hospital, they always quietly calculate an “economic account”.

The Chinese will experience several different medical experiences, depending on what kind of health insurance he participates in and where he lives. By the end of 2019, the number of people insured for basic medical insurance for urban workers in China was 329 million, while the number of people insured for basic medical insurance for urban residents in China was 1.025 billion at the end of 2019, according to the National Bureau of Statistics of China. The latter was unified in 2016 by the combination of health insurance for urban residents and health insurance for rural residents, which is lower than the basic medical insurance for urban workers. This means that while 1 billion people in China enjoy social health care, the other 300m people enjoy better health care.

In addition, having the same health insurance does not mean having the same health care. If you are lucky enough to be a resident of Beijing and Shanghai and have a local account, you have almost part of the world’s top medical resources. Chinese people living in municipalities directly under the Central Government and most provincial capitals or other developed cities usually do not worry about health care.

But if you don’t live in a big city, then when you, unfortunately, suffer from a disease in which the hospital in the city cannot be treated, or can only be treated conservatively (because of the geographical imbalance in the distribution of medical resources), you will face the problem of “seeking medical treatment in different places.” When seeking medical treatment in different places, the specific situation is very complex and changeable because of the different health care policies of each province and city, but on the whole, patients need to issue local referrals according to the regulations, which generally means that patients can only be recommended for referrals if they are really difficult to treat locally. If not recommended, health care usually does not take effect, which means that patients have to bear the medical expenses at their own expense.

In addition to residence registration restrictions, there are a number of issues that need to be paid special attention to when seeking medical treatment in China.

Perhaps the most concerned medical “systemic” problem in China is Chinese herbal medicine. As a treatment that lacks modern scientific evidence, traditional Chinese medicine and Chinese herbal medicine not only still have a very deep mass foundation in China, but also recommended by the government as a “worth trying” treatment. Although young Chinese with modern science education are skeptical about this, specialized traditional Chinese medicine hospitals are not only located in major cities in China but also often prescribe herbal or proprietary Chinese medicines to patients even non-traditional Chinese medicine hospitals.

Image byPexels from Pixabay

The problem of traditional Chinese medicine is not only a medical problem but also not only a scientific problem, but it also involves very complex social, economic, cultural and even political factors, this paper only discusses too much.

In addition, because the top medical resources are concentrated in Beijing, Shanghai, Guangzhou, and other super cities, the “queuing” phenomenon of a small number of hospitals, departments, and top experts has become a common pain for locals and outsiders. One of my friends registered at a famous hospital in Beijing in late 2018 and asked a dental expert to treat him, and the queuing system showed that he would not see the expert until the spring of 2019.

This kind of queue for months is exaggerating, but it is more common for a few hours or even a day or two. Local people still do this, and people who seek medical treatment in different places, especially those who seek temporary treatment, will have to face a worse situation. In several famous children’s hospitals in Beijing, we can often see parents who queue up all night to register. Due to the huge population of China and the extreme shortage of pediatric resources, many parents come to see their children overnight from other places. Because of the queue, they often have to spend the night in the hospital hallway.

Attacking doctors may be the most famous strange phenomenon in China. In China, some patients or their families are not satisfied with the treatment results, so they abuse or even attack doctors, there is no shortage of malignant criminal cases that lead to serious injuries and even death of doctors. There are many reasons for the attack on doctors, which some attribute to the fact that Chinese hospitals do not have a hierarchical health care system, and that patients can easily come to the doctor with an impure purpose-by contrast, it is very difficult for attackers to find a doctor in Canada, which does not even have an outpatient clinic.

On the other hand, Chinese doctors work hard, but their income is not very high, which has forced some doctors to “overprescribe drugs”: recommend expensive or excessive drugs to patients to find profits in their hospitals-doctors earn more only when hospitals make more money. Similar problems have intensified the contradiction between doctors and patients. On the other hand, due to the rapid development of China, many patients, and their families experienced a period of new China’s founding and poor education when they were young, and their lack of understanding of modern medicine also lacked rational thinking habits, which also led them to mistakenly blame doctors, especially when some elderly people were unable to help them.

In addition, China’s health care policy always affects the way hospitals operate. Since drugs that are not covered by health care are difficult to attract, the choice of drugs to be covered will directly affect the tendency of doctors to prescribe drugs. Because the Chinese government strongly recommends Chinese herbal medicine and uses policies to make medical insurance strongly support traditional Chinese medicine, Chinese doctors are often forced to recommend traditional Chinese medicine to patients. In addition, because the financial expenditure on medical care has been very tight, different hospitals can enjoy different medical insurance reimbursement ceilings, often lead to insufficient reimbursement amount, some hospitals are forced to use extreme treatment, and even persuade patients to withdraw from the hospital and so on.

At the end of all the problems, because China is a populous country and also faces aging problems, China’s public health spending has always been under great pressure. But for a variety of reasons, the Chinese government is trying to cut public spending on health care, which could make it more expensive or face more uncertain treatment and treatment quality in China in the future. The Chinese are well aware that by then, the gap in public health services between large cities and ordinary cities and rural areas is likely to widen.

The sudden outbreak of novel coronavirus has led Chinese residents and the Chinese government to pay unprecedented attention to public health issues, which may be a good phenomenon. As Chinese public opinion increasingly affects the government’s decision-making, the government’s determination to increase medical spending may come with the novel coronavirus epidemic, especially with regard to the increase in public hospitals and doctors’ wages. For most Chinese residents, this can also be regarded as a “blessing because of misfortune.”