Yesterday, we looked at some of the banking problems in China. Today we are going to start to see a trend; institutions in China are poorly connected at best. This affects hospitals abilities to effectively treat diseases, and provide responsible treatments.
Before we start it is important to understand that China does not have family doctors, almost all of the treatment is provided in a hospital or a small clinic.
I’ve learned a lot working in a large Chinese hospital. There is no question that China’s medical facilities have improved hugely over the past thirty years. Many of the hospitals have modern equipment and well-trained doctors. The stumbling blocks we’ll be looking at today are caused by the system, and not by individuals (this article is looking at hospitals in major cities, there are far more problems in the countryside).
It starts with medical records. Each individual is responsible for keeping their test results and for making their own medical history. Because of this system, if you were in an accident while in a different city (or just a different part of your city) the new hospital would have zero access to your information. This also makes it difficult to identify epidemics, because records are so limited.
Another major challenge is unavoidable in some ways; there are too many patients and too few doctors. This huge flow of patients is only made worse by the fact that seeing a doctor is too cheap. I can see a doctor in the emergency room for the same price as a plate of fried rice in the cheapest restaurants. This means that patients show up at the first sign of a minor cold, which takes time away from seriously ill people.
My hospital serves over one million patients each year, meaning that doctors only have about 5 minutes to try to diagnose and treat each person. I have heard this complaint from the ER doctors more times than I can count.
The problem gets worse because patients demand antibiotics (usually the strongest available), and the doctors don’t have time to explain that this is useless for a viral cold. China now averages 10 antibiotic IV bags per person per year (global average is 3). The result is antibiotic resistant diseases as well as antibiotic resistant patients.
The final breakdown comes at the pharmacy. There is a regulation which requires a pharmacy to only give drugs when patients have a prescription (which seems reasonable). A doctor told me that regulations are treated more like suggestions, not laws. So even if he denied the patient antibiotics, they’d still be able to buy them.
Hospitals are key to providing the high-quality of life Chinese people are starting to demand, and China is going to need to improve their system dramatically to be considered up to global standards (even in the major cities).
Part Three looking at how difficult it is to enforce laws and regulations after they’ve been passed.
Update: This article from People’s Daily, focused on abuse of antibiotics, appeared the same day as my post.
What do you recommend visiting laowai to do? I always have medical insurance when I holiday in Beijing but my blood group is Rhesus A Negative which Han Chinese do not share. Also I am aged 66 years, although fit and active. Should I carry medical records in case I become ill or am in an accident? This issue (along with pollution) worries me during an otherwise fantastic holiday in China.
I can make a few recommendations, but I think it would be wise to talk with your doctor about the blood issue.
Beijing in winter can have pretty bad pollution, and since it is hard to know just how bad it is, I would avoid taking long walks, or trying to run up the great wall. I don’t think it is necessary to carry your medical records, because your US doctor would send them over.
Outside of a few bouts of food poisoning (the most common problem for foreigners), I have been pretty health in China, so enjoy your trip!
I am British Tom – I live in the Highlands of Scotland. But thank you for your advice. I’ll consult my GP if I go to China for a long holiday. I am just grateful for the British National Health system!
Good article. Points out some dramatic and counterintuitive problems ie. health care as too inexpensive.
When I cracked a rib while riding a Chinese roller coaster, I first went to the local hospital – they refused to serve Laowai for fear of screwing up (at least that was the interpretation). I had to instead go to another hospital that was specifically designed to help Laowai – as in they had someone who allegedly could speak English. Between my Chinese and his English, they couldn’t do anything other than to say they couldn’t identify the problem. My return home two weeks later finally identified the problem. And this was in a large city about 12 years ago.
I won’t do anything involving blood work in China (even today, while better than it has been in the past, it’s still too iffy for me to want to chance it). And my visits in hospitals to visit others always leaves me aghast at the differences between China and Western nations. Added to that are some of the stories I’ve seen either in the news or through friends about additional “fees” (read: bribes) necessary to hospital staff to get treatment and it is not a promising sign.
If I’m wrong, Tom, please correct me. Thanks.
Spot on Mr. Chopstick. I’m trying to help my current hospital identify some of these issues. Doctors still don’t wear gloves when drawing blood, even though hepatitis is fairly common. Currently the doctor that tells you that you need surgery, is the same one who will need a “fee” for performing it.
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I’m not a friend of Chinese hospitals because I spent 10 days in one last summer. I had a bad skin burn of scale 2 and about 10% of my body. I would have so many complaints about this hospital but here just a few: ambulance staff seemed to have zero medical skills and absolutely zero medicine, doctor didn’t know how to best treat me and that’s why my recovery was slower, it was July and no aircondition in my room, no decent aircondition in the other rooms either in that part of the hospital, doctor gave me wrong instructions and zero medicine when I left. Luckily I didn’t trust them and after that went to a western clinic and got the help I was supposed to have. (I have a full story in my blog if you’re interested.)
So I’m not really keen to visit Chinese hospital any time soon.
I remember reading this story on your blog. The sad part of it was that it is fairly typical. I always hand friends my business card just in case they need treatment because without someone to guide you through the experience, it is awful.
I also tell exchange students that come here, that if they need a doctor I can recommend a western clinic for them. And I’m lucky that my condition wasn’t about life and death because I wouldn’t trust my life in the hands of that doctor that treatet me there. I was also far from worst and I remember this about 8 years old kid that had burned almost completely, I can only guess how long it took/takes for her to recover.
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China insists on having solution that is suitable for the conditions in China, and I bet the shape the hospitals are in is one of these solutions – right for China.
When anyone complaints about anything wrong with China, the size of the population will always come up as the trump card – no other country has as large population as China, and therefore China’s problems are always unique. And I suspect that these hospitals are part of the solution to this most difficult and serious problem of China: Large population.
No offense to you Bill, but China’s population often seems to be the excuse China uses for every problem (even the population pretty much doubled in the last 60 years after encouragement by the gov’t). Never mind that maybe it’s partially poor law enforcement, a lack of investment, or that they are spending money on the military, national security and space programs. Nope, it’s always China has a big population so they don’t need to prioritize their spending or address their problems.
Also the fact that hospital’s are not better in area’s with lower population densities, kind of makes it seem like it’s not just the population.
Ask the local’s how satisfied they are with health care, and I bet that they won’t say that this solution is “right for China”.
We would definetely recommend everybody to bring with you medicine and also sign up for a health insurance plan as soon as you coem to China or before, because like this you know that you have everything you might need in case of illness, accident and or something else. Besides, having your own pills will help to avoid using local drug-stores trying ti explain what exactly you need.
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