After reading an article about the myriad problems facing China’s health system, I asked the doctors in my medical English class to briefly reflect on the system based on their own ideas and opinions. Of the 17, 15 doctors wrote that China’s system faced serious challenges. The following are excerpts from their papers that I think accurately reflect the challenges currently facing China’s health. I have not fact checked them, and in some cases I’m fairly certain they aren’t accurate, but that the doctors believe these statistics is revealing.
This one echoed many of the main points of the other doctors.
“For patients, medical services are too expensive. It is said that the average cost is about 500 yuan for a common cold in a mid-level hospital (the average income per day is about 80RMB in Beijing). About 70% of people living in the city get social insurance, which could cover 60% of the cost. For chronic diseases, the cost is even more. So people with diabetes or cerebral vascular disease, do not go to see the doctor and do not take the medicine regularly because they cannot afford the cost. What is worse, some people living in rural areas do not go to the village hospital when they are ill because they have to sell their house and go into debt to treat the disease. In order to raise China’s health level, the cost of medicine should be lowered.
For doctors, this job is no longer a good choice. 90% of doctors said that they are extremely tired. Most doctors have to work 60 hours per week (the average work week is 48). Additionally, being a doctor is a high pressure job which means that they have to focus almost every minute. 30% of doctors admit that they are depressed. In these years even the doctor’s personal safety is threatened. Several doctors were killed by their patients or their family members because of the unexpected therapeutic effects. However, the income for the doctor is low, which is not enough to raise a family. In this situation, some doctors choose to quit for an easier life and fewer students want to go to medical school.”
Red Envelopes and unnecessary prescriptions appeared in more than half of the papers –
“Although most doctors do their best to help patients, there are a few doctors who did some ugly behaviors such as accepting red envelopes, lacking responsibility, and so on.”
“The government does not pay enough money for the health-care system, so the hospital and doctors want patients to buy more drugs to get more money. Even some drugs are unnecessary. 75% of hospital’s income is from drug sales. World bank’s report on China’s health system found that less than 1% of drug prescriptions were reasonable in 2005.”
Concerns for safety came up in nearly half of the papers, this was partially because of the murder of a doctor in Harbin around the time of the assignment.
“…Under these circumstances doctors are worried about troublesome patients and their families. They only dare to make secure diagnosis and operations that insure success. If the risk of the operation reaches a certain degree, some doctors may avoid it. Therefore many patients who have difficult or rare diseases can’t get treatment.”
Government waste was also a major concern, and it surprised me that they were so forward with their discontent.
“The rich and officials waste medical resources. VIPs are very common in many large hospitals. They always do many unnecessary tests and waste the expert’s time.”
“Currently, China is an extremely unfair society. The possession of medical resources is extremely unfair too. It seems the Chinese government only serve themselves. It is reported that about 80% of the health care costs were consumed by 8.5 million governmental officers of the Chinese Communist Party. Despite a loud voice demanding an increase in spending on public health care, the government never wants to spend too much on medical care. It is not difficult to understand. The Chinese Government has a huge budget for spending on cars, banquets, travel, and economic development, but it cannot afford the health care of the large population.
Chinese health is a big problem, and I do not believe that the Chinese gov’t will change its policy on public health care in the near future.”
“Huge gaps in medical resources make many people prefer to seek treatment at prestigious hospitals, instead of at local health centers, for even minor complaints such as headaches and colds. In many large- and medium-scale cities of China, doctors see at least 50 patients a day. Emergency services are so overcrowded that the staff has set up beds in the corridor. People start lining up early in the morning to obtain appointments the following day.”
“Production and circulation of drugs in China is in full accordance with the operation of the market – to pursue profit maximization. This is a serious departure from the public welfare and health services. As of the end of 2005, China has more than 4,000 certified pharmaceutical manufacturing enterprises, as well as 120,000 of the pharmaceutical retail enterprises. In 2005, China’s State Food and Drug Administration approved 1,113 new drugs, while the U.S. FDA approved less than 100.” (This author later wondered whether the oversight was really sufficient).
Most of the Doctors I have come into contact with since I have been in China should be sent to the countryside (cultural revolution style). They are Hong bao grabbing and lack any resposible attitude. Let’s face it, none of them became Doctors for their interest in healing… they became doctors for the money and prestige. Doctors here in China have a well earned bad reputation for whoring and profiteering. They will never admit to a patient that they do not know what a problem is and I suspect the amount of incorrect diagnosis is obscene. I have no sympathy for them and, just from my own experiences, feel that the doctors who have been beaten to death probably deserved it.
Sounds like you have come into contact with loads of doctors in China, is there something wrong with you? It certainly sounds like it.
Suck my balls, nomamanopapa. My Chinese girlfriend’s father suffers with diabetes and has had two strokes here in China. He also suffers from “yellow spot” and a host of other diabetic related injuries. So..yes I have been around lots of Chinese doctors, you pompous ass.
Now you have explained your situation your suggestion that the doctors that were beaten to death probably deserved it seems more than reasonable and I retract my suggestion that there is something wrong with you. Beating doctors to death is OK, well done. Place your balls accordingly.
I hate to say this, but it’s time for everyone to act like adults and treat each other with a little respect. Kev is clearly working through some other problems, and painting all Chinese doctors with broad strokes, but I don’t think he actually wishes death on strangers. Nomamanopapa probably isn’t helping Kev come to terms with his issues. Let’s just drop it.
Kev, it’s understandable why doctors in China are full of greed- their salary is down right laughable! They work in poor conditions, with no bonueses, 500/month salary maximum, treat over 1000 patience not only that they get attacked on a constant bases. How the heck do you expect them to behave so peacefully under these circumstances?
It’s the CCP’s problem. It has always been. Every other country in the world would never EVER in their rightful minds pay doctors in so dispicably low. They should just get their asses out of China and come to a democratic country like the U.S. where they will always be respected and paid handsomly.
As a medical-student here in the United states, it makes me sick how doctors are treated there in China. Never will I ever sat foot in China again. This article just proves it!
Physician incomes are low? Really? Please explain to me why they all have BMWs.
That guy really should include the income from hongbao and pharma kickbacks. After all, the physicians do.
My kind Chinese friends were most concerned to learn that my husband is very ill with cancer until I reassured them that he is well looked after under the British National Health Service which is funded through income tax. One friend was worried that we would have to sell our house or treatment would cease due to lack of money as she said is often the case in China. I reflected that this had happened to my sister’s neighbour who lost his job after spending all his savings on treatment for his wife’s cancer. She died and he was now losing his house due to insolvency – this is in a middle class neighbourhood in USA. Britain introduced the NHS sixty years ago and I have read that the doctors of the day were very against it as they enjoyed a powerful status and good income and feared losing this.
Comparing your final sentence to the Canadian case, Meryl, my understanding is that the situation was much the same with doctors, although there were certainly doctor advocates for the system. The irony for those in opposition at that time is that doctor’s work conditions and personal fortunes improved incredibly under the socialized system. With respect to the present discussion, it would be more useful to hear about the varieties of experience of different people in the Chinese system. As everyone here presumably knows, China is now a highly differentiated society. Pointing to the greed of doctors and government disregard as a way to reduce the population don’t really help us understand anything but our own inadequacies as commentators.
You are a hypocrite Lorim, you lambast people for making personal attacks but frequently attack other people with opinions you regard as being inferior to your almighty “scholarly” position. You are Ignatius J Reilly without satire. Perhaps you should worry about the lack of comment on your own blog rather than continually suggesting that some kind of censorship takes place on someone elses.
Right-e-o. And, for the record, I repeat my suggestion, Tom.
[…] from Seeing Red in China highlighted some points in a papers written by a group of doctors on the challenge of health system in China. Tweet […]
There are so many examples of the Government being happy to let the general population gradually decrease. This is one of them. China is still over populated and the government needs to reduce it’s population for numerous social and economic reasons. A shitty health service that is unaffordable to most or offers poor service is a calculated way of doing this, as is not promoting reasonable levels of road safety, failing to educated people of the dangers of smoking, etc. They don’t want to save and protect the general public, it’s not in their or the countries interest to.
Why would the Chinese government want to spend money to save all these people?
Life is cheap in China.
That’s why more and more Chinese come here to the U.S. or act like little puppies so they can marry an American citizen and get his/her greencard.
In all seriousness though, f nothing is done to regulate or reform the CHinese health care system, there won’t be any doctors in China. They will all come here to the U.S. for a better chance of a better life.
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“Huge gaps in medical resources make many people prefer to seek treatment at prestigious hospitals, instead of at local health centers, for even minor complaints such as headaches and colds.”
I wish I had the articles/figures, but I’ve read something about a problem in the US with people running to the emergency room for trivial things, and calls for some kind of program to educate people on what is and is not serious, what they can take care of at home, etc. I wonder if China wouldn’t benefit from something similar, because every time I had some minor illness (which I personally would just ride out, not even taking an over-the-counter medication) I had Chinese colleagues insist that I needed to go to the hospital.
I remember my own girlfriend (a Western-educated surgeon!) pulled the same thing when she woke up feeling a little off one morning during a visit to Wuhan…
“I think I have a fever.”
“Oh, well, we can stay in today and-”
“I need to go to the hospital for a blood test.”
“Huh-wha?”
She didn’t stick around long enough to get any tests/treatment: the doctor spoke in the local Wuhan dialect which she couldn’t understand, disregarding her requests to speak standard Mandarin. She ended up storming out, torn up medical forms flying everywhere. I’m not entirely sure this wasn’t some secret traditional Chinese medical technique for dealing with patients with minor ailments: the adrenaline-fueled rage seems to have cured her!
My Chinese girlfriend’s father had a major stroke last year and all I can say it was lucky I had been there to help. Apart from making sure that the poor old guy didn’t choke on his own vomit while the “medical staff” were busy counting imaginary things which were obviously clinging to the ceiling, I had an almost hysterical old lady (my GF’s mother) worrying, not about “how much” the treatment was, but about the fact she had no Guanxi with doctors and had no available cash to give HongBao. Luckily, I did have Guan xi and called in a favor. The transformation was amazing.
These doctors who bemoan their positions are posers who only became doctors for the prestige and the ability to palm large wads of cash. They moan that it’s a high pressure job… congratulations, saving lives and making decisions that affect peoples lives is what a doctor does. What were they expecting, an hour of work and 18 holes of golf a day?
I’d like to suggest a more aggressive comment monitoring policy, Tom. I’ll gladly accept the ax if I start talking about my balls.
Give it a break Lorin. I’ve read many of your posts and you’ve been more than guilty of personally attacking individuals for their personal opinions. If nomamanopapa wants defend the doctors based on his experience or disagree with me, fine, but if he wants to personally attack me then I have every right to retaliate and express my desire to have him orally clean my nut sack.
Personally, I wasn’t talking to you, Kev. And like I personally said, personally I’ll gladly accept a deletion if I personally start talking about my personal nut sack or if I personally accuse others of being ill because they talk about their nut sacks.
My main impression about doctors in China hasn’t been about greed and cost as much as just simple incompetence. Antibiotics for viral infections, piling on more clothes to deal with a fever (rather than say, oh, a tylenol), and drips for EVERYTHING.
For the record, from the rather too much experience I have had with doctors in the UK and the fortunately limited and still too much experience I’ve had with them in China I have nothing but respect for them and their profession. I have no problem with a doctor, or surgeon driving a BMW or living in an expensive villa, of all the careers I can think of there are not many more that deserves such luxuries. I feel sympathy for Chinese doctors and nurses, because the health system is clearly subject to the same corruption and bureaucracy that many other sections of the Chinese system are.
Doctors and nurses are as much a victim of it as anyone else and I cannot blame one for taking a hong bao in order to stay ahead of the game. I don’t think people choose the medical profession to make cash, it would be easier to study economics or a subject to get you into banking or commerce.
I stand by my comment that the Chinese government is accountable for the problems with the health system and although I can’t back up my opinion that they are complicit in basically letting people die in order to maintain population control it is what I think. I can’t think why they would spend such vast amounts fo cash on military ‘defence’ and other things when they could subsidise the health system here very easily other than that they do not care about the general publics lives.
Apologies to you Tom for degrading your blog I think it’s an excellent forum with great articles.
I concur. I came upon this article when i was looking up jobs in the medical field in mainland China. I was hoping to work a bit in China so i can gain some experience in the medical industry once i graduate next year from med-school. However, the way the CHinese goverment handle the health care system is completely backwards over there!
Maybe it is just me but i would never in my mind imagine anyone sane enough to attack medical doctors, but alone and behold the patients in China do. I’m glad i am here in the U.S. where we get treated respecfully. Seriously, the CCP has gone too far!
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Thanks for the heads up in this article! Now i know I will never want to work in China. The doctors in China have low wages even lower than accountants here in the U.S. $500/month -No thanks- I’d rather swim in a pool of glass shards. As a Chinese-American who is currently in med-school at Georgtown Medical center. It shocks me to see how badly the medical doctors are treated in China. It makes me cringe.
To be honest, i really feel sorry for the doctors in China. They work in poor conditions. 1 doctor for ever 1000 patients. They only earn 1/4 the salary while 3/4 goes to the pharmaceuticals! And instead of being respected for the hard work and appreciation. Those immoral patients attack doctors!!! It’s totally messed up! I’d get my ass out of the country if i was a doctor in China. Doctors deserve better treatment.
I’m so glad I live here in the U.S. where doctors are treated with outmost respect and dignity.