Posts by Jiamei FENG


To heal or to harm – problematic doctor-patient relationships in China

Jiamei Feng

Society and culture | Asia


According to a non-official survey in China, around 60% of medical workers in China are unwilling to let their children become doctors after growing up.

While this figure may be an exaggeration, today the reality is that working in the Chinese medical system is not so appealing. While surgeons and physicians are considered prestigious professions and count among the highest-paid jobs in Australia, in China a doctor working in a tertiary hospital “sees fifty or sixty patients” in a single morning, and may still earn less than 80,000 RMB (around $US 13,000) per year.

Not only is the salary far from satisfying; being on the job can turn into a nightmare.
Health practitioners get beaten or even killed because patients and their families are not content with treatment results. Sometimes people hire hospital violators, organised mobs or “professionals” to get greater medical compensation. To avoid further conflict, hospitals usually make concessions and pay.

On the other hand, the public is unhappy about expensive medical fees. China provides general healthcare insurance to almost every citizen, but the costs are still high. An ordinary family can easily become broke if someone in the family is diagnosed with a serious disease like cancer.

And doctors’ reputations have only worsened in the face of scandals, like news about receiving financial kickbacks from drug companies (thus raising drug fees) and “red envelopes” – when patients give extra cash to surgeons and anaesthetists for special care. The amount of money varies according to the doctor’s title, the hospital’s location and how serious the disease is. Traditionally worshipped as “angels in white” Chinese doctors are now criticised as “white-eyed wolves” – a metaphor for ungrateful souls.

The public also complains about the difficulties in seeing a doctor. The most extreme cases happen in specialist clinics in China’s tertiary hospitals. Patients prefer experts to young, unknown doctors and they are willing to spend hours or days to get registered. The registration fee is genuinely cheap.

Consequently, an illegal but often agreed silent occupation has sprung up – Huangniu, or registration scalpers. They sell specialist registration numbers to those who cannot wait at a much higher cost.

In January this year a video of a young girl went viral when while at a famous Beijing hospital she angrily claimed that she could not see an expert as a result of her rejecting scalpers, and that the hospital was playing ‘footsie’ with them.

[caption id="attachment_4886" align="alignnone" width="449"] A screenshot of the "girl condemning Huangniu" video. Her words sparked country-wide discussion.[/caption]

Medical institutions have attempted to eliminate this by adopting a real-name system and online registration. But scalpers have also upgraded their operations, remaining active in the shadows, while the police complain it is too hard to arrest them all.
The leading cause of doctor-patient conflict is China’s slow healthcare development. In 2014 the government spent $590.2 billion in medical services, accounting for 5.7% of GDP, lower than Brazil -- 8.8%. Financial aid accounts for a mere 10% of a public hospitals’ income, while 40% comes from medicine earnings, which directly pushes up medication prices.

Additionally, community hospitals, a supplement to big infirmaries, are in an awkward position. They are set to offer basic healthcare, yet lacking funds, they can barely afford advanced facilities for comprehensive treatment. Ambitious doctors are not interested in them either, due to disappointing payment and the bleak career path. They remain ‘deserted’ while major hospitals are overcrowded.

Moreover, the Chinese medical system is caught in a bizarre arrangement. In the 1990s, then Premier of China, Zhu Rongji, promoted industrialisation of healthcare services. Trade in medicines and medical equipment become entirely commercial. But supply channels are controlled both by the government and corporations. Staff in public hospitals, on the contrary, are “within the system” and their salaries increase with the rise in career levels and any official adjustment (which happened only twice in the past decade).

Leaving aside verbal and physical abuse, medical workers argue that they do not receive proper pay. A high professional rank and educational background are critical to a doctor’s career, but it usually takes eight years to get a master’s degree and at least four years of working experience to become an attending physician. Long working hours and night shifts make the job even harder. Receiving bribes and red bags seems acquiring what they deserve in an illegal way.

Subconsciously, citizens regard medical resources as public welfare. People pursue top treatment in the hope of a low price. In 2016, the government announced a raise in registration fees in tertiary hospitals -- from $US 1.3 to $US 3.7 to see a specialist. Although the price is low in doctors’ eyes, the new regulation still sparked controversy online.

China is actively promoting medical reform, yet the results are not satisfactory. Both practitioners and patients consider themselves victims and medical disputes continue. An ideal solution is to fully finance all public infirmaries regardless of hospital volume, but funding remains the biggest problem.

5 minute read

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Media Control in China: Zhao Wei and Weibo

Jiamei Feng

Politics | Asia


Often when it comes to film all the drama plays out on the silver screen. Not so in China.

A recent controversy played out on Sina Weibo, regarding a romance directed by one of China’s most famous actresses Zhao Wei. It is a revealing and cautionary tale about how much control the Chinese Communist Party (CCP) still has over the media.

Zhao has been forced to replace Taiwanese actor Leon Dai, and Japanese actress Mizuhara Kiko after finishing her new movie “No Other Love”, due to intense pressure on microblog site Weibo from both the public and Beijing.

Dai has a history of supporting Taiwan independence, while Kiko once visited Yasukuni shrine. Dedicated to dead Japanese soldiers, including those who fell in the Second Sino-Japanese War, the shrine has been condemned by the Chinese.

[gallery type="rectangular" ids="4199,4200"]
Weibo is a Chinese Twitter-like social media site, and the hottest microblogging service currently is Sina Weibo– the original inventor of the platform. It has various powerful functions, allowing users to insert rich media. The word limit for a basic microblog is 140 words, but users can edit and post “Long Microblogs” with lengthy text and multiple pictures.

[caption id="attachment_4218" align="alignnone" width="1346"] A screenshot of a microblog, otherwise known as Weibo[/caption]

Netizens can speak relatively freely on Weibo. Besides memes, commercials, news and harmless personal daily records, people use it to call out immorality, crime, and to criticise the political system – exposing injustice, corruption and the abuse of power.
Of course, this freedom is not entirely without limitation. Sina can delete posts and comments if they contain illegal content, or “sensitive words/information” unwelcome to Beijing, or the company itself.

For years, microblogs have served as a highly-valued justice tool. In 2016, however, things have started to change. Although netizens often criticize the CCP’s strict media control, they have paid more attention to Sina since the Zhou Ziyu Event.

The Taiwanese female singer insisted that Taiwan be an independent nation during her appearances on Chinese television. Angered, the public took to Weibo to ask her to apologise for the remarks.

Throughout the incident, a popular view emerged that Sina’s executives, in fact, support Taiwan independence, as the system deleted countless posts and comments in which furious netizens urged Zhou to apologise. Mistrust was bred.

The Zhao Wei Event is a replica of Zhou’s, but more serious and complicated. The movie was partly-financed by Alibaba, the country’s e-commerce giant as well as a major shareholder of Sina.

Three months ago when Zhao announced the cast on Weibo, her fans immediately realised that such choices would be a hidden danger to both Zhao’s movie and reputation. They kept reminding or questioning her about this on her posts, only resulting in deletion by the actress and her company.

The situation was inflamed on 25 June when she posted a joint photo with Dai to celebrate the movie’s completion. More protests appeared, while Zhao’s company threatened to sue, and Sina prevented users searching for the ongoing drama by blocking keywords.

[caption id="attachment_4229" align="alignnone" width="690"] The joint photo of Dai and Zhao that led to great controversy[/caption]
On 6 July, there was an even more surprising plot twist – the Party began to interfere. The official account of the Communist Youth League, a key element of the CCP, posted a long detailed microblog about the incident.

Although it used the word “alleged” when presenting Dai’s history of supporting Taiwan independence, the end of the article “kindly” reminded the public of three other movies which he stars in and will be soon on screen, and directly mentioned Zhao.

“Everyone makes mistakes – what is crucial is that you should be aware of and correct them,” it wrote.

[caption id="attachment_4263" align="aligncenter" width="604"] The screenshot of the article posted by the Communist Youth League on Weibo[/caption]

Making matters worse, Sina deleted the post after only 10 minutes, which led to unprecedented fury. As more political accounts got involved in the incident, Zhao finally threw in the towel and now the movie is in post-production.

Territorial unity is China’s most important political topic and nationalism is a mainstream ideology. The country is particularly sensitive to Taiwan. It may be seen as self-ruling from an international point of view, but in China it is considered an inalienable part of the territory. Any remark about independence can be a serious political mistake – as highlighted in both the Zhou and Zhao events.

And such control will continue to be stricter in the visible future. In February, President Xi Jinping stressed in a national speech the necessity of media’s subordination to the Party’s will.

Outside forces like business and the market might make some change in China, but they will never win the fight for dominance. Big Brother rules, as always.

4 minute read

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