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