Inequality Grows in Chinese Health Care System: IHT Special Report

China has an increasingly pyramidal health care system, with many small hospitals at the bottom, fewer midsize hospitals in the middle and a small number of very large hospitals at the top.

There are two main factors at work in creating this unwieldy system: patient preference, and the unwillilngness of young doctors to work at smaller hospitals.

China has an increasingly pyramidal health care system, with many small hospitals at the bottom, fewer midsize hospitals in the middle and a small number of very large hospitals at the top.

There are two main factors at work in creating this unwieldy system: patient preference, and the unwillilngness of young doctors to work at smaller hospitals.

China has an increasingly pyramidal health care system, with many small hospitals at the bottom, fewer midsize hospitals in the middle and a small number of very large hospitals at the top.

There are two main factors at work in creating this unwieldy system: patient preference, and the unwillilngness of young doctors to work at smaller hospitals.

Patients always go straight to the top, even for colds or headaches, said He Yuxiang,

a fourth-year medical student at the Peking University Medical College, one of the country’s top medical schools.

This creates a bottleneck at city hospitals, while smaller hospitals remain underutilized. [br]

“The way that Chinese people view going to the hospital is what’s causing the problems we have,” Mr. He said.

“It’s why the middle and lower tiers of hospitals have not had a chance to develop.”

Every morning at the Xuanwu Hospital in Beijing, patients, many from far away and sometimes on intravenous drips, spill out from over-full waiting rooms into the hospital corridors, said Dai Weijia, a doctor at the hospital. 

Meanwhile, she said, neighborhood family practices and clinics sit nearly empty.

But patient preference explains only half the problem, according to this International Herald Tribune Special Report carried on the New York Times website.

The other half is that medical students do not want to work at smaller hospitals …

Even in a top hospital, he said, pay levels are barely adequate.

It’s a vicious circle, said Cao Zemin, director of social services at Xiangya Hospital in Changsha, the chief city of Hunan Province.

Patients shy away from small hospitals because “many members of the staff have only a bachelor’s degree, if that,” Dr. Cao said, adding,

“Some have never received any formal training, like the barefoot doctors from before who have not had a single day of standardized, regulated medical education.”

With fewer patients, the doctors have fewer chances to learn and improve their technique, not to mention lower salaries.

So students with the most potential head for the bigger hospitals, and the patients follow. [br]

Thousands of medical students bemoan the lack of job opportunities after graduation,

yet the problem of skill shortages in second- and third-tier hospitals remains intractable.

Out of about four million medical graduates a year, fewer than half find jobs in big hospitals.

The rest continue in postgraduate training to improve their job prospects or look for jobs elsewhere in the health care industry — in pharmaceuticals, biotechnology or medical supplies.

Some choose to undertake further studies abroad.

Mr. He said that about one in five of his classmates planned to take that route but that the number was dwindling year by year.

“First of all, it’s very difficult to get one of those places,” he said. “Secondly, it’s a very expensive thing, and there’s not even 100 percent guarantee of success.”

Moreover, said Sheldon Liu, chief executive of InnoCare (Beijing) Investment & Development, a company in the health care field,

many of those who go abroad, especially to the United States and Canada, end up working in research laboratories rather than as clinicians,

since the right to practice medicine often does not cross national borders.

Two government-backed efforts could help to make better use of the pool of trained medical talent:

an expansion of higher-fee hospitals, and regulated residency programs.

The growth of a comfortably wealthy middle class has created rising demand for high-quality care in hospitals.

“People’s quality of life is improving,” said Xie Yibo, who as general manager in Suzhou of a company that makes firefighting trucks is a member of the emerging middle class.

“More and more people have money, so of course they will want to take care of their health. Now they have the luxury of being able to do so.”

Official policy is slowly making it easier for hospitals and investors to serve this new market.

In 1997, the government approved the establishment of the Beijing United Family Hospital,

a groundbreaking joint venture between the Chinese Academy of Medical Sciences and Chindex International, a medical supply company based in Bethesda, Maryland.

The hospital primarily serves foreign and wealthy Chinese clients.

Among its changes, the government will allow foreign-financed hospitals more freedom to set their own fees — sometimes as much as eight times above normal levels, he said.

Hospitals like the Sino-Japanese Friendship Hospital and the Peking University Medical College now have special wings for wealthy and non-Chinese-speaking patients, employing doctors who have trained abroad or have foreign language skills.