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Chinese patients fight for limited resources
By Yu Fei |
September 14, 2012, Friday
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Print Edition
Print Edition
PATIENT Dong Mei used to pay scalpers 300 yuan (US$47) to obtain a registration slip to consult with a specialist at the Beijing Friendship Hospital, since it was almost impossible to get one the legitimate way - by queuing up overnight.
But recent reforms initiated in the hospital, one of the best in Beijing, have made it easier for her to consult specialists. The hospital eliminated the mark-ups on medicine prices, but introduced a new fee for medical service. It costs just 2 yuan to consult with general practitioners, while specialists can cost as much as 60 yuan.
The changed fees have encouraged patients with minor health issues to see ordinary doctors instead of needlessly occupying the time of specialists. Visits to GPs or internists have surged 20 percent since the reform was introduced.
"We don't recommend that all patients see specialists, because they are limited resources. The price gap caused by the variable medical service fee acts as an economic lever to divert some of the patients," said Wang Yu, head of the hospital's medical department.
China's medical reform has been discussed by authorities ever since 2006. But not until 2009 did the central government launch the new round of healthcare reforms to improve access to affordable medical services.
Between 2009 and 2011, the central government spent 450.6 billion yuan (US$70.7 billion ) to establish a basic medical insurance system, build a basic medicines system, and improve services of grassroots medical institutions.
Currently, the reform has entered a "crucial stage," with difficult issues constantly emerging, said Chinese Vice Premier Li Keqiang recently. "Priority should be shifted to the improvement of medical treatment and service quality."
Health Minister Chen Zhu said reform of public hospitals is of great significance to solving the acute problem of "poor access and high fees" that makes it difficult for the public to visit doctors.
Experts say one of the biggest challenges facing healthcare reform is improving the efficiency and performance of public hospitals, where China's best medical facilities and doctors are concentrated.
The uneven distribution of medical resources between rural and urban areas has also been a subject of public complaints. Nearly all of the country's best doctors and most advanced facilities are located in urban areas, causing patients to scramble for limited medical resources.
Forced to line up
It is also difficult to see specialists, with many patients forced to line up late at night, buy registration slips from scalpers or forge personal relations with hospital staff in the hopes of getting preferential treatment.
Although the Beijing Health Bureau launched an online registration system last year to alleviate the problem, only a small quota of appointments can be made through the system and elderly patients are often unaware it exists.
Sometimes, the tension caused by limited medical resources leads to violence. A doctor was stabbed by a patient at the Peking University People's Hospital in April, allegedly because the doctor failed to treat the patient properly. Last September, a patient stabbed a surgeon at Beijing Tongren Hospital following a medical dispute.
In China, doctors often work long hours for little pay. Their relations with patients are strained, since many patients are dissatisfied with high medical fees and poor access to treatment.
No time to take a rest
Huang Jiefu, vice minister of health, said the tension between doctors and patients is a reflection of China's defective medical system.
The uneven distribution of medical investment, resources and talent causes patients to crowd into larger hospitals. "How could a doctor maintain a good attitude for all day long, with no time to take a rest, to drink and go to the toilet?" Huang said.
Experts say 80 percent of outpatients at the big hospitals don't need to have their first diagnosis in big hospitals. Instead, the first diagnosis could be done in smaller, local hospitals.
Fang Laiying, chief of the Beijing health bureau, said people should seek medical treatment from lower-level hospitals and community clinics instead of swarming into larger hospitals. "What we need to explore in the future is the establishment of a smooth referral channel between large hospitals and community hospitals," Fang said.
Before an effective referral channel is established by the government, a website HaoDF.com has attempted to establish such a channel.
The website provides referral services to patients according to the severity of illnesses, with a "triage team" made up of medical professionals analyzing information submitted by patients and passing their recommendations on to specialists, who decide whether or not to meet with the patient.
More than 5,000 specialists across China are cooperating with the website to set up appointments, with more than 240,000 patients meeting with specialists so far, according to statistics provided by the site's operators.
Experts say the establishment of a referral system will require community-level hospitals to improve the quality of their doctors. Community-level doctors are poorly paid, deal with difficult working environments and have few chances for promotions.
"A scarcity of the best minds is the bottleneck preventing the construction of a community-level medical system. I do not believe the best doctors should go to the largest hospitals, while low-level doctors end up in community hospitals," Huang said. "A doctor should be judged not by where he works, but by how many patients he cures."
The author is a Xinhua writer.
But recent reforms initiated in the hospital, one of the best in Beijing, have made it easier for her to consult specialists. The hospital eliminated the mark-ups on medicine prices, but introduced a new fee for medical service. It costs just 2 yuan to consult with general practitioners, while specialists can cost as much as 60 yuan.
The changed fees have encouraged patients with minor health issues to see ordinary doctors instead of needlessly occupying the time of specialists. Visits to GPs or internists have surged 20 percent since the reform was introduced.
"We don't recommend that all patients see specialists, because they are limited resources. The price gap caused by the variable medical service fee acts as an economic lever to divert some of the patients," said Wang Yu, head of the hospital's medical department.
China's medical reform has been discussed by authorities ever since 2006. But not until 2009 did the central government launch the new round of healthcare reforms to improve access to affordable medical services.
Between 2009 and 2011, the central government spent 450.6 billion yuan (US$70.7 billion ) to establish a basic medical insurance system, build a basic medicines system, and improve services of grassroots medical institutions.
Currently, the reform has entered a "crucial stage," with difficult issues constantly emerging, said Chinese Vice Premier Li Keqiang recently. "Priority should be shifted to the improvement of medical treatment and service quality."
Health Minister Chen Zhu said reform of public hospitals is of great significance to solving the acute problem of "poor access and high fees" that makes it difficult for the public to visit doctors.
Experts say one of the biggest challenges facing healthcare reform is improving the efficiency and performance of public hospitals, where China's best medical facilities and doctors are concentrated.
The uneven distribution of medical resources between rural and urban areas has also been a subject of public complaints. Nearly all of the country's best doctors and most advanced facilities are located in urban areas, causing patients to scramble for limited medical resources.
Forced to line up
It is also difficult to see specialists, with many patients forced to line up late at night, buy registration slips from scalpers or forge personal relations with hospital staff in the hopes of getting preferential treatment.
Although the Beijing Health Bureau launched an online registration system last year to alleviate the problem, only a small quota of appointments can be made through the system and elderly patients are often unaware it exists.
Sometimes, the tension caused by limited medical resources leads to violence. A doctor was stabbed by a patient at the Peking University People's Hospital in April, allegedly because the doctor failed to treat the patient properly. Last September, a patient stabbed a surgeon at Beijing Tongren Hospital following a medical dispute.
In China, doctors often work long hours for little pay. Their relations with patients are strained, since many patients are dissatisfied with high medical fees and poor access to treatment.
No time to take a rest
Huang Jiefu, vice minister of health, said the tension between doctors and patients is a reflection of China's defective medical system.
The uneven distribution of medical investment, resources and talent causes patients to crowd into larger hospitals. "How could a doctor maintain a good attitude for all day long, with no time to take a rest, to drink and go to the toilet?" Huang said.
Experts say 80 percent of outpatients at the big hospitals don't need to have their first diagnosis in big hospitals. Instead, the first diagnosis could be done in smaller, local hospitals.
Fang Laiying, chief of the Beijing health bureau, said people should seek medical treatment from lower-level hospitals and community clinics instead of swarming into larger hospitals. "What we need to explore in the future is the establishment of a smooth referral channel between large hospitals and community hospitals," Fang said.
Before an effective referral channel is established by the government, a website HaoDF.com has attempted to establish such a channel.
The website provides referral services to patients according to the severity of illnesses, with a "triage team" made up of medical professionals analyzing information submitted by patients and passing their recommendations on to specialists, who decide whether or not to meet with the patient.
More than 5,000 specialists across China are cooperating with the website to set up appointments, with more than 240,000 patients meeting with specialists so far, according to statistics provided by the site's operators.
Experts say the establishment of a referral system will require community-level hospitals to improve the quality of their doctors. Community-level doctors are poorly paid, deal with difficult working environments and have few chances for promotions.
"A scarcity of the best minds is the bottleneck preventing the construction of a community-level medical system. I do not believe the best doctors should go to the largest hospitals, while low-level doctors end up in community hospitals," Huang said. "A doctor should be judged not by where he works, but by how many patients he cures."
The author is a Xinhua writer.
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