Healthcare In China

Hello Friends and Family,

This will be the first of a series of posts about China and my observations about the healthcare system here.  There is a general rule followed by Expats that you don’t criticize your host country.  But at this point, I want to share my observations and research in the hope that we will all get past the sound-bite opinions and packaged perceptions.

First I need to correct the American way of thinking.  Communism and Socialism are not the same thing.  China doesn't have socialized medicine nor do they give more than a superficial bow to a government backed retirement system.   

China has always called it Communism with Chinese Characteristics.  This is a favorite phrase here.  In summary, it means that communism didn't change many of the basic tenements of Chinese Culture.  Meaning: the family takes care of the elders and it is the family as a collective who must take care of the sick or the infirm. 

When the decision was made in 1970 to institute the one child policy, government officials seem to have forgotten to consider how this would affect the family’s ability to care for the sick and elderly.  I have to say that after seeing the overpopulation here.  I have a better understanding of why the policy was considered necessary.  In 1970, at the time the policy was enacted, each women had an average of 5.3 children. In addition, China experienced serious famine and starvation for several decades. There was no way to feed all the people. Every day, I see the after effects of childhood starvation in the small stature and soft bones of the elderly. 

Saying I understand why they did it, doesn’t mean I agree with the forced abortions or ridiculously old fashioned approaches to birth control and sex education.  I’ll have a whole lot more to say on that in the future.

So let me give you some examples of how the healthcare system works here.  In theory, anyone can see a doctor for 1 yuan.  (16 cents).  The idea of clinics is new here so primarily you will go to the hospital and are seen in the department covering your problem: Cardiology,  orthopedics etc.  You will need to register with the hospital and have a hospital ID card first.  You will pay for your visit in advance and if an IV or medication is required you will stand in the cashier line a second time before it is administered.  The doctors have 5 year bachelor degrees here, meaning they don’t have the education of American doctors and they are dealing with a very uneducated population.  There is nowhere near enough medical facilities and you will register and wait hours to see the doctor.  Waiting areas are packed, with the windows wide open, no heat or air conditioning provided.   In order to make up for the low cost of seeing a doctor, you will most likely get an IV drip.  I know this sounds like massive over kill until you understand more.   The lowest price for an IV drip is 125 yuan.  There are short, 30 minute drips and long, 2 hour drips. There are different names for these in Chinese.  If you need antibiotics for an infection this is how you will get it.  If you walked in with hives, you would get a cortisone IV.  

The clinical pharmacy field here is not well developed. There are many pharmacies but it is unlikely that it will be staffed by anyone besides a clerk.  Those who do get a bachelor degree in pharmacy are likely to work at the hospital.  In addition,  the pharmacist may only deal with traditional Chinese medicine (TMC) compounding, mixing herb etc.  In which case, the pharmacist would be filling a prescription from a TMC doctor.  I have never heard of a person leaving the doctor with a prescription for western medicine.  If you actually go home with medication you will get it at the hospital.  

TCM Pharmacy

Another reason for the IVs and hospital provided medication is that amount of fake and poor quality medication here.  There is a lot of medication here that was meant for animals in other countries.  Also the doctors can’t be sure that someone will take a 10 day supply of medication on schedule. Thus it is quite common for someone to be told that they will need to return every day for 3 or 5 days for an IV.

Western Medicine Pharmacy, I appreciate getting
Amoxicillin without a prescription

Soon after arriving here, I read an article in the English language daily about a nurse that went to Singapore to work.  She was severely reprimanded for giving a patient his medication early.  She learned how important this is and stated that in China you get the medication whenever it is convenient for the nurse.  This kind of comment gives you a general idea of the training here.

Nurses learning to Smile.  2013

A hospital stay is a family affair here.  They will be an important part of the patient’s care.  Although there are a few VIP wards that may be different, generally China still has beds in wards. Each ward room has one bathroom.  No shower.  A 6 or 8 bed room is typical.  That one bathroom will also be used by the family members helping the patient.  Again the windows will be open as fresh air is considered very important to alleviate germs.   Since many of the cities here have terrible air pollution,  the air is NOT fresh!!  Hospitals don’t provide food and so the families will be feeding the patient.  Outside the hospital, street vendors will set up daily to sell food to the families of patients. Families coming from outside the city will spend the entire time in the hospital. It is unusual for them to get a hotel room because that is considered too expensive.  The family will be paying for the entire operation and stay. 

It is also common to have a hospitalization here where your bed will be left in the hall. If the wards are taken and you must be hospitalized then your bed will be left in the hall, possible for a week or more.  Again the family will be there to assist you.  You can get a pretty good idea of the desperate need for more hospitals and facilities

China could easily be ground zero for a massive viral/bacterial outbreak.  While masks are frequently worn (for the wrong reasons) gloves are still not mandatory.  That is to say gloves are usually worn but it isn’t 100%.  There is unlikely to be any clean up between patients on say an exam table and paper on the table is optional.  I have friends who have been in MRI rooms with blood on the walls. The training for the technicians is minimal so they just don’t understand why any cleanup is necessary.  A cleaner will often use the same bucket of dirty water for the entire day while mopping. 

Our company, as well as many other international companies, doesn't allow us to have medical care here.  There are two western clinics staffed with doctors from the US and Europe.  If we need care beyond their capabilities, we will be flown to Bangkok or Singapore. 

As we all know in the US, the Chinese government has plenty of money.  So why isn't healthcare a priority?  Why aren't new hospitals and better training a priority?   Healthcare barely gets mentioned at the federal level.   The ugly truth – if your country is terrible over populated would you want people to live longer?