My Chinese Health Care Experience

Each year, the employees of the University get a free health check.  This is performed at a small hospital/clinic on the Medical School campus.  It takes all morning and is very extensive.  Oh and it is completely free!  So last year I decided to take advantage of this to experience Chinese Healthcare for myself.

This exam would cost a lot in the US as it includes many – usually separate – tests and procedures.  The blood draw included testing  for lipids, cbc, several hepatitis B antibodies, and a CA125 test for women (used to detect ovarian cancer)  and PSA test for men.  Other tests include, an EKG, Chest X-ray,  Eye exam, glaucoma test, pap smear, blood pressure, and an ultrasound exam for thyroid, breast, abdominal aortic aneurysm, and ovaries.

First you sign up online for your appointment.  There is a two week period and each morning approximately 300 people are seen.  When you arrive, you check in and enter a large room with benches and examination room doors off all sides.  China still uses doctors and nurses for all healthcare so technicians are not part of the healthcare scene.  The physicians are both male and female but nursing is still pretty much an all-female profession.

Another thing I should point out is that China doesn't have HIPPA laws and your information is shared with anyone near enough to see or hear your results.  Although,  the written report was given in a sealed envelope.  Privacy also has a different meaning in China.  The number of people in the country and the number of people served by the clinic is a single day doesn't allow for the kind of privacy you have while seeing a doctor in the US.

First we had our blood drawn,  I was given two q-tips to hold on the puncture afterwards to stop the bleeding.  This didn't work very well for me and I bled for quite a while and got a nice big bruise on my arm. 

When we went to the ultrasound room, there was a queue on the bench outside the door.  Inside the door there were 5 chairs along with the nurse at a computer and a bed with a drawn curtain.  The patient was on the bed with the doctor, as he examined the patient and looked at the ultrasound screen, he called out the findings to the nurse who then typed them into the report.  So the 5 people in the chairs, the person waiting their turn behind the curtain and the patient on the bed all hear the details.  No one but the doctor and next patient can see behind the curtain.  Since all patients for this were female, the ladies seemed okay with this.   The doctor spent about 10 minutes with each patient. Far less time than would be allotted in the US for an ultra sound exam of anyone one of these areas.  I have heard Western doctors here say, ‘The Chinese doctors won’t miss anything big’.    The doctor picked up the inflammation in my thyroid and the cysts in my breasts.

The EKG (ECG) was performed by a very old machine and a dated technique.  I had clamps on all 4 limbs and then the machine had suction cups instead of leads.  I have been told by US doctors that this is completely acceptable.   The doctor looked at the strip (graph) right there and noted my inverted T-wave.  This usually means you have had a heart attack.  I always have to explain that I haven’t had a heart attack it is an infantile anomaly.  Hard to do when you don’t speak much Chinese.

For the Pap smear, there was more privacy, but not much time. Patients were told to take one leg out of their pants and panties and hop up on the table.  It was all over in about a minute.   I told my Gynecologist this story.  He roared with laughter and said he should try that kind of assemble line medicine. 

Several other things I noticed.  The blood pressure was taken by the small modern automated machines.  These are very popular in the US but not considered the most accurate.  I was surprised a troop of nurses didn't take the blood pressure.  I also noticed that almost everyone there had a systolic pressure close to 140.  That is the cut off for high blood pressure in the US.   This is interesting because the population here is chronically dehydrated and they eat a very high salt diet.  Not sodium chloride but mono sodium glutamate. 

I refused to be weighted because I didn't want “the whole world” to know how much I weighed.  Again no privacy.   This caused a stir of course.  And my Chinese colleague got to explain this to the nurse. (I'm just that crazy laowai.)   Because my friend had to help me with the language I had even less privacy than the other patients.  I had to adopt sort of an “out of body” mind set to keep from being mortified with embarrassment.   This year, when the health checkup came, I politely refused saying I have to do it all in the summer in the US.  

As you can see there are some pluses and minuses to this system.  The CA 125 blood test for ovarian cancer is expensive, about $175 in the US.   It is NOT used nearly enough in the US, yet here every women received the blood test and for free.  In the US, ovarian and uterine cancer are STILL not detected early which puts women at greater risk.   Personally, I am glad to see independent testing labs springing up in the US where a patient can get his own blood workup. 

Ultrasound of Thyroid with inflammatory areas
highlighted.

I have been on Thyroid medication for more than a decade. Yet,  I have never had a Thyroid ultrasound.  I asked my doctor in the US.  “Do you just assume that all women with low thyroid hormones have Hasimoto’s Disease.”  (That is the name of the inflammatory thyroid disease.)  She said no and sent me for an ultrasound.  While it doesn't change my treatment, it is important to know that you have a chronic inflammatory disorder because it can lead to other inflammatory problems. 

One the minus side, the speed at which these tests are performed means that they are not very thorough.  A small breast cancer could easily be missed.   Many of the exam rooms did not have paper on the table and there was no cleaning between patients.  This is typical for China.  Yes the doctors do where gloves for say a Pap test, or rectal exam but may not for a less invasive test.   I have always thought that because of the sloppy cleanup between patients, it would be very easy to spread disease here.  I have had other expats tell me the same thing in x-ray and MRI rooms, no cleanup.   More people in the population wear masks here.  That is good if a sick person is trying not to spread their germs to others.  If you wear a mask to keep from getting sick then you also have to make sure that you don’t touch an infected surface or person. Thus it is less effective. 

 Smoking is still very popular here so while a chest x-ray every year may seem excessive,  it is necessary.   Hepatitis B – the viral kind – is also very prevalent here.  There are 400 million people in the world with Hep B.  One-third of them live in China.  There are vaccination programs now to protect kids, although the rate of vaccination is not yet high enough to really control the disease.  It is common for a mother to pass the disease before birth.  There is a lot of discrimination against Hep B carriers.  They can be turned away from schools and jobs.  There are laws to prevent this kind of discrimination but it still exists.  I am unaware of any programs to vaccinate adults.  I sure the vaccine is available here but I don’t think there is the education or the motivation to make this a priority in China.

I think the employees at the University are grateful that their employer provides this service for them.  I know that other large companies also do this but it certainly isn't universal.  Of course, the University Employees are also going to be more educated and seek out healthcare when they have a problem.   However, the scope of learning here is very narrow; you can’t assume that education in one field connotes education about health or the body.  China is still very much in the era of “the doctor knows all” and questions are not asked.

China has a large population of people who are self-employed or employed on a more temporary basis and thus would not have access to health care or health insurance.  Health insurance here is relatively new. It is generally just catastrophic care (with a lot of exclusions) and for those with stable employment. The employer is required to pay 80%.  The Chinese Government’s goal is to have 85% of the people covered within the next few years.  That is not realistic at all.  But then numbers can be manipulated to say anything.

All in All, An interesting experience but not one I'm willing to repeat.