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.

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?