How is the health system in China

care: China's health system is sick

Beijing. "Late again!" Xu Qi lets out a tortured sigh. It is before four in the morning when she arrives at Peking University People’s Hospital. A long queue of 100 people has already formed in front of her, the first apparently staying overnight right in front of the entrance gate.

Despite the cool morning temperatures, there is a heated atmosphere, which is further fueled by the black market traders. They sell the coveted numbers that will be needed later when checking in at the hospital reception. This is forbidden, but controls and priority actions could not change this practice. "I hate these guys to the core, but unfortunately I can't do without them," says Xu Qi as she haggles over the ticket with a dealer.

Like so many others, she has come from the provinces and suffers from respiratory problems and pain in the throat area. "I have no choice, everyone comes to Beijing after all," she complains.

China has half as many doctors as the OECD average

The long queues in front of the hospitals are ubiquitous symptoms of a sick system in China, and especially in the capital. Although the health system was restructured a decade ago, the structural problems are still serious. There are just 1.6 doctors available to care for 1000 people; the OECD average is twice as many. In the case of nurses, the gap is even wider: here there are 1.8 caregivers for every 1000 inhabitants, while the OECD average is 8.8.

However, not only are there too few staff, they are also deployed in the wrong places. Because the principle of care is three-tiered: In theory, smaller clinics in villages and communities should take care of basic care and communal health centers should take care of the more demanding cases. In fact, however, the masses are flocking to the better equipped and specialized hospitals in the cities. These facilities are accordingly overburdened, as specialists also have to deal with illnesses such as flu or headaches. They often treat 200 patients a day.

That creates tension. And scandals. It wasn't until July that hundreds of thousands of children were injected with faulty vaccines, which caused public outcry but hardly really surprised anyone. The Chinese have long since got used to counterfeit and ineffective drugs. The mistrust runs deep, not only towards the public authorities and corporations, but also towards the doctors themselves.

Since the doctors earn comparatively little, they have drilled into various additional sources of money. For one thing, it is not uncommon for patients to give them red envelopes filled with money in order to obtain better or faster treatment. On the other hand, doctors are also happy about donations from the pharmaceutical industry, which means that unnecessarily expensive drugs are often prescribed.

The "white-eyed wolves": objects of hate and victims of beatings

That did not improve the reputation of the doctors. There is not much left of the "gods in white" in China, instead they talk about the "white-eyed wolves".

But they are becoming more and more fair game, and violent attacks on medical staff are increasing. Frustrated patients insult, spit at, or beat up doctors. Sometimes such arguments also end fatally. The responses from hospitals to such incidents vary. In the southern Chinese city of Guangzhou, the Zhongshan Hospital has hired martial arts experts to teach the doctors self-defense techniques. The hospitals in the east Chinese city of Jinan have been converted by private security companies into high-security zones including metal detectors at the entrance. And the police have more and more of their own premises in the emergency rooms of the hospitals across the country.

In any case, most patients think twice about whether they should go to a hospital at all. Because although 95 percent of the population has at least basic insurance, illness can still have ruinous consequences. Anyone who has to seek treatment pays a considerable part of the costs themselves despite the insurance, which in the case of cancer has consequences that threaten their existence. An example: A single pack of Nexavar, a cancer drug approved by Bayer in China, costs 3,000 euros. The average annual salary of a Chinese in 2017 was 9400 euros. 3000 euros for a pack that lasts 14 days is unaffordable in most cases.

Unaffordable prices and a monthly wage for antibiotics

The government is trying to take countermeasures. In 2016, President Xi Jinping unveiled the first long-term blueprint for improving the health system since the country was founded in 1949. Under the name "Healthy China 2030", access to medical care should become more balanced and fairer, while costs for the population should fall. In the long term, 80 percent of the medical costs are to be covered, leaving 20 percent of the patient's own contribution. The main objective is to close the supply gap between the often poor, rural regions and the urban areas and metropolises. Above all, the system should produce a large number of country doctors, i.e. general practitioners, not specialists.

This should be difficult due to the circumstances mentioned, because doctors now have the worst reputation in China among all professional groups - hardly anyone recommends their child to become a doctor today. Although doctors' salaries are to be raised as an incentive to take up a job, this will no longer help Xu Qi. As she leaves the hospital, she grumbles: "I had to wait all day, and now a month's wages for antibiotics are gone. I think this hospital made me sick."