Posted By Damjan DeNoble
It is not strange for Beijing expats to have grown up in small towns with a single health care provider. Whether that be a large University Hospital that is the only health provider for several rural counties/townships, or a Red Cross clinic that doubles as a senior care facility and is staffed by our neighbors, the psychological effect of having one, or maybe two, and at most three health care options, is the same.
We, the small town folk living abroad, came to regard health care institutions as permanent members of our community; “it is what it is” components of our existence that fit prominently within the permanent scenery of our daily lives, like the painted background in a community production of Shakespeare; noticeable but ignored until a need to seek it out arises; pushed to the side yet always on the horizon like the mountains surrounding Rome, Sarajevo, and Beijing.
In this way it is much like the town police department, the county fire house, the community town hall, or the very specialized tool stashed away in the garage, awaiting a situation that requires it to be wielded. But, unlike the police department, the fire house, or the town hall, which are specialized and authorized to carry out functions specific to the state and cannot and should not be privatized, the health care institution can. That is why there is something called a hospital industry, and why there is nothing called a police department industry.
This ability to enter the private market and become a product makes health care institutions that much more like the specialized tool in the garage. Whereas a tool’s brand is printed on its handle, a private hospital’s brand is printed on its lobby doors, its marketing materials, and its bills. In the same way that a tool is designed to serve a specialized function because trying to make a tool that fixes everything is impossible (think four hundred pound swiss army knife that needs its own wheel barrel), a private hospital has to be specialized if it wants to be efficient and profitable (think back to any pictures/articles of overcrowded, understaffed, and underfunded public hospitals in developing countries for what the opposite of specialized and efficient means when talking about hospitals).
Usually, when us small town folks move to the city, or go to college, or get involved with various careers that expand our horizons (and our wallets) we also come into contact with such specialized health providers, and after our first contact with such a provider we realize that our local hospital is not the best the world has to offer. Our consumer habits change. Suddenly, finding the best provider becomes an obsession fueled by various motivations. And, we start to use tools that help us find the best. Today’s preferred tools are social media like Web MD and various Find-A-Doctor sites. They have evolved to the point where the search process has become central to the entire health experience . Evolution is so fast that today we say “Lords of marketing and profit, help the private hospital that does not have a website.” But, two years from now we will say “Lords of marketing and profit, help the private hospital that does not have face book, twitter, and a YouTube channel.”
So, why is it, that when we move to Beijing, a city of 16 million people officially, and another 6 million or so unofficially, do we, the small town folks who know better, believe that the health care world in this city starts and stops with International SOS, Beijing United Hospital, and one or two other small outpatient clinics our friends know about? Beijing is not a small town, and there are care options here that are equally as good as Beijing United, with English speaking doctors to boot. This is the truth. If we just stop and think for a minute we’d come to see that hospitals and clinics here should be fighting for our money; creating a visible marketing war involving hundreds of small, medium, and large size players vying to outdo each other in the care they offer, and the medical staff they hire.
The little secret that no one tries to hide is that a battle has been evolving for quite some time. The in-patient services available at Tsinghua and Beijing University Hospitals are world class. They are so good, in fact, that if you were to go to Beijing United for emergency heart surgery, BU and your insurance provider would ship you to Tsinghua. If you were to go to Beijing United for an MRI, BU would outsource it to Chaoyang hospital, down the street. And, while I am on a roll, if some of the doctors at Beijing United were to go head to head in a skills test with many of the American or Singapore trained doctors in the two University hospitals, the contest would not even be close. Simply put, it’d be a contest of junior doctors versus senior specialists. But, still, for most Beijing expats, the world starts and stops with the players that advertise in expat magazines, and expat bars.
Perhaps, what drives the myth forward is the immigrants need to create a manageable world in the midst of the metropolitan jungle that defines Beijing. The capital of China is a very scary place for anyone to travel to; whether it’d be a young student from Hebei coming to study at University, or a college graduate from Texas, USA, coming to check out a few things and then deciding to settle here (Note: neither reference has anything to do with me). Any big city, in fact, is a scary place for most people. To protect ourselves in the city, we shrink it down to a few familiar streets, grocery stores, bars, and, ultimately, health care providers.
For the most part this is fine. It is human. I want to say that it can definitely be a shame to not get the “most” out of a city, just like any experience, but then who really does? Luckily I do not have to venture into the realm of moralizing because there is actually a very practical reason for why we should not let the search for familiarity confine us when making important decisions life (those having to do with health, our choice of residence, and our choice of air ticket vendor being some of the most important);
When we allow our mind to limit our choices in an environment where choices abound – we lose money! By limiting our options to the ones we find within the confines of our town-within-a-city, we are telling those few health providers, landlords, bar owners, and ticket web site operators lucky enough to operate within those boundaries, “Charge us whatever the hell you want!” Certainly, in today’s economic climate this is probably not the smartest way to operate.
Beijing can be a small town, but keep in mind that you have big city options (or medium-sized-country-options, for that matter). You wouldn’t pay 6000 RMB per month for a 40 square meter apartment because you know you can get a 120 square meter place for the same amount. So why pay 800 RMB for a consultation at Beijing United or International SOS when you can go to Beijing University Hospital and get the exact same procedure for 200 RMB?
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Hi Damjan,
This is a great topic for debate. There are many, many medical providers in this huge city of ours that have fantastic doctors and good equipment. However, I feel that your argument is lacking in some areas and a little misleading for some.
I have heard your argument about cheaper local hospitals quite a lot from expats who love to complain about expensive medical care from international clinics and Beijing United. However, these providers are always English-speaking, and care is rendered in a private, high-quality manner that they are used to in their home countries. Navigating the Chinese system in a crowded local hospital is daunting and rather scary for most expats, especially if they don’t speak the language. Yes, there are a few ‘VIP’ foreigner wings in places like Sino-Japanese and PUMC, but the cost of seeing these PhD level doctors is almost the same as a consultation with a doctor from BU or SOS.
The problem of familiarity and the restriction of the comfort zone is one we must address in this city. It is a boundary we have to break as expatriates if we want to live life to the fullest here. However, taking a risk at a chuan vendor for dinner or taking a trip to Tibet is a far cry from deciding to go to a local hospital for a risky procedure or surgery.
I have lived in Beijing for almost 11 years and I have been to both local and international hospitals/clinics and honestly, I still prefer the international ones. Let me say this:
If you are a veteran of Beijing, well-informed and speak the language (or have a translator) then this is an alternative that is viable. But just as Beijing has many excellent local providers, it has its share of bad ones.
In this case, you may be more limited to monetary concerns than simple choice. The international providers are expensive, but for the most part, they are just that – international standard.
I have been to Beijing Military Hospital to use their MRI and I was waiting in line shoulder-to-shoulder with farmers and people who were carried in on home-made stretchers of blankets. I watched as a man’s bloody catheder fell out as he was dragged away by his family. There were hundreds upon hundreds of people there, and when I visited Beijing Hospital there were just as many.
So there are costs that I am willing to pay. When I visited SOS and BJU care was rendered in a clean environment that I was comfortable with. I knew that I could be confident that they wouldn’t give me fake meds or dirty needles. I’d get anesthesia if I asked for it. These may be irrational fears but these are fears that many expats share, and to an extent, are founded. If you have insurance coverage, why not use it?
I don’t think you can compare hunting for healthcare bargains in Beijing like buying apartments. That’s where you live. Health is your life, and I’ll always pay top dollar for that. I respect your argument, but I don’t think you see the situation of Beijing expatriates – they aren’t swayed merely by ads in magazines, but by rational caution, lack of knowledge as to the best provider for their situation, and the unfortunate gap of language.
So I say that people need to make their own choice. Healthcare in China is a rapidly growing and improving industry, and local providers are far, far better than they were 10 years ago. I’ve seen some good doctors at Beijing Hospital and they were very professional. Bottom line – cheaper is not always better. If you go to an international provider, you’re paying for service, quality, and safety. If you can navigate the Chinese system safely, more power to you. The thing is, many expats still aren’t ready for that.
Arthur
There is certainly a rational caution that accompanies the decisions made by Beijing’s expatriates. Nowhere in the article do I say otherwise. And, like you, I believe that people need to make their own choices.
I think you also fairly point out that there are good local providers and bad ones, and that these are more readily attainable by expats with language abilities. But, I want to point out that you might be unaware of new options that can serve both the bilingual (language X + Chinese) foreigner and the foreigner who only speaks Chinese in taxis.
A crowded military hospital is one thing, a 25 room, semi public ward, with 40% occupancy and and 8 nurse rotation is another. Moreover, there is a growing number of American trained, Chinese doctors coming to Beijing and opening clinics. They are clean, efficient, and as good, in some cases, as clinics in the US. And, of course, the doctors speak English. To be fair, finding these clinics takes some asking around as most are not to be found online (somebody help with this!).
I don’t want my article to be perceived as an attack on any of the foreign owned health providers. They do their jobs well (Not as well as they could for the money they get, but well). For those expats with health insurance, the BU/SOS option is probably a good one for most outpatient services. But, many of the foreigners I know in Beijing, even the one’s that have been here for a long time, don’t have it. For this segment of the population, 800 RMB per visit is a cost barrier that causes many to put off a consultation for ailments they self diagnose to not be that serious. This in itself can be a real danger. To those people, in particular, it is of benefit to look elsewhere and explore other options.
So, in writing the article, I don’t mean to tell foreigners to stop going to these foreign owned providers. My intention is to make some folks aware of other options. I concede that the task might be intimidating to many (when I first came I dreaded going to the grocery store), but that is an excuse, and one that gets to the very heart of my article. It is perfectly fine and perfectly human to shrink Beijing down to a manageable environment, but when it comes to health care choices, which are, as you point out, life and death, well then its worth your time and money (which is vital for life as well) to look past this shell.
In turn, some questions to you, Maxwell Arthur,
Is the fact that insurance fully covers the outpatient bills of some expats a justification for going to Beijing United without a second thought?
Why does care at foreign hospitals/clinics in Beijing costs as much as, lets say, Beth Israel Medical Center? What is the justification? The fact that doctor’s speak English and the the hallways are clean?
How much is “many expats”? Because it’s certainly not enough to run Beijing United at even half capacity…
And, if Beijing United is not running at full capacity how has it survived for nearly 1.5 decades? Perhaps because its costs are so low? And its bills are unjustifiably high?
Good point is made by Laura Hilton of HTH in article that can be found here – .
“For years, the scarcity of options and lack of competition in the foreign healthcare market in Beijing and Shanghai have made it difficult for international insurers to negotiate discounts with the private facilities. The facilities essentially priced their services freely, and the rates were not cheap. Granted, it was not inexpensive to be among the first to deliver international quality, private healthcare in China, and according to the clinics, their prices were very closely aligned with their costs. With the advent of direct billing networks in Shanghai and Beijing, where patients are encouraged to use participating facilities which invoice the international insurers directly for some or all of their care, the result was that the larger international insurers were effectively channeling millions of euros worth of care to certain clinics each year and still paying full price.”