Choices for China’s medical doctors are limited

, an anthropologist/nutritionist/fluent Chinese speaker/Fulbright Scholar in Shanghai has written a great post, “Being a Doctor in China,” on how Chinese medical students view their role within the healthcare system. In a fascinating exchange the students profess to understand that the Chinese healthcare system does not do a good job treating the poor:

If it were up to them (which it is not) they would give poor people preferential medical treatment. One of them explained to me, “We know that the poor people need doctors the most. They don’t have education, or electricity, or money or food. But we don’t have this choice because of our own hospital’s regulations, who have their regulations because of funding from the central government. There just are too many people, and not enough money. So people have to pay, and if they can’t pay, we can’t help them.”

That the poor are under-served because of system constraints is a problem the world over, America included. What makes it striking in the China context is that the healthcare system was designed to serve everyone, regardless of ability to pay. In practice, however, the constraints put upon physicians by a combination of low salaries and understaffed facilities has created an healthcare system where access to healthcare is based on a hyper-capitalistic auction model: the highest bidder always wins. Physicians, regardless of low salaries, are not without blame for taking payments, but the overcrowding in the hospitals is a real problem:

These future physicians know the hardships that face poor people, and they know they provide subpar service. But time and again they would insist, “How can we provide good service when we have anywhere from 20-60 patients to take care of, and no control over who we assist? We have to treat everyone as equals, even when some have greater need than others”.

If one were to visit a hospital in a rural province, however, it is likely that the waiting rooms would be largely empty because the crowding of the sort described here is a phenomenon in China’s biggest and most admired hospitals. When China’s healthcare system was originally conceived people were required to access the healthcare system at the lowest level of care, usually rural clinics. Today those restrictions are no longer enforced and people enter the healthcare system at the point of access they perceive to be the best, usually a city hospital that’s known to have the best doctors. A possible solution to the top-tier hospital overcrowding is for medical students to move to rural provinces to staff the lower level hospitals. This is impossible, however, because of how low even the highest doctor’s salaries are:

According to my interviews (not just with these students, but with others), Chinese physicians make between $450 and $1,000 a month, depending on their specialty and how senior they are. This includes physicians in Shanghai, one of the most expensive cities in China, where the average rent for a 3-bedroom apartment is $1600 a month. Expenses for young college graduates mount up fast, including saving money for retirement, buying an apartment, a car, food, and oftentimes paying for aging parents. Because most Chinese people living in cities are in similar financial situations, charity and philanthropy have yet to take hold. Time and again my friends would point out to me, “How can we think about giving our money away when we don’t even have enough to live on as it is?”

The end result is a sad one for the immediate future of Chinese healthcare reform:

When asked if there is hope for future physicians to be able to provide the kind of patient care they wish for, one sadly shook her head. “There are too many problems right now,” she said. “There are just too many people in China. I hope that one day I too will have the ability to help give people the kind of medical care they deserve. But in this system, I’m not sure that day will ever come.”

Do check out Lua’s article, and her archives. Lua’s China Nutrition Project Blog has thus far been consistently excellent at highlighting healthcare issues from inside of the Chinese healthcare system so I suggest you go over there to check it out.