CHINA'S HOSPITALS

We could have it worse, give us the time.
(From todays New York Times)


In China’s Hospitals, Battlegrounds of Discontent

SHENYANG, China — Forget
the calls by many Chinese patients
for more honest, better-qualified
doctors. What this city’s 27 public
hospitals really needed, officials
decided last month, was police of-
ficers.
And not just at the entrance, but
as deputy administrators. The
goal: to keep disgruntled patients
and their relatives from attacking
the doctors.
The decision was quickly re-
versed after Chinese health ex-
perts and academics assailed it,
arguing that the police were pub-
lic servants, not doctors’ personal
bodyguards.
But officials in this northeastern
industrial hub of nearly eight mil-
lion people had a point. Chinese
hospitals are surprisingly dan-
gerous places to work. In 2006,
the last year the Health Ministry
published statistics on hospital
violence, attacks by patients or
their relatives injured more than
5,500 medical workers.
“The relationship between doc-
tors and patients is really tense,”
said a 25-year-old cardiologist at
Shenyang’s 4,000-bed Shengjing
Hospital. A 29-year-old neuro-
surgeon echoed that sentiment.
“I think the police should have a
permanent base here,” he said.
In June alone, a doctor was
stabbed to death in eastern Shan-
dong Province by the son of a
patient who had died of liver can-
cer. Three doctors were severely
burned in northern Shanxi Prov-
ince when a disgruntled patient
set fire to a hospital office. And a
pediatrician in Fujian Province
was injured after leaping out a
fifth-floor window to escape angry
relatives of a newborn who
had died under his care.
Over the past year, families of
deceased patients have forced at-
tending doctors to don mourning
clothes as a sign of atonement for
poor care, and organized protests
to bar hospital entrances. Four
years ago, 2,000 people rioted
at a hospital after reports that a
3-year-old was refused treatment
because his grandfather could not
pay $82 in upfront fees. The child
died.
Such episodes are to some ex-
tent standard fare in China. The
government said in 2008 that more
than 90,000 disturbances occur
every year, and Chinese officials
at all levels of government are al-
ways on guard against unrest that
could spiral and threaten the Com-
munist Party’s power.
And doctors and nurses say the
strains in the relations between
them and patients’ relatives are
often the result of unrealistic ex-
pectations by poor families who,
having traveled far and exhausted
their savings on care, expect med-
ical miracles.
But the violence also reflects
much wider discontent with Chi-
na’s public health care system.
Although the government, under
Communist leadership, once of-
fered rudimentary health care at
nominal prices, it pulled back in
the 1990s, leaving hospitals largely
to fend for themselves in the new
market economy.
By 2000, the World Health Or-
ganization ranked China’s health
system as one of the world’s most
inequitable, 188th among 191 na-
tions. Chinese consumers were
footing 60 percent of the nation’s
health care bill. Nearly two of
every five sick people went un-
treated. Only one in 10 had health
insurance.
Over the past seven years, the
state has intervened anew, with
notable results. It has narrowed
if not eliminated the gap in public
health care spending with other
developing nations of similar in-
come levels, health experts say,
pouring tens of billions of dollars
into government insurance plans
and hospital construction.
The World Bank estimates that
more than three in four Chinese
are now insured, although cover-
age is often basic. And far more
people are getting care: accord-
ing to the World Bank, hospital
admissions in rural counties have
doubled in the past five years.
“That is a steep, steep increase,”
said Jack Langenbrunner, human
development coordinator at the
World Bank’s Beijing office. “We
haven’t seen that in any other
country.”
Still, across much of China, the
quality of care remains low. Al-
most half of the nation’s doctors
have no better than a high school
degree, according to the Organi-
zation for Economic Cooperation
and Development. Many village
doctors did not make it past junior
high school, yet they are fully au-
thorized to prescribe drugs.
Primary care is scarce, so pub-
lic hospitals — notorious for rais-
ing costs — are typically the first
stop in cities, even for patients
with minor ailments. One survey
estimated that a fifth of hospital
patients suffer from no more than
a cold or stomach flu.
SHARON?LaFRANIERE