China's healthcare system - my article from Australian Doctor magazine

by Michael Woodhead

[NOTE: I WILL BE IN CHINA UNTIL JULY, NO BLOGGING UNTIL THEN. IN THE MEANTIME, HERE'S MY ARTICLE FROM MY DAY JOB]:

The Chinese have a saying: "Kan bing nan, kan bing gui," which roughly translates as "It's difficult and expensive to see a doctor".

This is evident at 8am in the foyer of a hospital in Kunming, the largest city in Yunnan Province, south-west China. There are lengthy queues to obtain one of the coveted ‘registration tickets' necessary to see a doctor, and arguments are breaking out among those who have been lining up for hours.

This is the frontline of healthcare in China because there is no primary care gatekeeper system to filter and triage.

Since the early hours, scores of people with minor ailments have arrived, hoping to claim a place in one of the outpatient clinics. Many of them are poor families from rural areas, who have come to the city because they have little faith in their primitive township clinics and under-trained barefoot doctors.

To see a doctor at a Chinese hospital, you first have to register and pay a cash deposit. However, the unrest in this morning's hospital queue has been triggered for another reason.

Because of the value of the registration tickets, scalpers exploit the economic possibilities and are brazenly working the queue, reselling tickets for many times their face value. And faced with long and often unsuccessful waits to get a clinic appointment, there is no shortage of willing buyers.

This is the reality for China's creaking healthcare system, which, through a mixture of underfunding and half-baked reforms, embodies the worst of both communist and capitalist healthcare models — long waits combined with high cost.

Hospitals are state-owned enterprises that receive meagre funding from government following the market reforms of the 1990s. The basic cost of a medical consultation is pegged by law at round 20 yuan ($4).

To cover their operating costs, hospitals resort to a wide range of surcharges that inflate medical bills. They have also come to rely on the commissions they charge on medicines, tests and procedures.

While most Chinese citizens are, in theory, covered by a national health insurance system, in practice, the caps, exclusions and lack of portability of these policies means that most people still face high out-of-pocket fees. Healthcare in China is strictly user-pays: no cash, no care.

‘Infusion room' syndrome
All this can create perverse incentives. For instance, the reliance of hospitals' budgets on drug mark-ups means that there is widespread overprescribing and overtreatment.

This is evident in the ‘infusion parlour' of the general medical outpatients clinic of the Kunming hospital.

The large room is filled with rows of seats, along which sit patients hooked up to IV drips delivering antibiotics or ‘tonics'. This is the routine first-line treatment for any patient with a fever, cough, cold or gastro complaint in China.

The hospital charges about 100 yuan ($20) per infusion — a healthy profit for them but unhealthy for patients who need only simple analgesics, fluids and rest.

"Hospitals giving infusions for minor illness has become a long-established bad habit, which is one of the important factors for antibiotic drug misuse," according to Professor Wu Yunming of Xuzhou Medical College in Jiangsu Province.

"Hospitals are businesses, and infusions represent a significant source of revenue for them."

To be fair to China's doctors, it is not individual greed or ignorance on their part that drives this poor practice.

Chinese doctors know antibiotic infusions are not best practice for minor illnesses, but infusions have become embedded in routine care because doctors depend on commissions for about a quarter of their monthly income.

The basic salary of a hospital resident is about 4000 yuan ($800) a month, equivalent to that of an entry-level public servant or teacher.

However, their contract includes performance bonuses of a further 1500 yuan ($300) — the so-called ‘grey income' — which doctors receive if they meet prescribing quotas in line with the hospital's revenue targets.

Senior doctors, especially those working in procedural specialities such as orthopaedics, can make considerably larger sums of money from commissions.

The government is trying to tackle this well-recognised cause of overservicing by banning drug commissions and allowing hospitals to charge higher consultation fees.

However, the early signs from pilot programs carried out in regional and rural healthcare facilities suggest that hospitals simply shift from drug mark-ups to additional fees for services.

Violence against doctors
Unsurprisingly, this mix of overservicing and overcharging is a source of widespread public distrust of doctors and hospitals. The feelings of being short-changed extend to the short consultation times.

The 80/20 rule, which prohibits GPs from billing 80 or more services on 20 or more days a year, is used by Medicare in Australia as a benchmark of poor care. But not so in China, where doctors working in clinics routinely see 80-100 patients during a four-hour shift.

"I'm so busy I don't even have time for toilet breaks, let alone lunch. I eat at my desk," one doctor told me during my visit to the hospital in Kunming last year.

A patient can expect to be with the doctor for about three minutes — six minutes if they are lucky. The perfunctory nature of such medical consultations means some patients resort to verbal and physical aggression to vent their frustration over perceived mistakes or miscommunication. Violent attacks against medical staff are commonplace.

In a survey by the Chinese Medical Doctor Association, more than 60% of doctors said they had been subjected to physical abuse and 13% had been physically assaulted in 2015. That year, there were 115,000 reported disputes in hospitals with 4600 serious "security incidents" leading to 1425 arrests.

There have also been several widely reported fatal attacks against doctors by disgruntled patients or their family members.

The most recent, in early May 2016, saw an emergency surgeon bludgeoned to death at a Hunan hospital by relatives of a traffic accident victim. After they were arrested, the assailants claimed the doctor had "not been vigorous enough" in treating their relative and had told them to wait their turn, according to Xinhua News Agency.

Such attacks have led to walkouts and public demonstrations by medical staff calling for authorities to crack down on violence.

On each occasion, the government has vowed to "strike hard" against offenders, but aside from ordering hospitals to hire more security guards, little has been done in reality.

Some doctors have taken to wearing personal protective gear such as stab-proof vests to work.

Primary care the solution?
China's health ministry is well aware of these problems and has two strategies to relieve the burden on hospitals: privatisation and primary care.

One of the key healthcare reforms underway in China at present is a move to bring "social capital" (namely, private investors) into the hospital sector. To encourage this, the Chinese government has relaxed laws to allow private operators to set up hospitals, with pharmaceutical companies taking a lead in the sector.

Just as importantly, China's health ministry has also eased employment regulations for doctors so that they are no longer tied to state-owned hospitals and have the freedom to work where they please.

In the past year, there has been a rapid increase in the number of ‘independent doctor groups' being set up to run private clinic services — the Chinese equivalent of US groupings such as the Mayo Clinic.

China's second major healthcare reform is a plan to boost the primary care system. This is a much tougher challenge. The current ‘community clinic' sector is very much an underdeveloped and under-resourced poor cousin to the culturally prestigious hospital system.

Some of the reasons may sound familiar. Few of China's doctors are willing to work in community clinics because the pay is poor, the clinics have little equipment and, unlike the hospital system, there is little prospect for promotion or career advancement.

China's health ministry has set itself a goal of having one family practitioner for every 2000 citizens by 2020 (the GP-patient ratio in Australia is around one FTE GP for every 1080 people).

But to meet this target, China would have to train an additional 400,000 medical practitioners. The scale of this task can be grasped by the fact that there are only 170,000 doctors in training, of whom 13,000 are in the generalist community practitioner training stream.

Primary care pilot projects have been trialled in China's major cities such as Shanghai and Shenzhen, but with mixed results.

They are declared a success by their proponents, on the basis of achieving 90% enrolments in their areas. However, there is still a marked reluctance among the Chinese public to actually use community clinics as the first port of call. Most still make a beeline for the major hospitals, which are still seen as the ‘centres of excellence' for medical care.

China's health ministry — like so many Australian governments — is nevertheless proclaiming that primary care is the way of the future for healthcare. They have also been mixing carrot-and-stick approaches to encourage the public to use primary care clinics, such as offering free consultations, but also making it mandatory to get a GP referral for a hospital appointment.

The ministry has also ordered that GP training pathways be set up and requires medical schools to introduce ‘primary care pathway' training quotas.

Meanwhile, the effects of a medical system that has embraced the alleged wonders of hospital-based care, can be seen.

Back in the Kunming hospital, by mid-afternoon the corridors are crammed with patients, hanging about at the doors of the clinics in the hope that a doctor will "squeeze them in" at the end of their official list.

But as one doctor told me, "It's too much. I'm supposed to finish at 5pm but most days I'm here for an extra hour or more. I am always late for dinner. I studied medicine for eight years and yet I work longer hours and earn less than a hairdresser."

He adds: "My parents are doctors but I wouldn't want my child to be a doctor."

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Michael Woodhead is Australian Doctor's clinical editor.

Why Beijing's war on hospital ticket scalpers is doomed to fail: top cardiologist says jail sentences won't fix supply & demand problem

by MICHAEL WOODHEAD
This week a Beijing court sentenced 15 hospital ticket scalpers to prison sentences varying from 19 months to two years in jail. It's all part of a very public crackdown on the practice of 'entrepreneurs' buying up the hospital clinic reservation numbers (guahao, 挂号) that are needed to gain access to see a doctor. Typically, these hospital tickets cost 20 yuan at the front desk but are bought up and sold for ten or more times their face value by scalpers (piao fanzi, 票贩子) who operate in gangs around the foyers of public hospitals.

In theory, China's hospital clinics operate on a first come, first served basis. Whoever is prepared to queue up early at the hospital ticket window in the morning gets the tickets. In practice, the scalper gangs either send their agents to stand in line and book an appointment - or they have inside connections with hospital staff to procure the tickets through the back door. The corrupt practice has been going on for years, but made headlines in January when a video emerged showing a young rural migrant woman ranting about the scalpers at a Beijing obstetrics hospital. The video went viral on China's social media channels and there was soon public pressure for 'something to be done'.



As in the past, the hospitals and the Beijing health department announced yet another "get tough" campaign on scalpers. They sent in the PSB to round up the usual suspects. They also issued a series of "Five Musts" measures that included real name registration procedures and an end to collusion between hospital staff and scalpers. And as usual, an example has been made of a few offenders in the media. The Party has listened to the masses and taken action. Never mind that the 15 offenders sent to jail weren't actually scalpers, but fraudsters. They had hired hospital rooms in which they used bogus doctors to swindle unsuspecting out-of-towners into jumping the queue and paying for dodgy TCM treatments.

But even if the authorities had enacted a serious and enduring action against hospital ticket scalpers, it still would not make any difference, according to one leading cardiologist.

Professor Yang Qing, has worked at the cardiology department at the Sichuan University Huaxi Hospital for 20 years. He says the problem is not due to the scalpers, who are only the symptoms of a monopolistic system. Professor Yang says it is important also not to blame doctors, who are also constrained by the system.

According to Professor Yang, every day his hospital cardiology clinic in Chengdu is besieged by patients from far and wide, seeking a consultation. Patients come not only from Chengdu, but also from across the province and even from overseas. A typical clinic has 20 allocated slots to see patients with an average consult duration of 6 minutes - but most will actually fit in 30 patients by running over time. Every day at the front desk he is mobbed by people saying: "Professor Yang can you add an extra place for me?" Some are very deserving patients who have traveled a long distance to see him - even renting rooms near the hospital. Others are former patients who want continuity of care and to be followed up by the same treating doctor. And there are also 'insiders' - acquaintances, connections and people who work in the hospital who seek an appointment with him.

Professor Yang says the demand for 'tickets' is inexhaustible and he only has a finite amount of time in a working day. On a typical day he works right through an after noon clinic without a break even to go to the bathroom. He is supposed to finish at 5pm, but usually does not actually finish until at least 6pm. If there is a chance he will add a few extra places, but he says he feels bad for not being able to accept all the requests. And his colleagues all feel the same way. They are not heartless, but they have other responsibilities and things to do - not to mention family life. Professor Yang says that in addition to attending to patients in the outpatient clinic he must also do surgery, supervise junior staff, take part in research and write reports. He must attend medical conferences and teach students.

Professor Yang says that the demand for hospital tickets is high, but the price is low and does not reflect the 'economic value' of the doctors' skill and experience. The scalpers are simply selling the doctor's appointment at a price the market is prepared to pay, he says. And the 'profit' is going to criminal gangs instead of to the hospitals.

Professor Yang says that what the scalpers do is an unsatisfactory and unfair situation, but he believes it is inevitable under a monopoly system. It would be unrealistic to expect them to be stamped out - and even if all the ticket scalpers were removed there would still be an imbalance between supply and demand of medical appointments, he says.

"When a resource is scarce, and when everyone wants to have this resource, the authorities' fight against ticket brokers is meaningless," he says.


Professor Yang says that in theory a system that guarantees low prices is good because it makes treatment affordable for everyone. However, in practice he says low prices enforced within a monopoly lead to low quality care and also to the 'detestable' practice of scalping.
 
Professor Yang's solution is a free market one - free up the doctors to set their own prices and let them manage their own patients. In this way, there will be competition between doctors that will keep prices low and affordable while raising levels of service and quality, he believes.

[Editor's note: Given that they have been given prominent place in the state media, Professor Yang's pro-market comments are presumably endorsed by the government and China's minister for health. It's notable that the learned professor suggests a new model based on the US free market healthcare system, and makes no mention of other more successful models such as the gatekeeper' system of Britain's NHS. 

The kind of problems that Professor Yang describes do not occur in the UK  because that country (like many others) has an efficient primary care gatekeeper system that ensure that patients do not go straight to hospital. To see a hospital specialist, patients in countries such as the UK and Australia must first go to see a community-based general practitioner, who decides if and where they should be referred. This means that patients with minor illness and chronic disease can be managed in the community' rather than clogging up the overloaded hospital system. It also means that patients are sent to the most appropriate specialist. 

Of course the system isn't perfect because financial restraints mean that public hospital patients often have to wait months for an appointment to see the doctor. In countries such as Australia, patients can jump this queue if they have private health insurance (but they still need a GP referral) But if any patient needs urgent care, they can receive it. 

Interestingly, China is pursuing both these options. It is loosening the monopoly of public (actually state-owned for-profit monopoly) hospitals. China is also moving towards a community/family doctor system. However the progress is glacial because of the entrenched financial interests of local governments [and managers] in their local hospital monopoly. So is the solution to hospital scalpers a crackdown, free-market healthcare or a gatekeeper system? You decide ...]

China's public hospitals and breastfeeding mums are the losers with latest free trade deal

by Michael Woodhead
China's private hospitals are the winners and breastfeeding mums are the  losers under the Free Trade Agreement Xi Jinping agreed with Australia today.

The FTA gives Australian companies unprecedented access to China's healthcare system, allowing Aussie  health providers to build and ­operate hospitals in China without the current restrictions that apply to other foreign health companies.

Until recently foreign companies have only been allowed to set up joint venture hospitals, although rules have recently been eased to permit foreign hospitals to be buy or set up hospitals and clinics in Shanghai, Beijing and Tianjin.

One of Australia's leading private hospital operators, Ramsay Health, has already announced a move to buy into a Chengdu private hospital group  that operates five hospitals. However, it remains to be seen whether other Australian companies follow suit, especially given that Australia has only a limited number of private hospital operators. Australian healthcare companies may also find it difficult to work in the cut-throat China healthcare environment as they are  accustomed to working in a heavily protected and subsidised market. Private health companies receive $5 billion in Australian government handouts a year in a support scheme introduced in the 1990s to prop up the uncompetitive industry when Australians abandoned private hospitals in favour of the public hospital system funded by Medicare.

Australians are more accustomed to dealing with China over resources than services, though one mining tycoon  has been quick off the mark to cash in on the free trade agreement to sell milk formula to anxious Chinese mothers. Billionaire Gina Rinehart, whose fortune come from iron ore mines she inherited from her father, has announced she will set up a massive dairy operation to produce milk formula for the China market. Australia's richest woman will acquire about 5,000 hectares of farmland in Queensland to that is expected to produce an estimated 30,000 tonnes of infant formula for export to China every year.

However, the move is unlikely to be welcomed by China's child health specialists, who are already struggling to raise China's pitiful 28% breastfeeding rate to somewhere near to the global average of 40%. Groups such as the World Health Organisation and UNICEF have called for urgent action to boost China's breast feeding rates, but they struggle against aggressive and unethical promotions by milk formula companies, who are also known to bribe hospitals and clinicians to promote their products.

Jumping the queue at Beijing hospital costs 200-600 yuan

by Michael Woodhead
Faced with the prospect of queuing for hours - or even overnight - for a registration ticket for admission to the Beijing Children's Hospital, parents are prepared to fork out up to 600 yuan to a scalper.
The going rate for a 5 yuan (80 US cents) registration ticket is 200 yuan ($32) for a general appointment and 500-600 yuan ($80-95) for a specialist appointment, according to the Beijing Daily newspaper.
To investigate the scalper situation a reporter from the paper went to the children's hospital foyer and posed as  parent seeking admission of their child for acute illness.  He didn't have to look far - in fact he didn't have to look at all, as he was surrounded by a group of three scalpers all shouting out offers of a variety of 'appointments' and proferring their business cards. They said they could supply registration tickets for appointments on any time and also for any department .
The conversation went like this:

Scalper: What department do you want - general or specialist?
Reporter: How much is a general ticket?
Scalper:  200 yuan. Can arrange any date within the next three months or next week. We have today, tomorrow ... you get the idea. Every day, every department.
Reporter: What about the 'named user ticket system' [similar to train ticketing, in which tickets are only valid for the user ID]?
Scalper:  No problem. We've been doing this for eight years. Just use my ID to get in the clinic, then switch when you get to see the doctor.

On the electronic screen in the hospital foyer there were almost 70 different clinical departments listed, and the screen showed that 90% were 'sold out' - no appointments available. Despite this, long lines stretched back from the registration ticket office window. One father from Shaanxi told the reporter he had been waiting all night without success, and so had turned to the scalpers to get a registration ticket for his sick child. He said he had seen at least ten scalpers operating at the hospital. Several of them were openly touting for business along the line for the registration office. Sometimes they helped each other out and 'swapped' tickets, sometimes they strove to undermine or 'outbid' their competitors. It was a very chaotic situation.
According to a spokesman for the nearby Yuetan Police Station, there were more than a hundred hospital scalpers operating in the area of the hospitals. Although they operated quite openly trying to 'recruit' customers in the queue, arresting them was not easy. This was because they had to be caught 'in the act' exchanging tickets and their illegal sale of tickets had to be confirmed by the person buying them - but most refused and fled. And even when caught, they scalpers faced a maximum of five days in detention and a 50 yuan fine. This was only a fraction of a single 'sale' of a ticket for 200-600 yuan, and thus was no deterrent, the police spokesman said. With no effective law this meant "social order is disturbed", he concluded.

Hospital ticket scalpers fight outside Beijing hospital gate

by Michael Woodhead
A gang knife fight that erupted outside the door of Beijing University Hospital in February has been revealed as a turf war between hospital ticket scalpers.
Twelve people have been arrested and seven charged with gang-related activities after a police investigation into the scuffle found that it was related to the re-sale of hospital registration slips.
In China, patients face long waits in queues at a counter to 'register' and get a number before they can make an appointment to see a doctor. In a way similar to tickets for trains and entertainment events, criminal scalper gangs obtain these tickets and re-sell them at a markup to people who want to jump the queue.
On the 25th February Xicheng police were called out to a mass fight with knives at the Beijing University Hopistal door. When they arrived they found tow injured men and a women, but the culprits had fled. The injured trio told police it was a fight between friends that had got out of hand - and they refused to co-operate or say any more. Police suspected there was more to the incident and set up a task force to investigate. They subsequently found that the fight was over protection money demanded by a local gang from a group of ticket scalpers working around the gates and doors of the hospital. The gang regarded the hospital as their territory and demanded payment from the scalpers. When there was a dispute about payment, the fight broke out. The police arrested twelve people who now face charges of assault as well as gang-related illegal financial activity.

Doctor defamed online by spurned patient

A well respected ophthalmologist at a Chengdu hospital was slandered online by a patient who claimed that he was unethical and had discriminated against her daughter. In an 'exposure' on an online forum, the female patient said her daughter had been refused treatment by a Professor Liu, who discriminated against her because she was a single mother and yet he consented to treat other patients who were less deserving than her. On a popular social media site the woman said the professor had no ethics and she warned that he discriminated against common local people. The post stirred up a lot of angry debate about the ethics of the doctor.
However, when reporter from Sichuan Online followed up at the hospital he heard a very different story. The staff said the woman was impolite and demanded treatment despite not having registered at the hospital. Also she had no medical records and her case was not urgent. A patient from Yunnan was seen instead as their case was urgent and because they faced extra expenses if the case was delayed until the following morning.
Professor Liu said he personally intervened after the woman  argued with nurses. He said it was reasonable in a busy clinic to ask the woman to return when she had her medical records. The other case was more deserving. A security camera recorded the woman acting aggressively and knocking over billboards and items on a table in rage.
However, this story was not told online, and the social media site was led to believe that Professor Liu was an arrogant and uncaring doctor with no ethics. His name has been blackened. Nurses and staff at the hospital said he was a caring and hard-working doctor who often stayed until 9pm at night to ensure that all patients in the waiting room were treated.

Inquiry rejects claims of Mianyang hospital whistleblower

by Michael Woodhead
A local inquiry into a Sichuan doctor's claims of over-servicing and financial irregularities at a Mianyang hospital has concluded that there is no case to answer.
In a story featured prominently in the People's Daily, the claims of Dr Lan Yuefeng have been found to be unsubstantiated by a major investigation conducted by health and disciplinary authorities in Mianyang into affairs at the Renmin Hospital. Dr Lan claimed to have been stood down over her claims that the hospital was driven by income targets that led to overservicing and inappropriate and unethical treatment. Barred from her office in the ultrasound department, she worked in a hospital corridor for almost two years.
However, an investigation by the local health department and party disciplinary and audit committees has refuted all of her allegations, according to the People's Daily.
The investigation found limited evidence of financial performance related targets and income at the hospital, but said these were in accordance with local health department guidelines and were corrected over time.
The investigation found that Dr Lan's claims of inappropriate use of a cardiac pacemaker for profit rather than clinical need were unfounded. The inquiry also rejected claims that there was 'medical chaos' at the hospital and no abnormal growth in servicing or revenue.
The investigator rejected claims by Dr Lan that she had been stood down because she voiced opposition to the inappropriate use of medical procedures such as the use of a cardiac pacemaker.
However, the inquiry did find fault with the hospital in terms of the overall quality of medical treatment, the attitude of staff to patients and the responses to complaints.
The investigation team said staff were lacking in political ideology and more work in this area was needed, especially for Dr Lan, whose political thinking was primitive. Political work needed needed to be strengthened to counsel Dr Lan and also to rectify the problems identified according to the law, it concluded.

Suzhou hospitals get real time online data monitoring for insurance and medication claims

The Suzhou social insurance fund has implemented an online real time data handling system for 43 hospitals that allows medical insurance claims and medication dispensing to be verified to enhance quality assurance and prevent fraud. The new system replaced the old manual input of claims data last year, and allows the health fund to collate medical insurance claims data alongside medication use and patient and hospital details. The system allows the social insurance centre managers to identify abnormal prescribing patterns and to give feedback directly to the hospital and the clinicians. For instance, in the first three months of operation data analysis has revealed that some male patients have been given medications for female medical problems and others have been given drugs for a different indication to the one for which they were being treated. The new system marks such anomalies with a red flag and gives feedback to the prescriber and to the hospital.
Source: Suzhou Daily

Tiantan hospital to move from historic location

Tiantan Hospital, a top-level hospital in downtown Beijing, is to be moved to the southwestern suburb of Fengtai district in 2017, officials said on Thursday.
The hospital is located inside the outer wall of Tiantan, the Temple of Heaven, a park where emperors held sacrifices during Ming and Qing dynasties.
Zhao Lei, deputy director of the Beijing Commission of Development and Reform, said moving the hospital from the Temple of Heaven will better protect the historic site.
The move will also help relieve pressure in urban Beijing and better allocate the city's medical resources, as most top-level hospitals in Beijing are concentrated downtown, he said.
"Within the radius of five kilometers from Tiantan Hospital are many hospitals, including Peking Union Medical College Hospital, Tongren Hospital, Friendship Hospital and Xuanwu Hospital," he said. "Moving Tiantan Hospital will help allocate quality medical resources to Fengtai district, and not as many people will have to swarm to hospitals downtown."
The new site of Tiantan Hospital will cover an area of 352,000 square meters, nearly four times the area of the present hospital. Construction is expected to finish by the end of 2017, for an estimated cost of 3.66 billion yuan ($603 million).
Source: China Daily

Cold blooded doctor comment angers relatives of dead Jiangxi woman

by Amy Li
The family of a 35-year-old woman who died giving birth last month is accusing a Jiangxi hospital of malpractice, and is considering launching a third-party investigation into the matter, Chinese media reported.
But what infuriated many Chinese bloggers more than the dispute over patient Li Xiaoyang’s death was what many called a “cold-blooded” comment from the doctor who operated on Li, Guangren hospital president Zhang Ning.
In an interview with Southern Metropolis Daily this week in Wuren county, Zhang allegedly said, “A hospital is the place where people die.”

Baby wakes in crematorium after being certified dead at Anhui hospital

A Chinese baby that had been declared dead by a hospital was saved from cremation when it started crying at a funeral parlor in East China's Anhui province on Wednesday morning.

The baby boy, less than one month old, was sent back immediately to the Anhui Provincial Children's Hospital for emergency treatment after he was found alive by a staff from the funeral parlor in Hefei, the provincial capital.

The Anhui Provincial Children's Hospital had issued a death certificate for the boy. He would have been cremated under normal procedures, according to the Hefei Municipal Funeral Parlor.

The baby had suffered from congenital respiratory system malformation since birth and was critically ill. His parents agreed on November 12 to give up his medical treatment, according to a staff member from the hospital.

"Because the baby still had life signs, we continued to give him transfusion to maintain his life for humanitarian reasons," said the staff member on condition of anonymity.

The reasons for the baby being mistakenly confirmed dead need further scrutiny, according to the staff member.

The baby boy is still receiving emergency treatment at the hospital.

A doctor and a nursing worker who were on duty on Wednesday and judged responsible for the accident have been suspended from work and laid off respectively, according to the hospital.

It is investigating the case and said it will release the results to the public in time.

Source: China Daily

Wenzhou doctor gets her skates on

A female doctor in Wenzhou City, Zhejiang Province, has started using roller skates to save time while on duty as she needs to shuttle between various hospital departments to treat patients, earning admiration from members of the online community.
The woman surnamed Cui, a cardiovascular physician at First Affiliated Hospital of Wenzhu Meical College, said she was exhausted after running around the hospital all day and the roller skates made it a lot faster and easier.
Zhang Huaiqin, Cui's leader, was the first one to post her story online.
"The new hospital is 20 times larger than before and cardiac physicians have so many urgent consultations," he said.
Zhang said their own department has capacity for 153 patients, but they are frequently required to care for patients in other wards because there are a large number of elderly patients with high blood pressure and heart problems.
Doctors are expected to reach consultation offices within five minutes, according to a Ministry of Health rule. To save time, most physicians run between different hospital departments, Zhang said. Doctors can run up to 12 kilometers a day, he said.
Some netizens expressed admiration for Cui's devotion to her job.
"I have seen waiters with roller skates, but never doctors in a hospital. It's a good idea and should be advocated among physicians," a netizen said.
The hospital said it doesn't encourage others to follow Cui's example due to safety concerns.
Source: china.org.cn

Baby dies in incubator after Hebei hospital power cut

Power cut at the Xianxian Maternal and Child Health Hospital blamed for incubator death

Health authorities are investigating a hospital in Xianxian County of Hebei Province, where a newborn baby died in an incubator after a power failure cut off its heat and oxygen supply for about five hours, local media reported.
The baby boy's mother gave birth on December 2 at the Xianxian Maternal and Child Health Hospital. The boy looked strong but with his face looked pale, the doctor sent him to an incubator for oxygen therapy, the parents told Yanzhao Metropolis Daily.
But the next day, a power blackout occurred at the hospital from 1:40am to 6:30am, cutting off oxygen and heat to the incubator, the parents told the newspaper.
The baby's father, Li Dabing, said he was worried whether the baby would catch cold in the incubator when the power failure occurred, but a nurse told him not to worry, as power is usually restored after an hour.
"I was thinking about taking my baby out of that incubator, but the nurse wouldn't help remove the medical equipment, such as tubes, from his body," Li told the newspaper. "I feared that the baby may catch cold there as even I felt cold in cotton-padded clothes."
They waited until the hospital restored power after a worker started the emergency electricity generation system.
The parents said the baby was then found suffering symptoms of exposure to cold, as his face appeared very red, he had a fever and kept sneezing in the incubator.
The baby was pronounced dead last Wednesday, three days after it was born.
"I believe the death of my son is directly related to the hospital's power failure and the cutting off of the oxygen supply," Li said. "As a public hospital, how can the medical workers restore power five hours after the blackout started?"
A hospital vice director surnamed Luo said that the poor condition of the hospital's facilities was to blame for the five-hour-long power failure.
Source: Yanzhou Daily

Shaanxi 'nail house' hospital attacked by thugs over demolition dispute

A hired mob caused damage to the hospital and attacked people

Twelve suspects involved in vandalism attacks at a hospital in northwest China's Shaanxi Province have been arrested yesterday, according to local police.
A group of masked men had been smashing the Century Hospital in Xianyang, Shaanxi Province in northwest China three times from September 13 to October 7. Many medical facilities were destroyed.
"We have lost almost 100 thousand yuan (around US$13,000) just in terms of property," said Wang Dongjun, vice president of the hospital. "Three staff on duty were also injured."
Wang said the hospital was smashed because it didn't agree with the demolition conditions provided by the property developers.
"We invested over 20 million yuan into construction of this hospital, but the developer only plans to compensate 1.4 million yuan for demolition."
Zhao Zhengyong, head of Shaanxi province pledged to examine the issue in October. Apart from the 12 arrested, the local police are after those at large at this moment.
Source: Sina

Contaminated instruments kill five patients at Beijing hospital

 Acinetobacter baumannii infection was transmitted from an inadequately-cleaned bronchoscope

by Michael Woodhead
At least five patients have died at a Beijing hospital with a 'superbug' infection from a dirty bronchoscope that doctors were sterilising themselves.
An outbreak caused by multidrug-resistant Acinetobacter baumannii  affected 12 patients being treated at the intensive care unit of a 1200-bed hospital in Beijing.
An investigating team led by Dr Xia Yukun of the Department for Hospital Infection Control & Research at the Institute of Disease Control & Prevention of PLA, Academy of Military Medical Sciences  traced the outbreak  to inadequate sterilisation techniques used to clean the ICU's bronchofiberscope.
The researchers found that there was only one bronchofiberscope in the ICU and bronchofiberscopy was performed once or twice each day for secretion clearance, tracheal intubations, and bronchoalveolar lavage. Usually, the bronchofiberscope  was sterilised thoroughly by professional staff in the hospitals' disinfection unit according to according to the appropriate guidelines for endoscopy cleaning and disinfection However, when the bronchofiberscope was used in an emergency situation it was cleaned  manually by a doctor in the ICU after use. During the outbreak period, 12 patients were infected with the multidrug-resistant Acinetobacter baumannii, which is hard to eliminate because it survives on many surfaces and has extensive resistance to many of the currently available antibiotics, including cephalosporins, aminoglycosides, quinolones, and carbapenems.
Five patients died of the infection during the outbreak.
The researchers say the bacteria might have been transmitted through direct contact with the bronchofiberscope or transmitted through healthcare workers’ hands during other medical procedures.
"In our investigation, most of the [bacteria] were isolated from the healthcare-associated environmental surfaces including the bed sheets, bedrails, dispensing table and nurses’ desk," they note.
"Our findings emphasize that bronchofiberscopy must be performed with appropriate infection control measures ... strict bronchofiberscope reprocessing should be performed after each procedure and at the end of the day according to the published guidelines. It might be wise to increase the number of bronchofiberscopes available in each ICU to guarantee professional bronchofiberscope
reprocessing," they conclude.
Source: BMC Infectious Diseases

Beijing man jailed for trying to evade $28,000 kidney dialysis fee

Man who faced 5000 yuan a month dialysis fees faked payment stamp

A Beijing man was sentenced to three years in prison with a four-year reprieve by a local court Friday for using a fake hospital stamp to avoid 172,000 yuan ($27,608) in medical fees for his wife's kidney dialysis treatment over four years.
Liao Dan, a 41-year-old unemployed man, was sued by the prosecutor's office of Dongcheng district in July after he defrauded the Beijing Hospital by using receipts with a forged seal so that his wife, Du Jinling, could receive dialysis. Liao could not afford the monthly treatment costs of 5,000 yuan.
He initially faced a sentence of up to 10 years for defrauding the hospital, but his case triggered an outpouring of public sympathy.
Donations totaling 500,000 yuan, enough to cover 10 years of dialysis, were raised by the public for the family, the Beijing Evening News reported Friday.
Liao used part of this money to repay in full his outstanding medical fees.
Liao welcomed Friday's verdict, the most lenient expected, handed down by the Dongcheng District People's Court. "The medical treatment for dialysis has been paid for by the donations. I won't rule out a kidney transplant operation for my wife as long as there's a match," he said.
Liao's wife Du, who is from Hebei Province, was unable to get her medical expenses reimbursed because she does not have a Beijing hukou, or household registration permit. Liao and his wife live on a monthly subsidy of 1,700 yuan as low-income earners.
Experts reached by the Global Times labeled the ruling as appropriate and reflecting humane judgment within the rule of law.
"When handing down criminal sentences, the judiciary department tends to show greater leniency when humanity is involved," Liu Tao, a law professor from the Beijing-based Chinese People's Public Security University, told the Global Times, noting that the State did not suffer any substantial economic loss as all money owed was repaid.
Feng Yujun, a law professor from Renmin University of China, told the Global Times that Liao "would not have defrauded the hospital" if his wife "had access to medical insurance."
Chen Lihao, a member of the Zhuhai Committee of the Chinese People's Political Consultative Conference, who has helped Liao's family, posted on his Sina Weibo, "The sentence has made [Liao's] wish of continuing to take care of his family come true."
Chen noted that the isolated case to some extent highlights problems with China's current medical insurance model.
Five central government agencies released a circular on August 30 that stipulates urban and rural residents with medical insurance coverage can be reimbursed for at least 50 percent for medical expenses related to critical illnesses.
Source: Global Times

Doctor killed in axe attack at Tianjin hospital

A female doctor was killed at the hospital affiliated to the Tianjin University of Traditional Chinese Medicine

 A female doctor was axed to death by a man in a hospital in North China's Tianjin municipality on Thursday, police sources have confirmed.
Kang Hongqian was attacked and killed at around 1:30 pm by the axe-wielding man in her clinic on the second floor of the No 1 Hospital, which is affiliated to the Tianjin University of Traditional Chinese Medicine, sources said.
Kang, who was on duty at the time of the incident, was a chief doctor with the department of acupuncture at the hospital.
The attacker, whose identity is not known, jumped out of the building after the attack and wounded himself.
He is now under police custody.
The scene has been cordoned off by police, who are investigating the cause of the attack.
Read more: China Daily

Nurse stabbed to death by disgruntled patient at Anhui hospital

On November 13 at the Second Affiliated Hospital of Anhui Medical University a man with a kitchen knife stabbed five staff, killing a nursing sister and injuring four others, two seriously.
According to a Xin'an Evening News reporter, the alleged attacker had previously been receiving treatment at the hospital but had been unable to pay medical bills, and so the hospital has suspended the supply of drugs. He is said to have left and then returned  with a kitchen knife and attacked the nursing station in the urology department. The local police rushed to the scene after receiving the alarm and quickly arrested the suspect. According to reports, Ms Dai Moumou, a 36-year-old urology sister was killed after being stabbed in the neck. The other victims included  a deputy chief physician, an attending physician and a male and female nurse. Hospital staff and managers paid tribute to the deceased nurse, saying she was an outstanding and dedicated worker who set a great example as nursing leader and teacher, as well being a selfless,  hard working and kind.
Read more: China Medical Tribune

Chinese healthcare: Gangnam style

A total of 30 people participated in a Gangnam-style healthcare video, says Wei Xiang, trade union chairman of the Henan Provincial Chest Hospital. Participants included several patients hospitalized in the hospital and the protagonist is the "hospital director of thoracic surgery".
The video of the dance by Henan Chest Hospital staff included doctors, nurses, gardeners, security and others, became immediately popular online with 5,000 comments in the first day it was posted, and the "hospital director of thoracic surgery" Zhang Junan has inadvertently became popular.
When asked about the reason for shooting the video, Lei Xinjiang, party secretary of the Henan Provincial Chest Hospital, said Gangnam style was popular throughout the world, loved by the people, and the main reason is the music is inspiring people happy. However, shooting this subject as a medical unit, the conception had to be in line with the party committee and government policy, embodied under the premise of the people demands. Therefore the hospital determined it should reflect the expectations of both doctors and patients around the harmonious relationship between doctors and patients, reflecting medical unit practitioners in a relaxed and happy work environment.
Lei Xinjiang said doctors and nurses go to work every day and are faced with different kinds of patients with a variety of the disease, which is not a cause for laughter, so this creates work pressure. The aim of the "Gangnam style" is to bring some humour and reflect their relaxed working environment with roles acted by drivers, cleaners and security.
 Zhang Junan the 'star' started 10 years ago in the hospital as a security guard, has 20 years of dance as a hobby and in his spare time began to teach dance. Now, he can be found teaching at the regular dance locations in the local square. "I did not expect such fame," he says."

Read more: China Healthcare