How much does it cost to go to the doctor in China?

by Michael Woodhead
How much does it cost to see a doctor in China? Well the basic consultation fees may be cheap at just 20 yuan or so, but figures released by the health department of Dongguan in Guangdong show that the average cost of a hospital clinic visit is about 155 yuan (US$25).
The average cost of clinic visits per person in a year was 530 yuan ($85). Bear in mind that most people with an illness in China go direct to hospital, where they will register and wait several hours to see a doctor for just a few minutes. No wonder they call it kan bing nan, kan bing gui (看病难, 看病贵 Difficult to see a Doctor, Expensive to see a Doctor).
The figures released by the Dongguan health department also show how much you might expect to pay for inpatient treatment. At this medium level city in an affluent part of China a public hospital bed will cost you 910 yuan a day (US147). The report says that the average costs per person per year of hospital treatment overall were 7820 yuan ($1260).
These costs were lower than the average for larger hospitals in cities such as Guangzhou, where a hospital clinic treatment would cost 250 yuan ($40) and an average hospital stay might be as much as 14,000 yuan ($2250).
These are the upfront costs for hospital treatment. Many people will be covered by some kind of basic national health insurance. Typically this might cover 30% of outpatient clinic costs and up to 70% of inpatient costs.
This means that a patient might face a 'gap fee' of 100 yuan per clinic visit and 300 yuan per day in hospital. However, like health insurance schemes everywhere there are major restrictions on eligibility,  procedures covered and 'caps' on reimbursement.
Some people questioned the high costs put out by the health department, saying they were not the fees they expected to pay for visiting a clinic for a cold or fever. However, the department said they were average costs, based on hospital finance department figures, and included costs of medicines and other services. For some patients undergoing procedures such as surgery, they could be much higher, raising the average.  They said they fees were higher at tertiary level hospitals and they had released the figures to show that it would be much cheaper for people to seek treatment for minor illnesses at community level "general practitioner" clinics.
For comparison, a mainland Chinese reporter went to Hong Kong to see how much it cost to see a doctor there. They found that in public hospitals the doctor consultation fees were a nominal 50HKD (40 yuan) and the costs of an inpatient stay was 100 HKD per day (80 yuan), including all food. There were very few queues. Locals said they preferred to go to local GP clinics for minor illnesses, or a private GP clinic, where the cost of a consultation was a modest 100HKD, rather than hospitals, which were for more serious illness.

Robot surgery for Chengdu | Aussies help with primary care | Weibo cancer medical fee man dies

Robotic surgery is now being used by hospitals in China, with the da Vinci surgery robot system completing its first operation at the Provincial People's Hospital in Chengdu. The 30 million yuan ($5 million) system can perform accurate and less invasive surgery in cases such as prostate cancer and gallbladder procedures but has been criticised by some clinicians as being an expensive system with a steep learning curve that does not offer any real improvements in outcomes compared to conventional surgery.

China is turning to Australia for advice and training in how to expand its primary health system. The National health and Family Planing Commission has asked Melbourne-based Professor Shane Thomas of Monash University to help guide the pilot programs of primary care taking place in Shenzhen. Monash is also hosting 24 Chinese health managers who are attending a leadership-training program at the School of Primary Health Care.

A Chinese man with cancer who became famous for using Weibo to solicit donations for his medical bills has died. Noodle shop owner Li Gang of Zhengzhou raised $16,000 to pay for medical treatment which he could not afford in 2012. His message went viral and he had many visitors to his noodle shop, but some commentators said it highlighted the lack of affordable medical care for most Chinese people with cancer.

One Country, Two Health Systems: or how Hong Kong has a socialist health system while China has a capitalist one

by Michael Woodhead
It is seldom remarked, but capitalist Hong Kong has a socialist health system while 'communist' China has a capitalist one. 
Hong Kong has a British NHS-inspired publicly-funded health service that remains efficient, good value for money and corruption free. China, on the other hand, has ditched its Soviet-era state-run 'health for the masses' system and replaced it with a state-owned user-pays system that is run on private lines. Don't take my word for it - there is an excellent article illustrating this in the obscure medical journal the International Journal of Radiation Oncology. It makes an interesting comparison of the Hong Kong and Chinese health systems through the eyes of oncologists who work in a cross-border co-operation clinic in Shenzhen.

Health systems
The oncologists note that Hong Kong's health system is based on heavily-subsidised public hospitals that provide treatment at no cost or only minor cost to all Hong Kong residents. It is an efficient system that accounts for only a modest 5.2% of GDP (compared to around 9% for many western  countries and 17% for the US). The Hong Kong public health system is perhaps a little too successful for some interest groups, as it means there is a very low uptake (27%) of private health insurance.
In contrast, China has a capitalist health system (where “money follows the patient') that is struggling to meet the needs of many citizens. Although China has a high rate of health insurance (often funded by employers), this does not cover expensive drugs or medical treatments. There is no safety net system provided by the state, and medical bills are a major burden, especially for low-income families. Initial consultation charges are a modest $2-3, but all Chinese hospitals have to be financial sustainable and thus doctors are encouraged to prescribe expensive drugs, order tests and even promote nutritional products, none of which may be justified by the patient's condition. As the oncologists say with some understatement: "there are serious concerns about the cost effectiveness and quality of services." 

Disease trends
In terms of cancer, Hong Kong and China are also poles apart. Due to preventive health and better treatment programs, cancer rates have decreased by 22% in Hong Kong in the last 25 years and cancer death rates have decreased by 29%. In China, however, rates of cancer have increased dramatically in the last decade as Chinese people have become wealthier and adopted unhealthy lifestyles and persist in smoking. In Shenzhen, cancer rates increased  from 37 per 100,000 people to 100 per 100,000 in the last 10 years. Many of the common cancers could have been prevented through screening and early detection- such as cervical cancer in women, rates of which have been decreasing in Hong Kong. Hepatitis B vaccination is another intervention that should reduce liver cancer rates. 

Doctor training
For oncologist training, Hong Kong follows the UK system of requiring several years postgraduate training regulated by peer group 'colleges' during which clinicians must demonstrate practical expertise in medical oncology, radiation oncology and palliative care, rather than being single branch specialists. Thus patients are treated by a team of oncologists in a 'one stop shop' model. In China there is no formal training program for oncologists, most specialise in one branch of oncology by doing written exams and there is no palliative care training. In China the work of oncologists is governed by 'standard operating procedures' in which the emphasis is on compliance rather than quality or outcomes. 

Access to treatment
When it comes to treatment, cancer patients in Hong Kong have access via public hospitals to the latest technology such as linear accelerators, at modest cost (US10 per attendance). Access is based on clinical need, not financial status or connections. Thus a full course of radiotherapy would be about $400 for a public patient, whereas it would cost $36,000 for a private patient. Across the border in Shenzhen, access to the latest radiotherapy equipment is - in the words of the authors - "appalling". There are only a handful of poor-quality liner accelerators and they are scattered across various hospitals - most patients and doctors do not know how to access them, and even those who do are often reluctant to use them because of fears about toxicity, not to mention the high cost. Shenzhen needs at least 16 such machines (Hong Kong has 37) but hospitals find it extremely difficult to buy such major items because of red tape from the Ministry of Health and the inflated costs of middlemen and the 'commissions' needed to import high-tech equipment into China. 

Drugs - if you can afford them
Access to chemotherapy drugs also differs markedly between Hong Kong and China. In Hong Kong, drugs are approved for use if they can be shown to be cost effective. Regulators model their the drug approval processes on those of western countries.
Patients pay US $13 per oncologist consultation and US $1.30 per drug prescribed. Some high cost drugs are not publicly funded but some costs may be covered by the public safety net or by charities.
In China, many chemotherapy drugs are not available or are long delayed in gaining approval from the China FDA. Drugs that are approved are available on a user-pays basis and can be very expensive. Pemetrexed, for example, costs US $1155 for the genuine drug in Shenzhen although a Chinese generic version is available for US $353. However, the quality of generic drugs is often poor. There are no programs for low income patients. 

Opium wars left their mark?
For palliative care, Hong Kong has developed an integrated  multidisciplinary system based in public hospitals and with hospices. In China, palliative care services are limited or non-existent. There are no palliative care specialists, and so treatment is provided - if at all - by anaesthetists. Pain relief is hampered by draconian regulations over the use of opioids. Most doctors are not allowed to prescribe them, and those who are authorised can only provide a week's supply. Many terminally-ill cancer patients are too weak to return to the hospital every week. This means that cancer pain is under-treated in China.

Looking to the future, on the positive side, health services in China are now evolving rapidly and there is a huge demand for good-quality clinical services. The authors say their Hong Kong-Shenzhen hospital has been operating for only a year but is already providing valuable lessons and experience. It has established a strict 'no-bribery' rule and has also become the first hospital in China to gain international certification for quality of management.

[Editor's note: This story is based on an article by Drs Anne Lee, Henry Sze, Lam Ka-On and Chen Xian of the Clinical Oncology Center, University of Hong Kong – Shenzhen Hospital.]

The New Rural Cooperative Medical Scheme has failed: families are still impoverished due to ill health

by Michael Woodhead
Despite covering 90% of rural residents, the New Rural Cooperative Medical Scheme is failing to prevent rural families from becoming impoverished due to expensive medical bills.
A new study shows that 14% of rural families have experienced financial ruin due to catastrophic health expenditure, and one in three people have been unable to afford to go see a doctor when sick.
A review of the NRCMS, which was introduced in 2002, found that it only covered a small proportion of a family's medical bills because the insurance fund did not have enough money. Families typically pay 200 yuan a year to become eligible for the NRCMS, but when sick they face thousands of yuan in bills for treatments that are not covered by the scheme, and face high out of pocket expenses.
Dr Li Ye and colleagues from the Department of Social Medicine, Harbin Medical University found that households in rural areas faced a high risk of medical impoverishment, even if they were relatively affluent. The NRCMS only covered 30-40% of medical expenses, and therefore families faced high levels of out-of-pocket costs when a family member became ill. The study found that 28-30% of families did not seek hospital treatment but self treated when they were sick, because of the cost.
The researchers said the NRCMS had failed in its primary function of preventing catastrophic medical expenses because of the limited scope and low level of its reimbursements
They said that unlike urban health insurance schemes, the  pool of insurance funds in the rural scheme was managed  at a local country level and was insufficient to cover even the most basic medical expenses of someone with a serious or chronic illness. Another problem with the scheme was the lack of cost control mechanisms in the fee-for-service medical system, which meant that hospitals and clinics could take advantage of the system and encourage overprescribing and overtreatment to gain money from the insurance scheme.
"In order to offer a better benefit package for NRCMS contributory members, the financing level of the NRCMS needs to be increased. The NRCMS benefit package should align policies across the whole spectrum of health care services, including primary care, hospital care and long-term aged care. The integrated policies are also important for preventing cost shifting games.
Meanwhile, stronger attentions on provider-side measures need to be paid to control cost of health care," they concluded.
The findings are published in the journal PLOS One.

Harbin hospital charges dead patient for drugs and tests

by Michael Woodhead
The relatives of a 41-year old woman who died of pneumonia at  Harbin University No 2 Hospital are seeking an explanation for why they have been billed for two days of drug treatment and tests after her death. 
The woman spent 13 days in the intensive care unit after she developed pneumonia and kidney failure in February.  She died on 24 February and the family received an initial bill of 197,000 yuan (US$32,000) for her treatment. However when they came to transfer her body to a funeral centre they received an additional bill of 22,000 yuan ($3500) for drug treatment. The family had no option to refuse as they had already paid a deposit of 250,000 yuan as guarantee, and the hospital refused to refund the difference. They listed the additional costs as being for injections, respiratory tests and blood and heart monitoring.
The family disputed the bill, with the older brother pointing out that his sister would not have needed any tests in the 48 hours after her death. However,  the hospital refused to deal with them, so they took their complaint to the local bulletin board of Tianya. Many other local people sympathised with them and told of similar complaints of overcharging by hospitals.
A reporter from the Legal Daily took up the case and brought in accountants to analyse the bills.  They found that the bills for the extra two days were similar in size to those of previous days but they were vague and did not accurately show what treatments and tests were given or at what time.  When approached by the Legal News, the hospital's accounts department said it would review the figures. It later came back and said that after reviewing the billing it found some uncertainties and it was willing refund the family 18,000 yuan.
Other online commenters pointed the the famous case at the Harbin hospital in 2005 when a patient hospitalised for 67 days received a bill for 5 million yuan.
A spokesman for the hospital refused to comment, and the hospital manager was repeatedly said to be in a meeting when reporters sought comment from him on the case.

How much does the average Chinese doctor earn?

by Michael Woodhead
Much of the recent highly-publicised violence against doctors by patients has been triggered by resentment and mistrust of the medical profession, especially in relation to their earnings. 
In theory, doctors have only a modest salary, but everyone in China knows that many doctors make a lot of money through the so-called 'grey channels'. This week the People's Daily mounted an investigation to discover the true earnings of a typical doctor and the sources of their income.

After speaking to doctors off the record and also to other people working at senior levels in hospital management and in industry, it soon became clear that doctors have many additional and unofficial (but often legal) sources of income. The phrase "drug-dependent doctors" describes the reliance of doctors on prescribing for their income. Another well know rhyming phrase in hospitals is 'physicians rely on commissions, surgeons rely on operations' (it sounds better in Chinese - 'Neike kao huikou, waike kao shoushu').
A typical doctor at a large tertiary level hospital in Beijing will officially earn about 46,000 yuan (US$7500) a year. In reality, doctors earn more than three times that - about 180,000 yuan ($29,000) a year. The additional income comes from four areas:

1. Bonuses  - from hospital, for meeting patient number and performance quotas
2. Commissions for prescribing drugs and ordering tests
3. Red envelopes - from patients to get preferential treatment
4. Moonlighting - doing 'outside clinics' at weekends - often in regional cities and towns

One orthopaedic surgeon said that without the 10,000 yuan ($1600) monthly bonus from his hospital, most doctors in his department would leave. The basic monthly income of a doctor is only about 2-3000 yuan ($320-480), and no-one would work for that. The surgeon said all doctors depend on their monthly bonus for much of their income, and also the annual bonus, which can be several thousand yuan. The real income for a hospital specialist is about 180,000 yuan ($29,000) a year, and for a head of a department as much as 250-300,000 yuan ($40,000-48,000) a year. The income varies between departments and specialities. Some areas such as orthopaedics, surgery and cardiology are the highest paying. Others, such as paediatrics, have a lower income because doctors in these specialities prescribe fewer drugs and use fewer tests. A doctor in a  regional hospital would also earn less - maybe only 10,000 yuan ($1600) a month.

Doctors also get commissions from the sales of drugs. It is well known that hospitals rely on commissions on drug sales, which make up 50-60% of their income. Doctors also individually benefit from drug sales, says a drug company representative. Whether they agree or not, doctor's income is related to how many drugs they prescribe. Companies reckon that 10-30% of drug sales income goes to doctor.s for choosing them and prescribing them. Surgeons do not prescribe as many drugs but they make money from 'red envelopes' in prioritising patients. Surgeons along with anaesthetists and theatre nurses also make commissions on the use of disposable medical items and the use of medical devices and tests.

Another overlooked source of doctors' income is moonlighting. At weekends, Beijing Airport is said to be a social meeting place for the medical profession as doctors fly off to do their 'outside clinics' in other parts of the country. For the top specialists in any field this is a lucrative source of additional income and they can make tens of thousands of yuan from just a single session - and millions of yuan a year. However the junior and low level doctors make much less than the top specialists. A doctor at a community clinic, for example, would get only 4-5000 yuan ($640-800) as a basic salary and would not get much income from prescribing or surgical work.

These kinds of grey income are a contradiction in the health system and are the underlying reason for doctor-patient tensions - it is all to easy for misunderstandings to occur and to flare up into trouble - like 'a minor incident sparking a war' as the Chinese saying goes.

One of the fundamental underlying problems is that the doctor's time is undervalued. Take a knee replacement operation, for example. Such an operation will require two surgeons, two theatre nurses and two anaesthetist and last at least an hour - possibly three hours of their time. And yet the 'doctor's fee' for the operation is only a few hundred yuan - where is all the money to come for the doctor's expertise - let alone for the equipment, drugs, gas and blood and dressings?  There are doctors with a conscience who will add a reasonable and standard markup for their time - and yet there are other 'business minded' doctors who add a lot more. And there are some doctors who use foreign disposable equipment which might cost 200 yuan ($32) to buy, but is billed to the patient at several times that amount.

"There are some bold doctors who when it comes to prescribing always choose the most expensive, not the most appropriate drugs," says one pharmaceutical  supplier. "And when a new drug comes out they all rush for it in a show of excessive and unnecessary prescribing," he says. It is the same with tests - patients are told they must have numerous complex and expensive tests that they don't need, because the doctor gets a commission, he says.

The situation in hospitals also has a rhyming slogan: "Getting to see the a doctor is hard (kanbing nan): registering is hard (guahao nan),  waiting is long (houzhen chang), time with the doctor is brief (kanbing duan), doctor's fee is expensive (kanbing gui), tests are many (jiancha duo), prescriptions are many (chufang duo) and drug costs high (yaofei duo). All in all it is a volcano waiting to explode - no wonder 70% of doctors have experienced violent disputes with patients.

It is hoped that the Chinese government's new health reforms - including those on drug pricing and supply arrangements, will help straighten out this situation. What is also needed to 'restore the honour of the doctor's white coat'? According to leading physician Dr Huang Jiefu, the answer is a turn to the free market. By giving doctors the freedom to practice where and as they wish - as set out in new government policy -  doctors will be able to set a true market value for their services. When they do this they will no longer need to rely on unethical and unfair 'grey market' channels to maintain their income.  The People's Daily ends by saying that new health insurance schemes should allow patients to afford private doctors by encouraging the public to pay in premiums and have a policy that they can use when they need it most.

China's rural health insurance scheme has failed: costs of treatment have gone up instead of down

by Michael Woodhead
China’s New Co-operative Medical Scheme has done the opposite of what it was intended to do: it has increased costs and reduced access to health services for rural people, a study has found.
The government-subsidised health insurance program for rural residents was introduced in 2003 and was designed to reduce out-of-pocket payments for hospital treatment for rural Chinese. The scheme had been intended to make healthcare more affordable following the demise of co-operative health schemes in the 1980s that left most rural Chinese without any subsidised healthcare.
The NCMS proved to be very popular and with subscriptions costing as little as 10RMB a month it soon covered 97% of rural residents - or about 830 million people.
However, a new analysis of the scheme shows that out-of-pocket costs for treatment have actually increased under the program. It seems that rural hospitals have been using the easier availability of funds from the scheme to raise their prices for services and have not been passing savings on to patients.
An analysis by Chinese health economists working at the LSE in London has found that the average cost of outpatient treatment went up from 205 RMB in 2004 to 308 RMB in 2009.  After re-imbursement, patients ended up paying 254 RMB for treatment in 2009 under the new NCMS scheme - almost 50 RMB more than they did without insurance.
The authors of the study say the availability of funds through patients’ NCMS insurance may have caused 'cost inflation' by inducing rural hospitals and doctors to use more expensive drugs and treatments, so as to make more profits for their cash-strapped instiutions.
"Much of the government support intended to subsidise participants’ payments for health care may instead have been absorbed by the insatiable quest for revenues and cost coverage at these smaller health facilities, simply to survive," they write.
Therefore it is not surprising that "the rapid expansion of NCMS through massive injection of government subsidies has so far had limited impacts on either improving access or reducing out-of-pocket payments for outpatient care," they note.
"In fact, our analysis indicates that rural residents covered by NCMS are less likely to seek outpatient care than uninsured residents who did not subscribe to the programme. There is no evidence from our analysis that NCMS has succeeded in reducing out-of-pocket payments for outpatient care," they conclude.
Writing in the journal Health Policy and Planning, the researchers warn that: "further infusions of government subsidies aimed at covering rising NCMS expenditures may simply induce further waves of cost escalation unless NCMS can use its leverage as purchaser and third-party payer to introduce cost-saving measures in participating health services facilities."

China medical education gets internships | Saving for medical bills | Women have hysterectomies for profit

 China will set up a standardised internship training program in 2015 for medical graduates before they become qualified to be doctors, according to the National Health and Family Planning Commission. Officials said China does not currently have a national standard for training, and training to become resident doctors depends on the hospitals where they are employed, leading to differential medical levels across regions. The new standardised "5 + 3" year training system will ensure that graduates get experience in several branches of clinical medicine before getting a full licence to practice medicine. According to the Global Times, the training bases will first be set up in top level hospitals and some lower level hospitals based on the local situation. They will be subsidized by the governments and central finance.
 
One of the main reasons why Chinese people save so much is to prepare to pay for future medical bills, a report says. In China, 64% of people surveyed were actively saving for health issues, according to ECNS. Savings rates for health were higher in China compared to other countries surveyed, and Chinese people used diversified strategies in saving for health issues, with local currency, whole life insurance and pure term life insurance among the choices.

And in Taiwan it is claimed that  many of the 20,000 women who have a hysterectomy each year do so to gain thousands of dollars in infertility compensation from the Labor Insurance Fund.
According to the China Post, researchers said Taiwan had the largest percentage of “womb-less women”and this might be due to the lure of  infertility benefits amounting to more than NT$100,000for women under 45 who have a hysterectomy.

Hospitals banned from linking doctor's income to prescribing and investigation fees

The Chinese government on Wednesday released a guideline on its basic medicine system that forbids hospitals from linking doctors' incomes with their patients' medicine and medical exam expenses.
Some hospitals link doctors' pay with revenues earned through medication sales and exam fees, creating greater economic burdens for patients in some cases.
The guideline, released by the health and reform office under the State Council, or China's cabinet, is intended to consolidate and improve the basic medicine system and offer solutions for problems related to local-level health care reform.
The guideline also calls for efforts to teach medical staff to use basic medicine properly, as well as encourages non-governmental local medical institutions to use medications that are on the basic medicine list.
The guideline also calls for quality inspections for basic medicine and the implementation of electronic monitoring during the medication production process. It also asks for inspection results to be released to the public regularly.
Source: Xinhua

Who will pay the medical bills for those with no children?

A recent road accident that left a childless Beijing couple seriously injured has renewed calls to establish a system that can provide financial and other help to couples who have lost their only child.
Liu Juan, 52, was taking an evening stroll with her husband Li Shuwen on Jan 24 when they were hit by a metal height-limit rod, which had been knocked over by a truck.
She remains in a coma in intensive care at You'anmen Hospital, with a brain injury, while her husband Li suffered four fractured ribs and a bruised lung.
Liu Fuli, Liu's brother, is the only relative who has visited the couple.
"The doctor told me she is still in critical condition and the best result for her may be that she remains in a vegetative state for the rest of her life," he said.
Liu says he is already feeling the pressure of having to cover the couple's medical expenses.
"The medical fees have reached 90,000 yuan ($14,500) and if my sister stays one more day in ICU, I will be given another bill for about 8,000 yuan," he said.
"Next week, I have to borrow money to keep them in the hospital," he said.
No official figures are available on how many parents in China have lost their only child, but experts suggest it could be as many as 2 million.
Others are now campaigning for the creation of a fund for childless parents who face huge medical and nursing expenses.
Du Peng, a director of the Gerontology Institute at Renmin University of China, said the government should speed up the creation of a support system for parents in similar situations.
A legal framework must be set up, for instance, to allow legal guardians to be chosen to protect the interests and rights of older people, who become too old or sick to take care of themselves, Du said.
The latest amendment of laws governing senior citizens' rights, which is expected to take effect in July, will provide the legal basis for the government to act, he added.
Source: China Daily

Payment reform fails to fill medical insurance abyss

by Tian Peng and Zuo Lin
After three years of expansion, China's medical insurance system now covers 95 percent of the population. However, as the world's largest medical insurance program, it has come under great pressure to make ends meet.
On the one hand, medical insurance funds nationwide are struggling to foot skyrocketing medical bills resulting from soaring medical costs and surging compensation standards. Meanwhile, the current medical insurance system, which already boasts universal coverage, leaves little room for expansion. Therefore, increasing funding size hinges on rises in urban employment, higher income levels, and larger government allocations.
Compared with their foreign counterparts, Chinese citizens spend a large percentage of their salaries paying for social security, namely endowment insurance, medical insurance, unemployment insurance, employment injury insurance, maternity insurance, and the housing provident fund. Given that social security contributions and taxes already take up over 25 percent of individuals' total wages, it would be difficult to raise the percentage any time soon.
Take Beijing for instance. The municipality's medical insurance fund experienced average annual growth rates of 20-30 percent between 2007 and 2011. In comparison, medical costs increased 50 percent in 2010 and 38 percent in 2011 and have been growing faster than average wages since 2008.
The public's demand for medical services is soaring while the medical insurance contribution-wage ratio is already high. The Center for Public Policy at the Institute of Economics under the Chinese Academy of Social Sciences (CASS) estimated that under the current system, most Chinese cities will see their medical insurance funds running out of capital before 2020, though they may vary in population size and age structure.
Given the circumstances, the top priority for policymakers is to ensure efficiency and fairness in the deployment of medical insurance funds.
Medical insurance funds worldwide generally pay hospitals in two ways: one is through a fee-for-service system under which hospitals are paid based on specific services they provide, the categories their services fall into, or the categories of illnesses they treat; the other is to pay hospitals fixed total amounts determined in advance (i.e. the "total prepayment" mechanism) or predetermine per capita amounts of payment and pay hospitals based on the number of patients they treat and predetermined price levels.
For a long time, hospitals in China have generally been paid based on specific services they provided. In other words, hospitals (doctors) that prescribed more medical examinations and drugs enjoy higher incomes. As medical insurance funds nationwide strive to keep down overall medical costs, the "total prepayment" mechanism is gradually gaining momentum.
The mechanism could effectively contain medical costs in the short term; however, on a closed medical service market where reform on the supply side lags behind and administrative forces play an increasingly larger role in allocating medical resources, payment reform alone could in effect "release demand while limiting supply," which in turn would make medical insurance funds unable to foot skyrocketing medical bills.
In the long run, opening up the medical service market should be the ultimate solution to adjust demand and supply and control medical insurance costs. An expert contends the first step of medical reform should be deregulating the medical service market, which is the simplest reform path with the least social impact.
Source: Caijing

Patients turn to loan sharks for money to pay medical bills

Zhou Weijie will never forget the date Aug 26, 2010. While the 21-year-old law student from Anhui University of Technology was crossing the street late that afternoon, a taxi knocked him down and he became unconscious.
In the following months, Zhou underwent one treatment after another, and the hospital bills piled up to 200,000 yuan ($32,000), until he came out of his coma.
Although Zhou got back his life, he was paralyzed below the waist.
Zhou says his parents borrowed 150,000 yuan from a loan shark to pay the medical bills.
As it was a hit-and-run case, the family could not claim compensation from the taxi driver.
Insurance company also rejected their claims because of the lack of legal proceedings.
During the family's most desperate moments, Gao Guangliang - Zhou's law professor, who is also a partner with a legal aid center in Ma'anshan city in Anhui province - came forward to lend a helping hand.
"I visited Zhou and his parents soon after the accident and asked whether they needed free legal support. I reckoned the family must be going through a hard time, both emotionally and financially," Gao says.
His center provides free legal assistance to those involved in a legal case, but cannot afford to hire a lawyer. Among their target clients are teenagers, migrant workers and people with disabilities.
With Gao's assistance, the local traffic department managed to find the taxi driver and claim part of the medical expenses from insurance company.
In April 2011, eight months after the accident, the case was brought before the court. Zhou and his family received 927,648 yuan ($150,000) of compensation in total.
"We successfully won the case, but the money is just a small compensation for Zhou," Gao says.
Both Gao and the legal aid center in Ma'anshan receive funding from the China Legal Aid Foundation, established by the Ministry of Justice in 2009, which provides legal support for the elderly, women, children, people with disabilities and migrant workers.
During the past years, the center has provided free legal assistance to 170,000 people involved in 100,000 cases.
"We have several main methods of reaching out to those in need of help, such as cooperating with legal aid centers in cities and NGOs," says Zheng Xiaze, secretary-general of the foundation.
He says during the past years, their largest group of clients has been migrant workers, as the number of people leaving their home villages to work in cities soars.
For Zhou Weijie, the life-changing accident changed his outlook on life and he is now clearer about his vocation.
"Before the accident, my goal was to study hard and get into a law graduate school," says Zhou, who has been dependent on his wheelchair for more than two years now.
"Now, I think it is more important to put what I have learned to help those in need. I used to think that only the disadvantaged need free legal aid. But I realize from my case that everyone of us can become vulnerable."
Zhou plans to join the legal aid center in the future to pay it forward
Source: China Daily

Urban residents believe health insurance is worthwhile

Almost 70% of urban residents support public health insurance

by Zheng Caixiong
A recent survey has found that most urban residents believe public health insurance is a worthwhile deal and it eases their concerns about visiting a doctor.
More than 69 percent of urban residents on the Chinese mainland support public health insurance, in which the government pays most of their medical costs, according to the survey released by the Guangzhou Public Opinion Research Center on Tuesday.
The center interviewed more than 5,000 urban residents by telephone on the Chinese mainland in September.
Eighty-six percent of respondents said government medical insurance has a high price-performance ratio and is a good deal.
Only 6 percent think public medical insurance is not worth the money.
Currently, urban residents are required to pay about 5 percent of their monthly income to join the government's medical insurance plan, in which the government pays more than 50 percent of their medical costs.
The government pays a higher percentage for inpatient treatment.
But there is public concern over the difficulty and high cost of getting medical treatment on the mainland.
More than 67 percent of respondents said medical costs are high, 24 percent found them moderate and 5 percent said they are cheap.
About 50 percent of patients preferred to buy medicines in local drugstores if they were not seriously ill, rather than visit doctors in hospitals because of the high medical costs, complicated procedures and long waiting times.
Zheng Fenming, director of the institute of modernization strategy at the Guangdong Academy of Social Sciences, said the difficulty and high costs of visiting doctors remain major problems in China even though governments at all levels have introduced measures to try to alleviate the situation.
"The previous medical reforms and measures to reduce medical care charges have had little effect," he said on Wednesday.
Zheng urged government departments to further increase medical resources by lowering the threshold to allow more foreign and private funds to establish hospitals.
"State-owned hospitals have basically monopolized the country's medical industry," he said.
Urban residents should buy commercial medical insurance if they want to enjoy high-quality medical treatment after the government has provided basic medical insurance, he said.
"Compared with some developed economies and regions, China's input into medical coverage is still not enough," he added.
Dong Changsheng, a Guangzhou office worker, said government departments should further boost investment in public medical insurance so that more people can benefit from the plan in the coming years.
"I feel comfortable only when I have government medical insurance coverage," he said.
Source: China Daily

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

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

Accident hero can't pay 100,000 RMB hospital bill

A Shandong high school student who risked his life to save a classmate from being hit by a truck is seriously injured and faces medical bills exceeding 100,000 yuan. Gong Yuben, 18, a student in southern Shandong province, lost most of his right leg and doctors may be forced to amputate his left foot. Gong was riding on the back of an electric bicycle driven by classmate Chu Haowhen when a lorry suddenly rushed toward them. Gong pushed Chu out of the way and was struck by the lorry. Gong lost most of his right leg and underwent two major operations at People's Hospital of Taierzhuang District. He was transferred to Central Hospital of Zaozhuang Mining Bureau on Nov 17. "The boy's physical state is very bad with severe anemia. There is infection and necrosis on the surface of the wound. There are still a lot of potential problems. The injury makes the situation very difficult to judge. Whether his left foot can be secured or not is still uncertain," said Xia Qing, 34, director of the hospital's orthopedics department. As the class committee member in charge of sports activities, Gong enjoys playing basketball. "My son always dreamed of entering a military academy and joining the army. But now all are impossible," said his father Gong Guangyong, a 44-year-old security guard with Taierzhuang District Security Company. "The driver of the lorry cannot afford our medical fee. I was diagnosed with a mild concussion, but I stayed in the hospital for only 4 days. Daben's family is poor as well. I had to save the money for Daben," Chu said. Before Gong Yuben was transferred to another hospital, the medical fee had exceeded 100,000 yuan. Gong Guangyong only makes around 1,000 yuan a month. Gong Yuben's mother doesn't have a job. His family is classified as low-income and receives an allowance from the local government.  
Read more: China Daily