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China must heed anger over health care standards to curb hospital violence
Lijia Zhang says China must revamp its underfunded and corrupt health care system to assuage the public rage that is fuelling a rising number of violent attacks on medical staff
PUBLISHED : Tuesday, 06 May, 2014, 4:54pm
UPDATED : Wednesday, 07 May, 2014, 2:30am
Lijia Zhang
ed to keep up with changes in China’s luxury consumption patterns
A man who randomly attacked medical staff in Heilongjiang province is sentenced in a Harbin court. Photo: Xinhua
Medical workers used to be flatteringly called "angels in white" in mainland China. Now their profession has become one of the most dangerous, following a spate of bloody incidents at hospitals across the nation.
In mid-April, a male doctor on a maternity ward was severely beaten by a patient’s husband in Jiangsu province; in March, a young doctor in Guangdong was attacked and paraded in public by dozens of people after he failed to save a drunken man from a heart attack.
To curb such crimes, on April 24, China’s top legal bodies jointly issued guidelines warranting severe punishment for those who attack medical workers.
Hospital violence attracted massive media attention last October when a patient, Lian Enqing, angry over the outcome of his nasal surgery, stabbed three doctors at the No 1 People’s Hospital in Wenling , Zhejiang province, killing one of them. A few days earlier, another unhappy patient stabbed his doctor six times before jumping to his death in northeast Liaoning province.
Many factors contribute to the growing violence in hospitals. A decline in morality has been blamed; specifically, the lack of channels for patients to complain. And the arbitration bodies, often affiliated with medical associations, are hardly independent. According to the Chinese media, before Lian took drastic action, he had tried repeatedly to complain but got nowhere.
Such attacks underscore the ills of the health care system as a whole. On the heels of economic reforms, hospitals were commercialised. With limited government funding, they have to generate income through treatment and drug sales to support themselves.
When I began work at a state-owned enterprise in the early 1980s, medical care was free, and thus wasted. I remember mock fights with a colleague where we would throw around the bountiful headache pills we had been given.
How things have changed. Three years ago, I went to Beijing Capital Dermatology Hospital, one of the largest of its kind, after finding a strange rash on my arm. Like all major state hospitals, queues snaked everywhere. When it was my turn, the doctor took one cursory look and sent me for an allergy test on an imported machine and then prescribed numerous creams and pills. The total bill was US$800 – more than the average monthly salary in Beijing. That is a typical patient experience in China, at least in one respect: I left feeling short-changed, even cheated. Over-prescription and excessive tests are commonplace.
There are 1,000 top hospitals in China. Each has to deal with some 10,000 people every day. Doctors have at best a few minutes for each patient, often leading to a lack of communication, which plants the seed of doctor-patient mistrust.
Then there is corruption. Some doctors, given their long hours, modest salaries (on average, a doctor’s basic salary is on par with a waiter’s – US$500 a month) and hard-earned skills, probably feel entitled to accept red packets, a common delivery vessel for bribes from patients or kickbacks from pharmaceutical firms.
In September 2011, before my late cousin – suffering from bone marrow cancer – underwent an operation on his spine, his anaesthetist demanded 20,000 yuan (HK$25,000) under the table, saying that it was a dangerous operation, and the cash would help him ensure things went smoothly. Our family decided we couldn’t take a risk and so we paid him.
When I visited the hospital a few days after the operation, a girl who shared the same ward said the anaesthetist had demanded 5,000 yuan after an operation on her leg. Her family also paid.
A survey conducted by the China Youth Daily last November showed that two-thirds of those polled don’t trust their doctor’s diagnosis and treatment.
The problematic doctor-patient relationship can easily lead to violent disputes. According to a survey by China Hospital Management Association, medical disputes have been rising yearly at the rate of 22.9 per cent since 2002. In 2013, about 70,000 cases of disputes were reported.
It wouldn’t be fair to blame unethical doctors for everything. China’s medical care is severely underfunded. Although the total government health expenditure has increased over the years, the amount as a share of gross domestic product has been declining. In the past several years, the proportion has been around 5 per cent, much lower than the world average of about 10 per cent.
The Chinese government has made a major effort in providing health care for rural residents as well as the urban poor. For example, the Rural Co-operative Medical Scheme was introduced in 2003, funded by a combination of individual contributions and government subsidies. However, the coverage is minimal and too localised, meaning you can be reimbursed only for certain things, at limited amounts and for treatments at your local hospitals, which are not always equipped to cope with serious illnesses. Overall, only 30 per cent of total outpatient expenses and 50 per cent of inpatient expenses are covered, on average. The out-of-pocket cost is a serious burden for many.
Rising medical costs and low quality of service have led to ever louder complaints about the health care system. And medical workers have borne the brunt of it.
In the wake of the recent hospital attacks, many experts have come up with suggestions for change. One idea is to issue doctors with business licences so they can practise outside hospitals and provide quality services. Others recommend increasing the number of private hospitals to boost competition and improve quality. More and more are calling for the market to play a bigger role, allowing prices of drugs and services to rise to reduce kickbacks and bribery.
The newly published directive is certainly a positive move. But a comprehensive reform of health care is urgently needed. Without it, the law won’t be enough to curb the violence.
Lijia Zhang is a writer, journalist and social commentator
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Very good analysis of this difficult subject. In China, patients wait 3 hours to see a doctor for 3 minutes, and quite rightly feel ripped off when they are charged hundreds of yuan for tests and medications that the doctor earns a commission on. The moves to allow doctors more flexibility to work in private clinics may not be the answer. Public hospitals can do a good job if adequately funded, as seen in Hong Kong and Taiwan. It’s not all the doctor’s fault. The public need to be more health literate – people expect too many drugs and drips for even minor illnesses, and they also refuse to use community clinics for minor illness such as a cold. The aggressiveness in hospitals is the same as that seen among tourists in Hong Kong and in drivers in China.