Flourishing or Putrefaction?

The Chinese Medical Care System

Xiaonan Ying
College of Science
Biology Department
Northeastern University
Abstract - Conflict between patients and doctor has become a controversial problem
in china. Majority of people only consider this as a result of impulsive action of
individuals. However, some issues in China medical care system might be the
essential cause. In order to identify and solve those problems, further analysis should
be done to the daily operation of health care service. In this article, comparison is
made between China health care industry and US medical system. Many issues, such
as population, efficiency and education are found. In addition, some suggestions are
also provided, which may improve China medical care system and relief tense doctorpatient relationship.

Key words China medical care system, hospital, patients, doctor, conflict

Introduction:
On December, 25th 2013, a patient stabbed three doctors with a knife in the Wenin
first hospital. One of three doctors died in emergency room. As that patient stated, he
believed that the treatment for his illness was unsatisfactory. So after serval
complaints without an ideal response, he decided to have his revenge to the Wenlins
first hospital. At that day, because he could not find the doctor who performed
operation, he just randomly stabbed doctors in the hospital. Actually, all of three
doctors had no direct relation with him.

This incident started a controversial debate in society. With further attention on

this incident, more similar cases are discovered in past decades, which illustrate a
question about existence of the conflict among doctors and patients. For the majority
of views, without a doubt, murdering another person will be considered as a crime.
And a patient murdered a doctor is surly appalling incident for society. On the other
hand, regardless the foolish decision that patient made in the end, some people believe
them its also a pervasive phenomenon that many doctors do not respect their patients
and frequently receiving bribery from patient, who want extra attention and services
from doctors. However, its obvious that there must be some problem or flaws
existing in the medical system of China, which disrupt the comprehension between
doctors and their patients and caused this sensitive relation. And we have to improve
our system and refrain from repeating this kind of tragedy.

Background study
In recent decades, medical system and health care system in China have been
improved dramatically. With the great effort of government and series policies they
implemented, its true that, china is becoming the one of the most advanced countries
in the medical field. However, critical issues were emerged during the operation of
this medical system. In 2013, according to the statistic data from National Health and
Family Planning Commission of PRC, the annual number of new patients visiting
hospitals was 7.3 billion. Among those patients, the number of disputed cases between
doctors and patients is 70,000. In addition, after the calculation, the data shows that
every people in China will visit hospitals 5 times annually. And 5 persons in very
100000 patients may have issues with their doctors, and even have physical conflict.
(1)

The case shown in the beginning is only the one example of many more similar
incidences. On July 16, 2009, a nurse in Beijing hospital was cut on throat by her
patient. That patient claims that the rabies vaccine he took was poisoned. December 8,
2008, a doctor in Shanghai second hospital was knocked out by a new patients friend
with no reason. After investigation, that person said that he did that because doctor did
not help his friend first. Existence of this kind of disputes could be predicted with
negative feedback about doctors from people. With the increasing attention of society
and efficiency of internet media, doctor-patients conflict is discussed greatly.
However, in order to understand the essence of this problem, further analysis about
the operation of medical system and the characters of patients and doctors needs to be
done.

Perspective from hospitals:

One of the most fundamental problems that Chinese medical system has to face is
enormous population of patients. From my own intern experience in Zhejiang First
Hospital, Dr. Linfei needed to meet more than 50 patients per day. It means that
doctors will spend less than 10 minutes with every new patient even without any rest
for 8 hours each day. In China, there are about 2 million certificate doctors of
medicine, which is twice the number of doctors in the US. However, statistics data
from Centers for Disease Control and Prevention show that the annual number of
patients visits in US is only approximately 271 million, (2) which is significantly less
than the 7.3 billion of new patients in China. The average time US doctor spend with
patients is generally more than 15 minutes. According to the research from Morrell
DC, patients feel that they have inadequate time to communicate with their physician
in 5 minutes meeting schedule compared with meeting at last 10 and 15 minutes

schedule, respectively.(3)(4)

Because of the huge population of the patients, the working pressure of doctors in
China is significant. In contrast, the reward for them is relatively insufficient. The
average income of a medical doctor is a little more than 10,000 US dollar, which is far
lower than the standard income of middle class, which is 25,000 dollar. (5) Its
predictable that some doctors will want to earn any extra money as possible. In
addition, small bribery, also known as, red pocket is one of the most common
phenomenon in China. In fact, most people would consider this as a normal behavior
if the consequence will not against the law. Its just like a gift. But, this red pocket
is becoming a hidden rule for many patients. They believe their gift will let doctors
give them better treatment. In most case, doctor will receive this red pocket because
of unsatisfactory of their income. As Jingqing, researcher of UNSW, said red packets
emerged from and can exert an influence on the power relationships between doctors,
the Party-state and patients, and are a response to distrust and quality shortage in the
health-care system.(6) This phenomenon will gradually corrode the basic operation
of health care service and potentially increase the possibility of misunderstanding
between patients and doctors.

Furthermore, deficiencies of management of China Health care delivery system

are also a part of cause. Unlike the hospitals in the US, which has support from
professional hospital manage system, most hospitals in China do not have an
independent management system behind. And the structure of China hospitals is based
on Medical institution standard, which was made by government instead of any
professional medical service management organization. This standard says hospital

should be governed by a president with the help of a vice president and following
departments. In fact, this standard is just considered as a reference, and individual
hospital or medical center could change details in it if necessary. Thus, the hospitals
are the centers of health care service in each city. And different province has different
health care service. And because of the centralization of authority, president of
hospital may likely lose the vision for the improvement of hospital.

However, in the US, hospitals are just a part of health care network. And they
have excellent internal organization. As Phoebe Lidsey Barton wrote in his book
Understanding The U.S. Health Service System, Most hospital have traditionally
been organized along three related but separate lines of authority: the medical staff,
hospital administration, and the governing body. The balance of power among this
trinity continues to shift as hospitals respond to accelerating changes in the health
service system. (7) Its just like the structure of American government system,
accurate, stable and adaptive.

Incomplete management system of hospitals in China will provide a chance for

potential of a dispute between patients who want better treatment and doctor who
want earn more money. Unfortunately, earning more money is becoming a common
impression for patient about hospital.

Perspective about patients:

Standing on the patients point of view, doctors and hospitals need to be
responsible for the consequence of their treatment to patients. It is correct. However,
the general situation is that Chinese people is over depending on medical treatment.

For example, a physician in Zhejiangs First Hospital refuse to give her patients
antibody medicine because after series examinations and analyses, doctor believe its
not necessary for patients to use antibody. But, that patient insisted and said antibody
will cure him much faster. This kind of phenomenon show the misconception or
superstition of patients that going to hospital and consuming medicine is best way to
cue their disease. The cause of this situation is insufficient knowledge of patients
about their disease and how medicine works to help their own immune system. Thus,
at the time that specific disease could not be cured efficiently after treatment, extreme
disappointment feeling will generated and patients may tend to believe doctors
incapability should be responsible for their suffering. As most doctor-patients dispute
cases showed, if patients died, it is very likely for their family members to blame
doctor for killing that patient.

The education level of patients will influence doctor-patient communication.

According to the research done by Karolien Aelbrecht and his team about relationship
between doctor and patient during medical consultation across the Europe (Belgium,
The Netherlands, UK and Italy), the result shows that patients who have lower
education level positively referred to aspects related to the affective/emotional area of
the process. But patients with middle and higher education referred to taskoriented/problem-focused area. (8) This research illustrate that patents with various
knowledge base will have different approach to the suggestions that doctor given. It is
the key for hospitals and doctor to understand their patients better, and help them with
appropriate method that reduce risk and increase friendly and trusty relation.

Possible solutions

First of all, some designs of US medical care system structure is worthy to learn for
Bureau of Health of China. For example, most hospitals have professional health care
system to manage the hospitals, such as Partners of BWH, BCH and MGH. This
system helps the hospitals to have a very high standard of daily operation. When
standard are made, its much easier to improve medical system without any detour.
However, problems of US medical system also exist also. Because of independent
management of departments in hospitals, longer time will be required for them to
balance their power. However, efficiency should be the key to improve China medical
care system.

Second, In order to increase the capability of each hospital, its also necessary to
separate patients and allow all the hospitals equally share the work. Its important
because inequality of number of patients will greatly reduce the efficiency of
operation. Specifying the function of each hospital should allow patients to find best
cure.

Conclusion:
From the result of analyzing the medical care system of China, negative efforts
have been made by both hospitals and patients, which tension the doctor-patient
communication and lead to tragedy consequences. However, more essential causes are
also being revealed. Numbers of population, inequalities of doctors, flaws of obsolete
system and misunderstand of patients are disrupting normal operation of China
medical service. Hence, better solution should be proposed to change the way people
do and think. In order to appease this conflict between doctor and patients, medical
care system in china should be improved and provide benefit to every people.

Reference
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