Wednesday, 5 March 2014

Why Beijing's plans to privatise medical services get a lukewam reaction from China's doctors

by Michael Woodhead
Beijing is one of several cities that has recently announced plans to encourage doctors working in public hospitals to set up private clinics. The government used the socialism-friendly euphemism "social capital" for the private capital investment it wishes to attract for establishing new medical facilities. 
However, the plans come with a few strings attached, which will deter most doctors from even thinking about setting up private clinics. Firstly, the city also announced that Beijing already has enough medical clinics in the central area, and it will only permit new clinics to be set up outside the fifth ring road. It also stipulated that only experienced doctors who hold the grade equivalent to 'associate professor' would be able to set up the new private clinics.
The reaction from doctors has been underwhelming and many have questioned how such a monumental change in the current system will be implemented. In theory, the new proposals will "free up" doctors to better serve patients in more flexible ways. Doctors however, have described these predictions as wishful thinking.
Firstly, the number of senior doctors who qualify to set up new clinics is only a small proportion of the total number of working doctors. These senior doctors are in short supply and they are the backbone of the current public hospital and medical school teaching system. How will the system cope if these doctors leave to devote their time to private clinics?
Doctors say that if a new layer of private clinics is to be established, there needs to be a plan for how patients will be managed in public hospitals. If the privatisation plan is to succeed there will need to be a move away from large hospitals treating minor illness, and these functions being taken over by local clinics. Big hospitals will have to become specialist centres with expertise in treating serious diseases, they say.
In places such as Hong Kong and the US, there is a long tradition of doctors working in private clinics as well as in public hospitals. How will China manage this balance? In the US, for example, patients can only get their medical fees reimbursed if they go to a  doctor approved by the insurer or government, and the doctor and clinic must have acceptable quality and safety standards - how will China manage such a system? In addition there needs to be safeguards that private clinics will operate in an ethical manner. In western countries there are a range of professional associations and health department systems to define and oversee standards. With new private clinics in China there is also a danger that they will inherit the 'prescribing for profit' and overservicing practices of some existing hospitals in an effort to increase revenue, doctors warn
In reality, there is also a big difference between the government 'permitting' and 'encouraging' doctors to set up private undertakings. As anyone in China knows, running a private enterprise can involve a lot of 'mafan' (trouble) - and that 'mafan' can also mean paying out a lot of money. How many experienced doctors will be prepared to take on this risk?
These are just a few of the doubts that doctors have expressed about the new proposals for private clinics in China. They say "jumping into the sea" of private enterprise is a huge step for a doctor to take - there are so may unanswered questions and risks that it will need more than just "permission' from the government to make them do it.

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