Thursday, 14 May 2015

Personal experience of the Chinese health system

An overseas Chinese friend of mine has just come back from China, where she returned to care for her dying father. Her experience of the Chinese health system was mostly positive, but her story reveals some of the reality behind the rhetoric of recent government pronouncements on reforms.
Her father was seriously ill with lung cancer and had only a few weeks to live. After the diagnosis, at an army-affiliated hospital, the doctors did not try to offer futile chemotherapy with expensive drugs, but just offered a poor but honest prognosis. There was no access to what we in the west would call palliative care. Instead, doctors recommended that he return home, to be cared for by family members. In some pain and discomfort, the father was provided with some analgesics, but no opioids.

After about a week, the father was in considerable pain and returned to the hospital for treatment. He lived for another 18 days, being given a mixture of analgesics and other drugs to ease his bowel problems. The cost of treatment was 18,000 yuan. As he had been a member of his employer's urban health insurance plan, the father (or rather his family) was able to claim back about 70% of the medical expenses. However, the hospital treatment did not include 'extras' such as meals, dressings and bed linen! The nurses provided most of the basic medical care but none of the ancillary care such as washing, feeding and chaging bed linen that nurses in western hospitals would do. Instead this was left to the family. As the family were not able to be on 24/7 carer duty they hired a 'kanghu' carer at a cost of 800 yuan per day, to do basic chores such as feeding and cleaning the patient.

The family were satisfied with the overall level of medical care provided by the hospital, though they found it somewhat basic until they used their guanxi to find a better team of doctors and nurses. This was done because they knew someone who knew one of the senior doctors at the hospital.No money changed hands, but the father benefited form having more attention paid to his care by the more senior medical practitioner in the hospitals. After the father passed away, the family presented hongbao containing about 200 yuan to each of the 20 medical team who cared for him. This was done to maintain face and  confirm the good guangxi that was used to obtain better care for the father.
Funeral arrangements were made for the father via the hospital contacts, who no doubt gained some financial advantage from their referral.

The family believed their father received good care that was personal and respectful - but no doubt because they were able to use their connections in what was essentially a small city where everybody knew everybody.

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