One of the Chinese characteristics is the belief that when anything goes wrong, it can go wrong in ways more complicated than what can be imagined by common sense. Such is the case with the medical system's metamorphosis amid the market-oriented reform. It should be pointed out that, as it is being complained that health care is no longer affordable by common people, the medical professionals may not be on the receiving end of the increasing amount of money the system is devouring on a daily basis. The failure is not just one-sided, in that decent medical services are getting more distant, rather than closer, from the low-income people and the vast masses in rural China. In the meantime, it also hurts the medical staff in their reward and their morale, and eventually will hurt the sense of honour of this profession. I just happened to witness two medical emergency incidents recently and have learned from them a lesson which I doubt I could have gained from the published sources so far. Both incidents took place in Beijing, where people are supposedly covered by the best medical system available in China. One involved a friend's son who was stricken by pneumonia and was ordered to stay in a municipal-level paediatric hospital. But the child was lucky that no major operation was required on him, and he was discharged after a week although for that week, the family had to spend one-third of its monthly income on the medical and in-patient care bills. That was more than 1,000 yuan (US$125), not including the diagnoses and prescriptions the child had received from the neighbourhood healthcare centres. Since the father was a self-employed driver, not on the payroll of any large institution, he didn't have any insurance policy to claim a refund for the expenditure. Then during the just-passed May Day holiday, as another friend of mine was knocked down by a sudden bout of high blood pressure and was rushed to the ER department of a national level hospital, I made more disturbing observations. Nearly 3,000 yuan (US$375) was charged for the ambulance and less than 12 hours of ER check-ups and care. Fortunately, the patient had a State-sector job and was entitled to get most of his bills refunded. But it was the doctors' condition that scared me not the way they worked, but the way they got their reward. I chatted with two doctors, one after another, while waiting outside the ER department. Contrary to the overcrowded scene in most hospitals, this was one of its divisions in one of Beijing's newly developed areas, and was not having many visitors one rainy afternoon of a public holiday. Like many Chinese do, we compared notes about work hours and pay, and other things in Beijingers' daily lives. The neurologist told me his monthly take-home income was "just about the amount your friend would pay for today, and maybe even less," while he sometimes had to work on a 48-hour basis because the facility was too new and didn't have many patients. The physician was apparently able to earn a little more, and brought home 4,000 yuan (US$494) in one or two months last year. But these are not high incomes in Beijing. Receiving kickbacks for prescribing expensive medicines is prohibited in national hospitals, it's reported. But where has the money gone now that the patients are paying so much? The neurologist pointed to the practically empty large medical facility: "Never has a day passed without me noticing some new building or interior decorating work going on. Not just in this division, the hospital is expanding nationwide, making takeovers of local hospitals." But why can the management be expanding and building fervently and ignoring its employees' rights? The answer seems simple: It has got the money. It has no respect for rules. And it has no one to police its behaviour. Email: younuo@chinadaily.com.cn (China Daily 05/08/2006 page4)
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