18 August 2019
Oversubscription by certain doctors has resulted in patients incurring unnecessary medical costs. Photo: Bloomberg
Oversubscription by certain doctors has resulted in patients incurring unnecessary medical costs. Photo: Bloomberg

Attacks on doctors, nurses highlight need for medical reform

On March 5, the day the National People’s Congress (NPC) opened, a crowd of 100 forced a doctor in Chaozhou, Guangdong province, to march through the streets carrying a placard “this doctor killed a patient”. He was sobbing and humiliated; the patient had died earlier that day.

Violence by patients and their families against doctors and nurses has become so severe it has forced its way onto the legislative agenda – 89 medical professionals in the Chinese People’s Political Consultative Conference (CPPCC) proposed a regulation that would turn hospitals into public places and give the police, not local security units, control over them. They have submitted it to the State Council and the Ministry for Public Security.

CPPCC member Ling Feng, deputy chairman of the Chinese Doctors Association, said that in 2010, there were 17,243 incidents of aggression against medical staff, nearly 7,000 more than in 2005. These included threats, insults, beatings and injuries. In the first eight months of 2013, the number of staff affected was 2,240 compared to 1,865 in all of 2012.

“There has never been such violence in our hospitals throughout our history,” he said. “In the world, it has been rarely seen.” In three of the worst incidents in February this year, a man in a Harbin hospital used a steel tube to kill a doctor. In Hebei and Nanjing, a doctor and a nurse were seriously injured in attacks with a knife and with fists.

The violence and frequency of these attacks put health on the NPC agenda this year and the front pages of the mainland media.

The root cause is a breakdown of trust between a proportion of the patients and their families and the staff treating them. The patients believe that doctors are more interested in profits than treatment, so they order expensive checks and medicines, often imported, from which they and the hospital benefit financially and for which the patient has to pay.

This belief is not without foundation. Unable or unwilling to cover the full cost of public hospitals, the government allows them to generate income from patients to cover their running costs. This has created a strong financial incentive to utilise expensive high-tech diagnostic tests and expensive drugs.

Most hospitals tie the income of physicians to the revenue they generate. This has led to widespread over-prescription of drugs, especially antibiotics. Receiving up to half their income from selling drugs, hospitals are run as profit-making enterprises. In addition, some doctors often receive red packets from patients to ensure a successful operation and kickbacks from drug companies to prescribe their products.

A recent survey by China Youth Daily found nearly 70 per cent of think doctors’ diagnoses and treatments are suspect. Another survey found that 71 per cent of doctors would choose another occupation, if they had the chance.

Chen Jingyu, an NPC delegate and deputy director of the Wuxi People’s Hospital, said doctors had become the victims of the problems of China’s medical system.

“These disputes are a result of this system. I often tell my daughter not to marry a doctor. They never have an eight-hour day, they do not have holidays and are exhausted. Many have resigned.”

The simplest way to address the problem would be for the central and local governments to provide more funding to hospitals and reduce their dependence on expensive drugs and treatments. A system of medical malpractice insurance would also help the doctors.

To provide better health care, private capital has over the last 10 years flooded into the medical sector. By 2011, there were 8,440 private hospitals compared with 1,823 in 2002 and accounting for 38.4 per cent of all hospitals in China.

Since 2009, public hospitals have been allowed to allocate no more than 10 per cent of their resources for “special medical needs” – in other words, private wards in which they can charge up to 1,500 yuan a day. This is a good way to let public hospitals increase income.

Union Hospital in Beijing, for example, has 120 beds in nearly 10,000 square metres in its special unit; it receives nearly 50,000 patients a year, with over 2,500 staying in the unit and more than 1,000 operations.

These units provide at least 10 per cent of the income of the hospitals that have them and up to 30 per cent in some cases, reaching 100 million yuan.

Feng Shiliang, director of the Liaoning Diabetes Treatment Center, has proposed to the NPC that such centers should be shut down. “China’s medical resources are extremely stretched. It is hard and expensive for members of the public to see a doctor. This issue has not been resolved. But in some cities, where the shortage of resources is especially severe, these special centers have been established to benefit a small number of people. It is extremely unjust.”

Feng’s appeal has fallen on deaf ears. Given the shortage of capital for China’s public hospitals, the special centers are a useful, if temporary, solution to the problem.

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Hong Kong-based writer, teacher and speaker

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