In 2008, the Chinese government unveiled the Healthy China 2020 reforms, which were designed as long-term plans to establish a universal health care insurance system. The aims were to design a science and technology-based system with inclusive health insurance programs and also improve health care infrastructure to provide affordable care for everyone in the country. Trying to balance the expansion of coverage, the management of costs and the building out of the necessary health care infrastructure is an immense challenge; however, it is one that is being met pragmatically through testing of possible solutions.
There were limited concrete plans when the initiative first started, however, there were small-scale experiments in some localities around the country. Restrictions on foreign companies participating in joint ventures to manage hospitals were somewhat relaxed, while one municipal government in Anhui province was permitted to experiment with splitting hospitals from pharmacies in order to control costs and prevent corruption between pharmaceutical salespeople and hospital staff. This was purported to allow health insurance in China for expats the local pharmaceuticals authority to control bidding over drugs, especially those considered essential, and keep the costs low.
The concept of the family physician or the GP (General Practitioner) is non-existent. The doctors also see tons of patients every day and have no chance to build any relationship with the visitors, like the polyclinics in Singapore. Not only that, but they have an irritating habit of wanting to put you on a drip for every little illness, and will put you on tons of tests for every little thing (including a blood test for the flu). With health insurance not provided by the company, I did not have much choice but to go local.
My present company gives me health insurance, and so the world of ex-pat hospitals and clinics opened to me. Small clinics that serve the local community (including rich Chinese) employ GPs, whom we have gotten very close to. Our family physician, for instance, is also a friend as well. We occasionally go for drinks together. We can communicate in English, and most importantly, we trust the standard of care and ethics of the doctors.
Things get complicated, however, when it comes to surgery and more complex issues. I found that out for myself firsthand when I took a student who broke an arm to Shanghai Family United Hospital, a few years ago. The western physician that saw her noted she needed surgery, and called upon the paediatrician of the attached local hospital. He explained to us that foreign doctors are not licenced to conduct surgery in China, even though their hospitals are licenced to operate in the nation.
And how bad could a Chinese surgery be? A superior in my previous school and a teacher in my present school have seen for themselves – hospitals full of pools of blood all over the place. Another teacher, whose husband was admitted to the hospital for a heart attack, was even more shocked. She was allowed in the operating theatre, ungowned. The surgeon wanted to use instruments that she saw lying around when she went in, and she had to insist on them opening up a fresh package of instruments. In the middle of the surgery, someone opened the door to the operating theatre, ungowned, and then walked out.
Medical personnel in developed countries must be suffering seizures by now from a reading of such malpractice. Infection is the number one killer in any form of surgery, and yet the atmosphere of lasses faire prevails within the Chinese hospitals of a first and second-tier city in China. And since it is so expensive, the insurers are not willing to fly expats out for treatment, noting the clause that patients can only be flown out if the local facilities are unable to treat them!