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As a result, many are looking towards the private sector

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When Cheng Yingsheng, the director of one of China’s top university hospitals, was placed under investigation for alleged corruption in June, it marked a difficult spell for doctors in China. The authorities have recently rattled them with a string of high-profile arrests of leading medical figures. But that is not the doctors’ only worry. The government is also pushing through a health-care reform that is upsetting many of them.

China’s doctors have long felt aggrieved. Their wages ($13,000 a year on average) are low compared with those of other Chinese professionals. Yet they work long hours, often more than 50 a week. That is in part because there are too few of them. China has 2.4 doctors per 1,000 people against an average of 3.7 in the OECD, a club of mostly rich countries. Chinese doctors tend to get less respect than their peers in Hong Kong and Taiwan. Trust in them is so low, and medical scandals so rife, that reports of patients physically attacking them are common.

To make up for their low wages, many doctors bump up their income by over-purchasing medical equipment or over-prescribing medication. These scams usually involve illicit profit-sharing deals with medical-device suppliers and chemists. Because more than 95% of Chinese citizens use state-backed health insurance, this means the government has in effect been footing the growing bills.

The new reforms are meant to reduce this by weeding out over-medication and squeezing the cost of equipment. Poorer-quality state-run hospitals are often in debt, and China’s populace is ageing fast. So a price cap now limits how much a doctor can charge for each treatment. A fixed annual wage for doctors is being gradually brought in. In June the State Council, China’s cabinet, told provincial authorities to start imposing the reforms across every city by the end of the year.

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The reforms under way are said to have already saved 400bn yuan ($55bn). But medical professionals worry that the new system may make it harder for them to do their jobs responsibly. Nurses are using decades-old manuals to prepare for operations. Doctors are relying on tatty medical equipment and giving low-level treatment to save money. At a hospital in the province of Shandong doctors were said to have debated whether to follow standard procedures during surgery for a cerebral aneurysm. At issue was the cost.

What is more troubling for doctors is that when a treatment or operation goes over the cap they have to pay for the excess themselves. A video that went viral last year showed a Shanghai doctor explaining how he paid 14,000 yuan out of his own pocket in order to perform an operation for throat cancer. “Holding a scalpel is worse than holding hair scissors,” he lamented.

Doctors have been loth to treat patients with complicated illnesses that need lengthy procedures far exceeding the price cap. In the past they would usually welcome patients with severe pneumonia and prescribe complex treatment, but now they often turn them away. They are less willing to prescribe costlier imported drugs, so patients who need them must buy them off their own bat. When hospitals started barring patients with complex conditions from staying for more than 15 days to control spending, the health regulator denounced them and encouraged aggrieved citizens to report them.

The health authorities have also vowed to continue their war on corruption. Doctors have been told to voluntarily hand over ill-gotten proceeds. There are plenty of examples of what happens if they don’t. Earlier this year, before Dr Cheng’s case was reported, the medical world was shocked by the arrest of Tian Wei, a member of the Chinese Academy of Engineering, for alleged corruption. Last year Wang Tianchao, the former director of the top state hospital in Yunnan province, was sentenced to life in prison for accepting bribes. He owned dozens of properties.

For veteran doctors seeing their incomes plummet, work in private hospitals is plainly preferable. Public ones still handle 83% of the population. But private hospitals now outnumber public ones and their share of patients is growing. With its finances strained, the government might encourage this trend, or at least nudge better-off citizens to take up private insurance as a way of balancing the books. However, that risks widening the gap in the quality of treatment between rich and poor, which is hardly in line with the Communist Party’s lofty ideals. ■

Subscribers can sign up to Drum Tower, our new weekly newsletter, to understand what the world makes of China—and what China makes of the world.

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China.css-2x8c4j{margin:0.875rem 0;}.css-2x8c4j .e12sz0jx0+*{margin-top:0.875rem;}.el1rg701+.css-2x8c4j{margin-top:0;}.css-1aogxph{color:var(–mb-colour-greyscale-london-20);font-family:var(–mb-typeface-sans);font-size:var(–mb-typestyle-label-2-size);font-variant:var(–mb-typestyle-label-2-figures);line-height:var(–mb-typestyle-label-2-leading);}.css-1aogxph s,.css-1aogxph del{-webkit-text-decoration:line-through;text-decoration:line-through;text-decoration-thickness:0.0625rem;}.css-1aogxph b{font-weight:var(–mb-font-weight-semibold);}.css-1aogxph i{font-style:italic;}.css-1aogxph sup{font-feature-settings:’sups’ 1;}.css-1aogxph sub{font-feature-settings:’subs’ 1;}.css-1aogxph u{text-decoration-thickness:0.0625rem;}.css-1aogxph a{color:var(–mb-colour-greyscale-london-20);-webkit-text-decoration:underline;text-decoration:underline;text-decoration-thickness:0.0625rem;text-underline-offset:0.1875rem;}.css-1aogxph a:hover,.css-1aogxph a:focus,.css-1aogxph a:active{text-decoration-thickness:var(–mb-spacing-3xs);}.css-1aogxph a:hover{color:var(–mb-colour-base-chicago-30);}.css-1aogxph a:hover span{text-decoration-color:var(–mb-colour-base-chicago-30);}.css-1aogxph a:focus{background-color:var(–mb-colour-base-chicago-90);color:var(–mb-colour-greyscale-london-5);text-decoration-color:var(–mb-colour-greyscale-london-5);outline:none;}.css-1aogxph a:active{background-color:var(–mb-colour-base-chicago-90);color:var(–mb-colour-base-chicago-30);text-decoration-color:var(–mb-colour-base-chicago-30);}

This article appeared in the China section of the print edition under the headline “Going private?”

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China

June 29th 2024

• →This week China could rethink its economic policy
• →Roxie, one of China’s few lesbian bars, closes its doors
• →Health-care reform is upending the lives of China’s doctors
• →China’s probe returns from the far side of the moon

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From the June 29th 2024 edition

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Discover stories from this section and more in the list of contents

⇒Explore the edition.css-v7aorn{margin-top:0.875rem;}.css-v7aorn +.eq1asik0{margin-top:3rem;padding-bottom:0;}.el1rg701+.css-v7aorn{margin-top:0;}.css-9ejc71{position:relative;border-bottom:0;border-top:0.0625rem solid var(–mb-colour-greyscale-london-85);color:var(–mb-colour-greyscale-london-35);}.css-9ejc71 .ebxshaw0{margin-top:0;}.css-9ejc71 >.e5z0ibw0>*{padding:var(–mb-spacing-md) 0;}.css-9ejc71 >.e5z0ibw0>*:nth-of-type(2){border-top:0.0625rem solid var(–mb-colour-greyscale-london-85);}@media (min-width: 37.5rem){.css-9ejc71 >.e5z0ibw0>*:nth-of-type(2){border-top:0;}}.css-9ejc71 >.e5z0ibw0 .e5z0ibw0{gap:var(–mb-spacing-sm);}.css-yb4x8x{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:column;-ms-flex-direction:column;flex-direction:column;-webkit-align-items:stretch;-webkit-box-align:stretch;-ms-flex-align:stretch;align-items:stretch;-webkit-box-pack:start;-ms-flex-pack:start;-webkit-justify-content:flex-start;justify-content:flex-start;}@media (min-width: 37.5rem){.css-yb4x8x{-webkit-flex-direction:row;-ms-flex-direction:row;flex-direction:row;}}@media (min-width: 37.5rem){.css-yb4x8x{-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;}}@media (min-width: 37.5rem){.css-yb4x8x{-webkit-box-pack:end;-ms-flex-pack:end;-webkit-justify-content:flex-end;justify-content:flex-end;}}.css-1j1j36d{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-box-flex-wrap:wrap;-webkit-flex-wrap:wrap;-ms-flex-wrap:wrap;flex-wrap:wrap;row-gap:0.6rem;-webkit-column-gap:var(–mb-spacing-sm);column-gap:var(–mb-spacing-sm);}ShareReuse this content.css-169lzn0{position:relative;-webkit-align-self:auto;-ms-flex-item-align:auto;align-self:auto;display:none;}@media (min-width: 80rem){.css-169lzn0{grid-column-start:9;}}@media (min-width: 89rem){.css-169lzn0{grid-column-start:13;}}@media (min-width: 80rem){.css-169lzn0{grid-column-end:13;}}@media (min-width: 89rem){.css-169lzn0{grid-column-end:17;}}@media (min-width: 80rem){.css-169lzn0{grid-row-start:1;}}@media (min-width: 80rem){.css-169lzn0{grid-row-end:span 4;}}@media (min-width: 80rem){.css-169lzn0{display:block;}}.css-169lzn0:last-child::after{height:0;}.css-1y1zooy{display:inline;}.css-1y1zooy >*+*{margin-top:2rem;}.css-1y1zooy >*:only-child{margin-top:1.25rem;}.css-1y1zooy >*:last-child{position:-webkit-sticky;position:sticky;top:1.5rem;}.css-mqgbir{margin-top:6rem;}.css-mqgbir .ds-section-headline{margin-bottom:1rem;}

More from China

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Chinese authorities try to stop parents gaming the exam system (again)

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They will go to great lengths to try

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China’s alarming sex imbalance

By 2027 one in six young Chinese men won’t be able to find a partner

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Behind DeepSeek lies a dazzling Chinese university

It models itself on Stanford, and is in the tech hotspot of Hangzhou

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Panama symbolises the Sino-American struggle for influence

The superpowers use soft and hard power

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Tensions with the West are fuelling China’s anxiety about food supplies

Grain pains are growing

Hail China’s new “ice-and-snow economy”

The country is betting on winter sports and tourism to boost growth in its rustbelt

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Источник: www.economist.com