Huang Shu (right), is a well-known spine surgeon who left a public hospital in Northwest China in 2002 and set up a private hospital in Beijing, which provides his own unique treatment and receives about 300 patients every day. Huang says private hospitals need more policy support. Feng Yongbin / China Daily

Medical profession engaged in healthy debate over nature of care

While job-hopping is quite common, few medical professionals make the switch from a public hospital to a private one. A position in a public hospital has traditionally been regarded as an "iron bowl", offering long-term employment.

Yang Jie is one of the exceptions. While working in a public hospital in the 1990s she was chosen by the Beijing Health Bureau to go to Singapore to study nursing. After two years in Singapore she decided to work at a private hospital when she returned to Beijing.

"My colleagues said I was crazy," the 41-year-old nurse says. "Even my parents spent several weeks trying to persuade me not to go to a private hospital. They said a private hospital could close at any time."

There were only a few private hospitals in China at that time, mostly treating venereal diseases, and many had bad reputations.

Yang, who now works at Beijing United Family Hospital, a private general hospital in Beijing, which is a joint venture between US-headquartered healthcare provider Chindex International and the Chinese Academy of Medical Sciences, says it was her experience in Singapore that made her decide to change to a private hospital.

"I had never fed patients or cleaned a bedpan before in my five years working in Beijing," she says. "Two years in Singapore changed my attitude toward nursing and I really wanted to promote such patient and family oriented services in my country."

Yang says that in Singapore hospitals, about a dozen of patients are cared for by two staff nurses, who do daily medical checks and give status reports on the patients' condition to the doctors. Two assistant nurses are in charge of tasks such as giving injections. The cleaning work is done by another group called house attendants.

"In China, nurses have to do all these and there is such a high number of patients that there is no time to give them the attention they need," Yang says.

Even though she has now been working in the Beijing United Family Hospital for 15 years, Yang says that many of her friends in public hospitals don't want to make the change because they still have concerns about working at a private hospital.

Better service, higher cost

However, more and more Chinese patients are now using private hospitals and clinics, as private healthcare providers have developed a reputation for having a better service than public hospitals for those that can afford to use them.

Sharon Liu, 34, who lives in Canada but wants to deliver her baby in Beijing so she has the support of her family, says her experience of a public hospital was so unpleasant that she burst into tears as soon as she got outside.

In order to make an appointment with one of the top doctors, Liu says that she got up at 6 am. "But there were still 20 or more patients waiting, and less than 10 seats were available for those waiting."

Liu only needed to do a regular health check on that day and the doctor only saw her for 10 minutes. "But in Canada, even for a regular checkup, doctors will spend at least 20 minutes with a patient and they will provide very detailed information to patients."

The public maternity and children's hospital Liu attended receives more than 5,000 patients a day, and there is a line stretching back 200 meters from the window where patients have their blood tested every morning. A one-hour wait to have a blood test is normal.

According to the Ministry of Health, there are 1.5 times more public hospitals than private ones, however, waiting times at public hospitals are 30 times longer than private hospitals.

Although many patients believe private hospitals provide more efficient service and have more experienced doctors they are too expensive and thus, out of reach for patients. Only six of the 1,000 private hospitals in Beijing are covered by the medical insurance system, and although private hospitals account for one-third of the hospitals in Beijing, they only cater to 12 percent of patients.

According to the Ministry of Health, China had more than 8,800 private hospitals in March this year, a 21 percent increase on the same period last year, while the number of State-owned hospitals fell by 3 percent during the past year.

The National Development and Reform Commission issued policies in May and December encouraging domestic and overseas private investors to set up medical institutions, including hospitals, clinics and health service centers at various levels.

Yet even though the government is showing a positive attitude towards private hospitals and clinics - State-owned hospitals can outsource some of their services to them - there are few official policies to support them.

Lack of support

The lack of support for private hospitals is the reason 50-year-old Huang Shu, a well-known spine surgeon who left a public hospital in northwest China in 2002 to set up a private hospital, says he regretted his decision.

"If I could make the choice again, I would definitely stay in the public hospital," he says.

His hospital, which provides his own unique treatment, receives around 300 patients every day, some of whom are from foreign countries - during our conversation, he received a phone call from an official from Australia who wanted to make an appointment - but even so, the hospital costs a lot to run. The rent for the four-story building is nearly 200 million yuan (25 million euros) a year.

The Chaoyang district government has helped him find a new building that he will move his hospital to this year and has given him 70,000 yuan in financial support. Huang also operates two clinics in Indonesia and these help financially support his hospital in Beijing.

"But we still feel helpless. From a policy prospective, private hospitals should get the same support as public ones," he says.

Huang says it is difficult getting medical insurance to cover his unique treatments, as in China medical insurance is linked to the costs of the medical treatments and medicines that are provided by public hospitals.

But he says another problem is he can't compete with public hospitals when it comes to attracting new doctors.

"Graduates from well-known medical colleges want a Beijing hukou (the highly sought after residence permit) as well as an apartment, which most public hospitals in the city can provide. But for us, all these are impossible," he says.

And another reason talented doctors are hard to find is that even though private hospitals offer higher incomes, doctors working in private hospitals have difficulty moving up the professional ladder. This is because in China the public department that manages the hospital, for example the local health bureau or a certain institute, is in charge of doctor certification. In order to avoid being held responsible for any possible lawsuits in cases of malpractice, some departments delay or refuse to give new certificates to doctors working at private hospitals.

"For senior professional titles, such as deputy-chief and chief physician, we can qualify for the title by passing the national test, but we can't get a certificate," says Xiong Ning, an ophthalmologist, who previously worked in two public hospitals in Beijing, but who moved to the Jia Yue Eye Surgery Centre, under the Singapore Medical Group, a few months ago.

However, Xiong says she decided to join Jia Yue, because the public hospitals she worked in did not specialize in eye surgery and she wanted professional development. Jia Yue offers her opportunities to go abroad to learn new techniques.

To some, such as 39-year-old Zhou Jingsheng, who worked in the rehabilitation center of a public hospital in Beijing for many years, switching to a private hospital offers more job satisfaction.

"Rehabilitation gets less support in public hospitals because it brings in less money than surgery," he says. "Now I can dedicate all my time to taking care of my patients and learning new techniques. Job satisfaction is really important to me."

Zhou says he loves his job and wants to provide patients with the best help he can. He visited the US to learn about rehabilitation techniques in 2008, and in March this year, he joined Beijing United Family Hospital.

"Here, I can apply what I learned in the US and provide better treatment to patients."

yangwanli@chinadaily.com.cn

(China Daily 08/24/2012 page24)