To optimize medical services, discourage unnecessary visits to top hospitals

Editor's Note: From "bare-foot doctors" to the most expansive and effective medical insurance system, China has made remarkable achievements in the healthcare sector. In the second of a series of commentaries, a senior journalist with China Daily traces the eventful journey of China's healthcare achievements.

One Monday I took a bus to the China-Japan Friendship Hospital in Beijing to see a doctor, but I had to get down from the bus about 1 kilometer away from hospital after being caught in a traffic jam caused by "patients" trying to find a place to park their cars.

At the entrance to the hospital, I saw about 200 people waiting in line to have their body temperatures checked as a preventive measure against COVID-19. Once inside the hospital compound, I had to jostle against hundreds of people waiting to register, pay the medical bill, get medicines or see a doctor to reach the patients' desk.

Such scenes are common in hospitals in China due to the COVID-19 pandemic.
Statistics show that in 2019, patients made 8.72 billion visits to hospitals and clinics in China with 266 million of them being hospitalized. While there are nearly 1 million medical centers in the country, only 32,000 are hospitals that provide inpatient services. The others are either village clinics or urban community medical centers.

The fact that 97 percent of China's 1.4 billion people are covered by medical insurance of different kinds and the lack of facilities to diagnose serious illnesses in most clinics and medical centers prompt people to go to the big hospitals in cities. By paying a registration fee of between 10 yuan ($1.53) and 100 yuan, they can see the best doctors in the best hospitals even if they are not suffering from any serious disease.

That explains why the country's top hospitals, which usually are located in metropolises and provincial capitals, are always crowded while the clinics and smaller hospitals are largely deserted.

To meet the increasing demand of patients, many big hospitals have been expanding in scale. A hospital in Zhengzhou, Henan province, claims to be the largest in the world as it has 10,000 beds and handles about 20,000 patients a day. There are a dozen hospitals in China that handle more than 10,000 patients a day.

Doctors in these hospitals work under great pressure. Sometimes a doctor has to see more than 100 patients a day. While the doctors are exhausted, the patients are unhappy because the doctors take only a few minutes to prescribe them medicines or treatment, as I have experienced.

No wonder doctor-patient disputes are reported frequently. In some extreme cases, patients or their relatives attack doctors, sometimes with weapons, believing the doctors did not provide proper treatment. Some doctors have even lost their lives in such attacks. To protect doctors, security has been strengthened in hospitals－a hospital in Guangdong province even made doctors wear helmets a few years ago to protect them against such attacks.

To solve these problems, we need to improve hospital services. And to improve hospital services, it is necessary to reduce the number of patients visiting big hospitals, say, by encouraging people suffering from cold, fever and other mild symptoms to visit community or lower-level hospitals. Thanks to China's medical network, 90 percent of the population can visit the closest medical center within 15 minutes, according to a recent news release from the national health authorities.

China's hospitals are divided into three categories with category 3 being the best. Under the policy, in most cases, as much as 95 percent of the medical cost of community hospitals is covered by insurance while only 80 percent of the expenses of category 3 hospitals can be reimbursed.

This policy may be working well but it is not enough to stop people from swarming to the best hospitals to seek the best treatment, not least because when it comes to health, people usually don't mind paying a little more.

While the reimbursement ratio can be further adjusted to divert the patients' flow to the medical centers and clinics, it is high time the medical authorities considered introducing disease classification methods in hospitals. Unless it's an emergency, or unless a patient is suffering from a serious disease or has a referral from another hospital, he or she should be discouraged from visiting a category 3 hospital.

This, I believe, will help the country make full use of its limited medical resources and enable hospitals and doctors to do what they are best at－treat patients with full care and attention.

The author is former deputy editor-in-chief of China Daily.

The opinions expressed here are those of the writer and do not necessarily represent the views of China Daily and China Daily website.

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