Health Reform                                                        May, 2010   


Brenna and I had colds.   Not so bad, but she wanted to go to Shanghai to the Expo in a few days, so I thought we should make sure there was no serious problem developing.   No fun walking around the Expo with some hacking cough.

My cough had descended into my chest, sort of a bad sign, so I called my people at the school about a medical visit. 


Pay first, then see doctor ... about $0.58 ... each
Pay first, then see doctor ... about $0.58 ... each


Students here seem to get sick a lot, which I attribute to the lack of heat in the dorms when it is actually freezing outside, or maybe to their relative lack of exposure to coffee, sugar, fat, and high-fructose corn syrup.  Anyway, a lot of students call me to say that they are in the hospital, for two or three or five days.    They are being treated for some variation on cold like symptoms.   I did not want some school nurse telling me I had to go to the hospital for three days.   I was not that sick, and neither was Brenna.   What I wanted was to make sure we did not have some weird disease, and if needed get a shot or some medicine stronger than coffee, sugar, fat, and high fructose corn syrup.

The school arranged a car and driver to take us to the real hospital, not the school clinic.   (The school clinic is where the students go, and the faculty also unless they have something really serious).  

Those who think that China is some mono-formulaic culture, with no innovative capability, are, of course, wrong in many ways.  In the US, we have been using public private partnerships to bring more flexibility and cost control to construction and management of projects. So, too, in China.  Our school, ZUST, is a government school, but the management of daily maintenance, cleaning, food service provision, is contracted out, just like in regular American schools. 

Contracting out includes providing the school with cars and drivers for transporting faculty to far off meetings, or picking up people from airports, or taking foreign experts like me to the hospital.   The cost is not small.   A trip to the Hangzhou airport is billed at about 250 rmb, which is about $36.   A taxi is a little more than half that amount (note – this was in 2010).   But, convenience and no buying of cars and servicing them and depreciation and driver overtime and health care and pensions and vacation pay (not).   Whatever. 

The cost for a trip to the hospital, near xihu, should be about 75 rmb if done in a taxi.  About $11.  For the school car, the cost is double (they want to charge for both directions) - rmb 150, about $22. The school will pick that up, of course, for foreign experts like me. Not for regular faculty.   “Take the bus.”

It probably would have been possible to navigate through the hospital without assistance from someone who speaks Chinese.  Pretty much everyone working in the hospital has had at least some English, many probably have a lot of English, and pointing at my throat and coughing works pretty well as an indicator of the problem.

I took along some reinforcements anyway.   Dr. Dang, the Ph.D. marketing professor, agreed to go along and manage the process for us.  Good idea, since I did not know the procedure anyway.

Once in the door, one is directed to the payment window.   This is the Chinese version of giving people at the front desk your insurance card.   No need to sign waivers of anything. No need to show passports or proof of employment at the school.  “Sick?  Ok. Pay up.  Sign here.”

Economics suggests that in a monopoly system, prices should be above marginal cost. Economics also suggests that if prices are too low, the system will be abused and there will be excess demand, and probably long lines by which to ration care. So we have a problem here, as you shall see.

There were, in fact, two people in line ahead of us to pay our visit fee. We must have stood in line for at least three minutes, waiting, waiting, waiting.    When we got to the counter, we explained the reason for the visit (so the clerk could direct us to the right department), she handed us a bill for this initial visit.   Total for Brenna and me, 8 rmb.  $1.16. $0.58 each. 

We were directed upstairs to the respiratory department (I know, because all the signs are in English, and even in Chinese).    Again, there was someone ahead of us seeing the doctor.   We were forced to wait in the hall, again, for what seemed like ten minutes but was probably more like five.

We walked in, explained our problem to the doctor, who listened to our chests, asked a few questions (fever?  How long?  Other medical problems?)  and prescribed some medicine.  I asked if he was giving us zhongyao or xiyao, Chinese medicine or western medicine.   He laughed, and said we were not sick enough for zhongyao, but he would give us some anyway.

I think if we had had more time, I could have asked him what he thought of the Knicks and Bulls, but we wanted to get out of the hospital so we could go shopping.

We went back downstairs to the pharmacy, stood in line once again for about three minutes, gave the clerk our prescription, and waited.   And waited more, this time for at least five minutes.    We got bottles of Robitussin, just like in the US, but with Chinese labeling.   But Robitussin, in the same style font and package design.   Just like in Walgreen’s.   And some zhongyao, not like in Walgreen’s, but take two pills twice a day.

The pharmacy cost was a little high. Total for Brenna and me, the same medicines for each, about 200 rmb, about $29.  Dr. Dang said that the pharmacy is where the doctors make their money, since they receive- I dunno- commissions, or kickbacks, or profits, or something from the sale of the meds.   Just like in the US. Hard to support a family, I guess, on doctor visits of $0.58.   Even in China.

To celebrate, we let the school driver go home alone, and we went shopping for coffee filters. Carrefour, the French retailer, was about three blocks from the hospital. 

But the cost of the car and the driver was only about 50 rmb less than the cost of the doctor, the hospital, and the medicine.   I could write more about this, but I will let you all have that discussion.   Socialized medicine.  Gini curve.   Price above marginal cost.  Returns to education.   Benefits of being the odd one in the group.  And, as you will see below, maybe the perils of underinvestment.

Health care in China is not always wonderful.   A good friend of mine had thyroid cancer several years ago, had part of her thyroid removed, and now takes thyroid medicine every day.   Not such a big deal.   But the dosage of the med needs to be carefully controlled, because the side effects- sleeplessness, irritability, inability to concentrate- can be significant.

China does not have a history of personal physicians.   You have a chart, and whichever doctor is available when you come is the doctor you see.   Sort of like buying hot dogs at the local stand.   You can’t always get your dog from Mortie, the guy who gives you extra fries with that.   Personal physicians are available, of course, but that gets into money that most people do not have.

So the monitoring of the meds can be a little iffy.   Doses need to be changed with body changes, and it seems that not all doctors are equally well-informed about practices.    My own online research suggests that beta blockers can be used to mitigate the side effects, but Chinese doctors do not want to add a medicine on top of a medicine.   Bad harmony.   So side effects are just that.   Side effects.   Live with it.

My friend is in Dalian, which is an international city on the coast.   Not some rural county in the interior.   But the ranks of cancer specialists seem a little thin.  Using a little of my guanxi, I called a zhengfu guanyuan government official IIT student who is a doctor, to see if he could find better treatment for my friend than she was getting.  We got referred back to the same doctor my friend had been seeing.    So no progress there.  Maybe she is getting the best care there is.

I am sure there is a way to deal in a more sophisticated way with thyroid cancer side effects, but I cannot find it.   But I have never before confronted the possibility that there might be better care easily available, but I could not have it.   That’s what I get for living in a city in the US.   But my guess is that even with better universal care in the US, that possibility will confront more and more people over the next couple of decades.   Rationing, not by price, but by location.   I know this has been the case in poor areas in the US, and in China, for as long as there has been sophisticated medicine.   If you want to drive a few hours to get treatment, maybe you can have it.   But if you need to do that every week, or every two weeks, or once a month, better be prepared to not use up sick days for other illnesses.    I have already seen that for specialty surgery in the US.   I won’t be surprised to see it extend to more prosaic treatment, as rural areas empty out.

People suggest that China will become more like the US, and the US will become more like China.    Could be right, for more things than we think.