Introduction to Chinese Medical Service

[Nanjing to Seoul]

Okay. . .I have an abscess in my leg. I hurt myself and it got infected. No big deal. I've had them before. Staph infections are rather common and I know what to do.

So, at the insistence of the wife, I went to the foreigner section of the local hospital. This is my fifth time dealing with Chinese hospitals. . .first thing, doesn't matter if it's terrible or a good hospital, they are all the same.

We'll divide it up into sections:

1: REGISTRATION
Behind the registration booth is usually a rather frazzled overworked clerk that looks at you with a level of disdain that can range from mild annoyance to complete antipathy. They rarely make eye contact, take your paperwork out of your hands, slam the information into a computer, give you your "treatment book" and then demand 20-50RMB for the privilege of being registered. No, we have not going to triage yet. We haven't seen a nurse. We just got registered.

2: TRIAGE
When you get to triage, the nurse doing it usually spends most of her time on her phone and ignores you completely. I say "her" because 95% of nurses in China are still women. Male nurses are EXTREMELY rare. If she could have you do everything, she would gladly let you. After that's done, you're down another 100RMB and we still haven't seen a doctor.

3: INITIAL DIAGNOSIS
In the waiting from packed filled to overflowing is every type of disease and malady you can think of. This is the medical version of Grand Central Station. People are hanging out windows, spitting on the floor, smoking cigarettes next to a "no smoking" sign that has an ashtray under it and smelling a bathroom so ripe with ammonia it would make a dead person's eyes water. When the doctor sees you, expect a lightning fast consultation (less than five minutes) where the doctor won't make eye contact and doesn't listen to anything the patient says after the first sentence. See, in China, people just do what the doctor says without question. It's the norm here. You do, you don't think. You react, you don't proact, if that's even a word. When they an American who begins saying "wait, I need to know what's happening. Tell me what you're doing," the self-righteous indignation comes out and you get the attitude "I am the doctor, you are the patient. I outrank you." Now you're down another 150RMB. So, 300RMB and you haven't done one thing medical yet.

4: PROCEDURES
Hospitals will always put inpatient service for everything. Doctors here are 1/2 medical "professionals" and 1/2 salesman. They actually get a small commission on the amount of patients they can intake. So it is in their financial interests to push expensive in-patient service to everyone. . .and get every angry when you say "No, I don't think I need to be intaked. I've had this before. Outpatient is just fine."

Moving on, if you want a bed or a wheelchair, good luck finding one. And if you do, they are under lock and key. See, people have stolen them before. Well, that's the urban legend. I can't imagine someone being able to steal a mobile hospital bed, but stranger things have happened.

5: IN PATIENT CARE
This does not exist. Your hospital room is a prison cell. Literally. No TV, no internet, no nothing. Also, it's a dead zone for cell phone service, so no texting anyone. All you can do is watch the paint dry.

On top of that, the nurse will only come into take vitals. You need to go somewhere, your family has to take you. If you need to eat, your family needs to buy you food. If you need to get an examination, the nurse will point you in the general direction and then go back to her paperwork. If you get lost, it's on you. Why don't you understand what I said to you?

So, food given to patients is not medically appropriate (imagine just having a coronary eating super salty food) and all medical services given to you must be given to you by people who no medical training (your family). Add to that the rooms are filthy, the windows might be broken, there is no climate control, no insulation to keep the cold out and the heat in. . .and people smoking EVERYWHERE! Even in rooms with oxygen tanks.

Now comes the doctor. . .he will see you at most five minutes day, ask you a question or two and then walk away. No examination, no real medical service. Just a cursory, perfunctory attempt to do something that shows the appearance they they are doing their job. Oh, and don't ask to see their medical license or their medical degree. They will get angry and say things like "No one ever asked me for that. How rude" or "I'm a doctor. Accept it." or "What do you know what you're looking at if I let you see it?"

6: MEDICINE
Usually, they push the most expensive brand name they can because that makes the hospital the most money. Even if the generic works just as well, the brand name is always pushed. It also doesn't help that the word "Generic" in Chinese means "common" and no one wants the common medicine, because common medication is bad. Try explaining that they are the same and people look at you cross eyed and give you "well, maybe you're right, but this is China." The usual excuse for anything said to people here that challenges a few of their fairy tale urban legend notions.

7: INVOLVEMENT
Chinese people are not involved in their treatment. Most go to hospital assuming they will die and are just lying there waiting for death. Giving up is easy, because hospitals are where people go to die.

8: GETTING TREATMENT
Remember that Hippocratic Oath? That doesn't apply in China. Pay first, pay again, pay immediately, then the doctor will see you, so long as you have the invoice and receipt to prove you paid.

9: INSURANCE
China has one of the most screwed up health insurance ideas, namely because it is an unregulated new industry and no laws have been made to reign it in. Here's how it works:

1: Pay all bills immediately to the hospital
2: Get your official invoices with the red stamp
3: Contact your Insurance company's English speaking phone line (hahahahahaha. That doesn't happen. My medical Chinese is terrible so if my wife is unavailable, I have to do it).
4: Get the insurance claim form.
5: Fill it in and total everything. One oversight will cancel the claim.
6: Mail it in with all invoices.
7: Wait two to three weeks.
8: Get an email saying if your claim has been approved or denied. If Denied, there is no recourse.
9: If approved, the insurance company will reimburse into your bank account, after the deductible, 80% of the invoice through direct deposit.

Yes, it is as annoying and inefficient as it sounds.

This is medical care here. Pure capitalism. Most hospitals are private, money making ventures for universities, business, corporations or just a private rich fat cat that see gold in someone's suffering.

The public ones are just miserable beyond recognition.