The U.S. health care reform debate has been contentious so far; however, one thing everybody can agree on is that the issue of providing quality healthcare to the 300 some odd million people in the nation is a one of colossal proportions. Now imagine multiplying the number of people that needed healthcare by 5 while drastically the quality of care in the status quo in terms of healthcare infrastructure, medicine, and pharmaceutical drug quality. That is the situation that the Chinese government currently faces.
While it would be impossible to adequately address the myriad of healthcare issues in the country, it is possible to focus on some of the major barriers to quality, affordable care. Many issues such as strained doctor-patient relationship, crowded emergency rooms, lack of pharmaceuticals, health insurance, and strained infrastructure are a direct result of the too many people clamoring for too few services.
The hospital that I worked for is considered one of the best in Jiangxi Province and is located in the city of Nanchang (pop: 5 million). Perhaps it is because of this that the hospital had a turnover of about 10000 patients a day while conditions within the hospital were so crowded that patients had to sleep on cots in the hallway. It almost felt as though I was in the midst of a warzone hospital in some old black and white film. The hustle and bustle, lack of patient privacy, and chaotic atmosphere are impossible to convey to those of us used to our quiet, clean, and orderly hospitals. The quick and easy fix to this problem would seem to be to increase the number of doctors and hospitals, a relatively simple solution that is difficult in implementation; however, literally down the street from the state hospital was another hospital that was almost empty on a daily basis. In fact, the hospital (and many others I later found out) was practically begging people to come in and even had staff handing out fliers on the street.
I later visited this hospital and it seemed to have decent facilities and staff, why the disparity in the number of people? The reason I found from talking with some patients as well as hospital staff is that people did not trust the place as it was thought to be corrupt and overcharge for procedural services and medicines which leads to the another issue in Chinese healthcare: that of doctor compensation and the commercialization of healthcare.
In an environment where political lobbying, corporate political contributions, and doctor-pharmaceutical company relations are becoming increasingly apparent, the U.S. should look towards China as an example of where this road leads: destroyed doctor-patient relationship, mistrust in the healthcare system, patient noncompliance, and treatment breakdown. The pharmaceutical lobby is one of the largest on the Hill and in 2010 spent over 150 million dollars, and pharmaceutical companies gave doctors and nurses in the U.S. around 250 million dollars in 2009 and 2010 to promote their products and speak at conferences.
A short summary of the situation in China is that doctors are paid relatively modest salaries of about 3000RMB per month; however, they receive bonuses that are many times this amount for the number of patients they see as well as bonuses from Big Pharma for all the prescriptions they give out. Patients know this, and therefore generally distrust and even resent treatment options the doctor recommends. Frequent fights broke out at the hospital because of this mistrust between patients and hospital staff because patients believed doctors to be corrupt. The situation has gotten to the point where the hospital is almost seen as the enemy, for example, even while I was at the hospital, a group of about 100 people started a riot/brawl because one of their family/friend had died from lung cancer the night before. The group was absolutely convinced that the hospital was somehow responsible and demanded compensation. When this was refused, the brawl broke out.
China provides an extreme example of what might occur in the U.S. if the country continues down its present path. While healthcare reform had a lot to say about the compensation of pharmaceuticals, there was little mention of the relationship between pharmaceuticals with Congress and physicians. Limiting the amount of money companies are able to provide members of congress, having full disclosure of payments received from pharmaceutical companies, and divorcing corporate interests from our healthcare system would go a long way in instilling patient trust in the system. Belief in the system is the key for continued quality of care and works to ensure the success of any healthcare reform. While hospitals can be built and doctors can be trained, trust is a more nuanced aspect that, once lost, is hard to retrieve. Although our situation at home will likely never approach the levels that are occurring in China, we as a country have the benefit of being able to learn from this extreme example of a healthcare system under enormous amount of strain and make the necessary preparations to make sure such a situation never arises on our native soil.
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