Written by: Ailee Slater - 19/8/2014
When Chinese factory worker Dou Huhai was taken to the hospital with two crushed fingers, the prognosis wasn’t bad. A doctor told Dou that the fingers could be salvaged – but then learned that Dou had no money to pay for the procedure and no health insurance. Instead of saving what he could of Dou’s fingers, the doctor performed a simpler – and cheaper – amputation.
Dou’s story, as detailed by the World Health Organization, is a frightening demonstration of where China’s health care system fails, and it’s significant to note that Dou’s injury was a result of drowsiness on the job caused by medication taken to cure a cold when a doctor’s visit wasn’t affordable. Rural and low-income Chinese can’t pay for necessary medical care, and poorly paid doctors can’t afford to treat them for free – so what’s the government doing about it?
Health Care in China: A Brief History
During the Mao period from 1949 to 1978, health care in China was centrally run: the government set medical prices and paid doctors’ salaries, and provided health coverage to over 90 percent of the population. Basic health care services were given to rural Chinese for free, and private insurance or health care facilities largely didn’t exist.
From the end of the Mao years and into the 1980s, low-income Chinese saw a massive reduction in public health benefits as the centralized insurance system disappeared. Hospital prices increased, as did out-of-pocket expenses for patients. Doctors, too, found themselves struggling: with a decrease in state funding, hospitals were surviving solely on patient fees, leading to low salaries for doctors and the near necessity of requesting full payment and even bribes before a medical procedure could be performed.
Government Action to Improve Health in China
In the past decade, the Chinese government has done a remarkable job of acknowledging the problems plaguing its national health care system, and has implemented new legislation and funding to make the system better. Much of this good work came as a response to the SARS epidemic in 2003, when the highly contagious respiratory illness lead to sickness, fatalities, economic woes and a damaged national reputation.
Since then, China has increased its health care spending (in 2002 health expenditures were US$19 per person, but in 2011 that figure had increased to US$155 per person) and has begun work on the Healthy China 2020 initiative: a plan that proposes to bring health coverage to over 99 percent of the population by the year 2020. The news service Bloomberg reports that China has already spent more than US$180 billion since 2009 implementing new insurance programs offering health insurance to nearly 100 percent of China’s rural population.
Although the government laudably improved the affordability of health care for low-income Chinese, expats accustomed to Western hospitals will be well aware that when it comes to health care facilities, further progress is needed.
Public hospitals in many parts of China – especially those away from populations centers like Beijing and Shanghai – suffer from a lack of staff and equipment, leading to long wait times and overworked, underpaid doctors. The GSK scandal of 2013, in which pharmaceutical representatives were accused of offering bribes to Chinese doctors, accurately reflects what was an endemic culture of bribery in China’s health care system. Doctors desperate for extra money will often refuse to treat patients who can’t pay up front or don’t offer an additional bribe, even in emergency situations.
With the recent government investment in health care, advocates are hopeful that doctors’ salaries will improve in the future and that with universal coverage, patients who can’t afford a bribe will still receive timely and adequate treatment. Unfortunately, many public Chinese hospitals have also been accused of poor sanitation – indeed, the U.S. Embassy of Beijing warns visitors that rural health clinics can cause infection and disease through their use of unsterilized needles, and that facilities may lack the sophisticated equipment necessary to treat serious medical afflictions.
Patients nervous about public hospitals do have the option of receiving treatment in a private facility – however they will have to pay a good deal more to do so. The most highly regarded private hospitals in China hire Western and Western-trained staff who are not only highly qualified but also able to speak English and other European languages, and hospital administrative staff ensure that good levels of sanitation and comfort for patients are maintained.
In fact, even the Chinese government has admitted that more private hospitals might be good for the country: in spring 2014, officials announced new opportunities for foreign investors looking to build private health care facilities in China. Authorities have said that with more investment and new private hospitals, the burden on China’s public services will be lessened and citizens will have access to better care around the country.
Outpatient Care in China
Health reform in China has largely focused on improving access to inpatient and emergency services, and indeed, health care in China has long been distributed primarily through hospitals. For patients experiencing a sudden illness or injury, government-sponsored insurance that pays for an ambulance and surgical care is very much appreciated – however some health care advocates say the Chinese system would do well to include more access to preventative and general wellness care.
Because the Chinese system is so strongly centered around hospitals, many expats prefer to hold a private insurance policy that offers coverage for disease screening, women’s wellness check-ups, and general visits to a GP.
Some private insurance plans serving the Chinese market will also cover Traditional Chinese Medicine: which is in fact a popular method of preventative and non-critical health care in China. Visiting a Traditional Chinese Medicine practitioner, a patient will discuss their needs and may be recommended acupuncture, herbal tinctures or other forms of therapy. Expats living in China who are interested in coverage for Traditional Chinese Medicine should ask their insurer about coverage for complementary therapy – many plans offer 12 visits to a practitioner per year, and sometimes more.
Is Insurance Necessary for Expats in China?
If you are living in China without private insurance and need to see a doctor, prepare to pay for your care up front. Chinese hospitals are not expensive by Western standards, but if you can’t pay immediately you may be turned away – which could be a minor inconvenience or a problem of life and death proportions, depending on the seriousness of your medical affliction.
To make health care in China run smoothly, many expats do choose to hold a private insurance plan. With this insurance, it’s possible to visit private hospitals where it’s easy to communicate with doctors and levels of sanitation are maintained. Expats living in rural areas may also appreciate holding an insurance policy that offers emergency evacuation: rural villages are often many miles from a hospitals and lacking in ambulatory services, and even if a patient does get to a nearby facility, she may find it staffed by doctors who don’t speak English and aren’t trained in treating life-threatening medical problems.
Along with emergency evacuation to the nearest well-equipped hospital, private insurance can also guarantee wellness visits, dental care and eye care, and cheaper access to medication and regular health care screenings.
What Insurance Plan Is Best for Expats?
When evaluating a health insurance policy, expats in China should consider a China-only plan versus an international plan. A China-only plan will cover health care needs while in China, whereas an international plan will further provide coverage (including emergency care and evacuation) while the policy-holder is traveling abroad. Expats who enjoy frequent holidays outside of China will appreciate an international plan, especially if traveling with children. Expats in China might also bear in mind that some insurance plans are transferable, meaning coverage can be maintained upon moving away from China: a good choice for temporary expats or those who relocate often for work.
How Much Does Expat Insurance Cost?
Costs vary: depending on the policy-holder’s age, country of birth and current health care status. An insurer will also adjust price based on what services the policy holder requires. Private insurance for a spouse and dependents will be more expensive than an individual policy, and add-ons such as maternity care, psychological services and regular medication for chronic conditions will likewise lead to a larger monthly bill.
Expats with a family or expected health care needs may be happy to pay more for a private insurance policy, while young and unmarried expats may prefer a cheaper insurance policy to cover emergency services only. Of course, there is no requirement to hold health insurance as an expat in China – but plenty of people in China both resident and expat – Dou Huhai included – would argue it’s not a bad idea.