It's money upfront or you will suffer in agony
Aburly Canadian friend recently suffered a freak mishap that raised questions about the quality of health protection in supposedly cosmopolitan Shanghai.
Strolling home along one of the French Concession's recently relaid but crumbling red-brick pavements, he stumbled - and all but snapped his foot off.
Twisting as he fell, he lunged a leg out for support. He's a big guy but has particularly narrow ankles, and the resulting torque of the impact sheared both of his leg bones clean through, just above the joint.
With blood flowing out of the bottom of his jeans and a foot pointing the wrong way, he somehow retained enough composure to take control of the situation. Assisted by a few kindly passers-by, he scrambled into the back of a taxi and gave directions for a reliable private hospital he knew - luckily, just around the corner.
But the service at the emergency ward fell far short of expectations. The stricken Canadian was drifting in and out of consciousness and another friend had arrived to look after him. He described the scene as chaotic and that hospital staff refused to do anything until they got their hands on a cash deposit. Health insurance details - for which the Canadian had been paying premiums in case of such an emergency - were sneered at.
As he had suffered a particularly bad break and a major operation was needed to save his foot, hospital staff demanded almost 100,000 yuan (HK$114,000) on the spot to ensure their costs were covered. How they expected anyone to lay their hands on that sort of money in the middle of the night defies comprehension.
The Canadian says that it took almost half an hour's negotiations - in Chinese, as staff spoke little English - to get the cashier to accept a credit-card payment. He maxed out three gold cards in the process.
Meanwhile, the hapless patient lay unattended, bleeding.
Such tales are far from rare on the mainland, especially in second- and third-tier cities away from the affluent coast. Having to scrape together an advance payment for treatment is the norm for ordinary mainlanders, most of whom have little or no access to emergency health cover.
But Shanghai, if you believe the rhetoric, is supposed to be different. The city's government insists it is at the forefront of national medical reforms, and top hospitals there are supposed to work as well as other health-care systems around the world.
That this could happen at one of the city's most respected teaching hospitals, in a wing dedicated to treating expatriate patients, has caused many foreigners to think twice about life in the mainland's biggest and richest city.
When it comes to health care, expatriates feel few qualms about expecting to be treated differently to locals; perhaps it's a neo-colonialist mindset, but they wouldn't live there otherwise. Emergency insurance cards and 24-hour support lines are supposed to provide safeguards to allow expatriates and their dependants to jump queues and be given a higher grade of service.
Wealthy mainlanders, it has to be said, expect nothing less.
Discussions about the Canadian's sorry tale, however, have precipitated a host of similar nightmare stories that suggest this isn't an isolated case.
A couple of years ago, one friend was admitted to a different private hospital in Shanghai, suffering from acute abdominal pains. Doctors informed him that he had a case of advanced appendicitis which could prove fatal unless it was operated on within 12 hours.
Unfortunately the only operating theatre available was at the company's other hospital - on the other side of the city. Staff informed him that there was no possibility of a transfer as the hospital had only three ambulances to cover the whole city.
He was left to hail a taxi in the pouring rain in hospital pyjamas, clutching at his stomach and trundling an intravenous drip.
The Shanghai health system is not only found lacking in emergency cases; the misdiagnosis of serious diseases is also a common complaint.
Another friend recounted an experience with his son, who was five at the time. Over several months, they visited doctor after doctor in an effort to discover why the boy was suffering from lethargy, dizziness and a lack of appetite. Invariably they were sent away with mumbled explanations that the boy's sickness was probably due to a virus or a simple stomach upset.
When the family went to Hong Kong, however, hospital doctors immediately rushed the boy into intensive care. He had been suffering from a form of potentially lethal blood poisoning that had advanced to a critical stage.
Thankfully, the boy has since made a full recovery but the family now have a new policy - whenever they feel sick, they get on a plane to Hong Kong.
There is, however, one tiny silver lining to my Canadian friend's experience. He has nothing but glowing praise for the way he was looked after in his private ward - once they knew his credit was good, that is.