China's rehab services suffer from lack of investment
Rehabilitation services face increasing demand on the mainland, but the sector is suffering from a lack of investment and a failure to attract staff
Seated beside a bed much larger than those usually found in hospital wards, Zhang Xiue looked hopefully at her 72-year-old husband as his legs were bent and stretched time and again by a young female rehabilitation technician.
The old man's journey to the Shanghai No 1 Rehabilitation Hospital started six months ago at their home in Taixing, Jiangsu province, when he had a sudden fall and lapsed into unconsciousness. Even with an operation after his stroke, he still could not move his limbs, speak, or even eat.
Discontented with her husband's recovery, Zhang decided four months ago to move him to this hospital, one of just a handful of dedicated rehabilitation institutions in the city.
"I am glad he can now swallow food - his stomach tube was removed a month after we came here. He can also speak simple words," Zhang said. "He still lies on the bed, and can't sit or walk. But I'm confident my husband's situation will improve."
Zhang said she never had heard of medical rehabilitation before her husband's stroke, and his treatment had rekindled the family's hopes.
In a room next door, Hang Chao , 36, stood with his legs bound to a vertical bed and his arms supported by a table, as part of rehabilitation exercises for a rare nerve condition.
Four weeks previously, after his hands and feet went numb and he could only lie in bed, Hang was treated by a leading general hospital in Shanghai, which recommended a follow-up programme at the rehabilitation institution.
Like Zhang and Hang before illness struck, most mainlanders have little if any idea of rehabilitation and what it can do. This is partly due to the snail's pace at which this relatively new medical field is developing on the mainland, even as officials face the problems associated with an ageing society.
According to Professor Li Jianan , the newly elected president of the International Society of Physical and Rehabilitation Medicine, at the end of 2009 there were only about 300 rehabilitation hospitals on the mainland, of which four out of five were not qualified to conduct treatment because of a lack of licensed doctors and technicians. Among the country's 10,000 or more public hospitals, a third have set up rehabilitation departments, many of which stand empty for most of the time.
The Ministry of Health, clearly unaware of the slow growth of rehabilitative medicine, has called time and again for fast and sweeping development of the sector.
In particular, health authorities have called for private capital to be injected into rehabilitation centres and have encouraged most of the country's public Class-B hospitals, those with 101to 500 beds and which serve several communities in a city, to turn themselves into rehabilitation centres in the coming years.
Rehabilitation hospitals, however, have little appeal to investors and hospital management. Luo Zengyong , vice-president of the public Sichuan Rehabilitation Hospital, which was built after the 2008 Sichuan earthquake claimed tens of thousands of lives and left hundreds of thousands injured, said a number of rehabilitation institutions on the mainland were struggling to make ends meet, mainly because the authorities would not allow them to charge fees that came even close to recouping their costs.
"Our prices are so low. For example, we charge just 38 yuan (HK$47) for a 45-minute-long rehabilitation training session for a child with cerebral palsy," Luo said. "Our service is even cheaper than a foot massage."
At his hospital, Luo said a lot of advanced equipment, such as spa rehab tubs, was seldom used. "The more such equipment is used, the more losses we suffer," he said.
"Therefore, although many experts and authorities play up the bright future for rehabilitative medicine in China, very few private businesses are interested in the sector, since they know they will make little if any profit."
Tang Dan , president of the Guangdong Provincial Work Injury Rehabilitation Centre, said the demand for rehab services on the mainland stemmed from the country's ageing society, with its growing ranks of patients with chronic illnesses, and from the injuries caused by accidents and natural disasters.
With the economy thriving, Tang said people had higher expectations for their quality of life, and more turned to rehab treatment and exercises. Patients who might have died before but were now saved by modern medical technology were also big users of rehabilitation services.
He said the fact that only a small number of rehab services were now included in medical insurance schemes had deterred potential operators, given that poor patients could not afford them and that rehab hospitals did not receive many patients.
Li said that years ago he proposed to mainland health and social security authorities who oversee medical insurance arrangements to include 70 rehab services, but they agreed to include just nine items in the insurance scheme. "The authorities seem to think that rehabilitation is a waste of social resources," he said "It clearly is not."
Tang said: "The medical insurance scheme is unreasonable. "Why don't they include a wider range of rehab items? I think policymakers don't see the real benefits rehabilitation provides."
Without more professional rehab training, many patients were doomed to be a burden to their families and society, Tang said. But rehabilitation offered many the hope of partial, if not full, recovery and of becoming contributing members of society.
Li said a common misunderstanding about rehab, not just among ordinary people but doctors and government officials, was that it was a form of relaxation. They fail to see that rehabilitation training involves investment in technology, which costs money, he said.
Since the Shanghai municipal government announced its hope in 2011 that the city's 80 or so Class-B hospitals would switch to rehab services, only one, the former Shanghai Yangpu Geriatric Hospital, had made the transition, with the remainder adopting a "wait-and-see" position.
Wu Xiaotong , president of what is now the Shanghai No1 Rehabilitation Hospital, was optimistic about its prospects.
"Surgery performed by mainland doctors in on par with Western counterparts," he said. "But our patients don't recover as well, and the reason for that is the absence of rehabilitation medicine in China."
"To me, rehabilitation is a new medical frontier on the mainland and full of opportunity."
Wu admitted his hospital was still at a preparatory stage and a severe lack of qualified staff was the biggest obstacle. There are 11 licensed rehabilitation doctors, short of the 60 the health ministry requires for a standard rehabilitation hospital, and just 26 licensed rehab technicians, 94 short of the number the ministry deems necessary.
Li said the shortage of professionals was a bottleneck restricting the development of rehab services on the mainland, where officials expect to see 3,000 rehab hospitals by 2020. He suggested grooming clinical doctors as rehab specialists to help meet the shortfall.
Wu said that to motivate clinical doctors to sit for tests to obtain a licence to practise rehabilitative medicine, he himself had applied to take the test, even though he was a senior orthopaedic specialist, and would attend classes every week with other doctors on his staff.
Zhou Yang , another orthopaedic doctor at the Shanghai Rehabilitation Hospital, said that since changing his practice to rehabilitation his income had fallen by a third, but he felt happy about his future. "The job gives me a sense of achievement and I am highly valued," Zhou said, giving the example of a 12-year-boy who was in a vegetative state four months ago but could now walk, eat and speak following rehab treatment in his ward.