Doctors in demands for overhaul of outdated healthcare system

Medics in the mainland hope reforms outlined in Third Plenum will give them greater freedom to operate

PUBLISHED : Tuesday, 03 December, 2013, 11:55am
UPDATED : Wednesday, 04 December, 2013, 2:15pm

At 6.30am Liu Yinglong’s  office is already packed with anxious patients waiting for the top paediatrics cardiac surgeon at Beijing Anzhen Hospital to check on their babies.

The demand for Liu’s expertise is so great he has to see about 30 patients in the morning before his official rounds start at 8am. Later in the day, his office is crowded once again with the sick and needy.

Liu, like many mainland doctors, has a huge workload. Only a fraction of the patients who ask for his help come from Beijing. And up until recent years medics were only allowed to register at one hospital or medical practice.

The result is that Liu spends his spare time treating patients in other parts of the country, but only as a “consultant”.

“Only 7 per cent of our patients come from Beijing, the rest come from all over the country,” said Liu, whose team performs 2,500 heart operations a year.

At weekends he goes to other cities to carry out surgery. To date, he has operated in 140 cities. For the last 16 years, he has been campaigning for an overhaul of the system.

Now, it seems his labours have won the backing of the country’s leaders. After their third plenum in Beijing last month, top Communist Party officials promised to would lift more of the restrictions placed on medical practitioners.

Liu’s proposal to allow doctors to work officially in more than one place was included in a health care reform document released four years ago and several provinces have pilot schemes to introduce the reforms.

So far the response to the tentative changes has been low key.

In Beijing, only about 1,000 doctors have been allowed to register to work in a second hospital. In Guangdong, the figure is 3,800.

Doctors have to get approval from their own hospital to work at a second, but Liu said administrators were often wary of giving staff greater freedom.

“The situation cannot be improved right away because doctors are valuable assets of the hospital and a hospital president depends on them to see patients and make money,” he said. “How can the hospital president pay salaries and bonuses if doctors all go away to practise elsewhere?”

Gong Xiaoming , a gynaecologist at Shanghai’s No.1 Maternity and Infant Hospital, said giving doctors greater freedom to operate was key to improving the quality of health care on the mainland.

Doctors in public hospitals lack motivation to improve the service because they are low paid, the workload is huge, he said. They are unlikely to get decent pay from public hospitals because they were already struggling to cope with high costs and low government funding.

It is common for low-paid doctors to make money by prescribing unnecessary drugs to get kickbacks from pharmaceutical companies.

“If doctors are reasonably paid in their practice elsewhere and focus their work in public hospitals on training young doctors, it will improve access to medical services and increase satisfaction among patients,” % he said.

Gong left his previous job in Beijing in June. One of the conditions of his new role was freedom to practise at a second hospital.

“The evaluation mechanism in public hospitals has flaws,” Gong said. “Doctors are assessed on how many patients they see and how many surgeries they perform, but never how many qualified doctors they train.

“Now you see many private hospitals built, but they are not popular among patients because patients don’t feel they’re reliable. By training more doctors in public hospitals it will provide the healthcare market with more trained staff and they can work at grassroots level hospitals or private hospitals and patients will have access to more professional  health care.”