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Alice Yan

A health project in Shanghai in which patients receive medical advice over the internet from regional specialists could hold the key to relieving an imbalance in the mainland's health system that sees big hospitals crowded with patients, but grass-roots health centres almost deserted.
At the Wangxin community medical station in Waigang town, northwest of Shanghai, 68-year-old farmer Xing Peirong sits beside a young doctor, Li Xixu, who discusses Xing's diabetes with a second doctor over an online link.
"Dr Chen Yuhong, I will read out the basic statistics of my patient to you," says Li, before describing Xing's height, weight, waistline, blood-sugar and blood-fat levels, the results of check-ups on his liver and kidneys, and the drugs he has taken.
Xing has been a diabetic for many years and has regularly taken drugs prescribed by Li.
But recently his blood sugar began rising, which puzzled the doctor.
That's when he sought the opinion of Chen, a leading endocrinologist at Shanghai's famous Ruijin Hospital.
"It's my second time using long-distance consulting. I am very pleased as it allows me to receive [advice] from the cream of the crop," Xing said.
"In the past I have been to major hospitals in central Shanghai and each journey takes two hours each way. It's not convenient for me or my children, who have to take time off work to accompany me."
Cyber consultations have been taking place for two years in Jiading district, where Waigang is located.
All the district's community health centres are now connected to diabetes specialists at Ruijin Hospital.
Another long-distance diagnosis project enables small hospitals to get cardiogram analysis from Shanghai's Renji Hospital. The district went further last year by getting the region's most qualified medical staff at Jiading Central Hospital to analyse data sent through the internet from all of its community hospitals, because the low-level institutions were short-staffed.
Peng Qian, the director of information technology at the district health authority, said the government was keen to promote long-distance consulting so that grass-roots hospitals could attract more people by providing input from leading doctors at major hospitals.
"We want to build a 'tier-treatment system' and realise a scenario in which most patients are treated at low-level hospitals, rather than crowding them all into big ones," he told the South China Morning Post.
This is in line with a communiqué on deepening medical reforms released by the Communist Party at its 18th plenary session two years ago.
It's common for big hospitals in the mainland's biggest cities to be full of patients not only from the surrounding region, but from around the country. People complain that they must queue for hours for a consultation, only to find that it lasts just several minutes. Beds in such hospitals are often full throughout the year.
The opposite problem is experienced at low-level hospitals, where patients are few and doctors have too little work. Such health centres are generally avoided by local residents who distrust their medics. Medical graduates show little interest in working in such hospitals.
In Jiading district, installing hardware for the long-distance scheme cost the authorities about five million yuan (HK$6.3 million), said Peng. Patients don't need to pay for a consultation by a top specialist; the cost is covered by the authorities.
While the long-distance system is not new on the mainland, Peng said that only a limited number of hospitals across the country had taken advantage of the technology and that his district health authority was the first to back the project.
Doctor Li said that having access to guidance from the Ruijin doctors had taught him a great deal about treating his patients. For eight years before the programme, he had made little progress and felt a "glass ceiling" blocking his professional development, he said.
Bo Yanqing, vice-director of the Waigang Town Hospital that administers several community medical stations, said since the long-distance system was adopted, the number of patients at hospitals in the town had risen 10 per cent annually. The results were particularly noticeable among diabetes patients, who were controlling their blood sugar better than before.
She said the help from the central hospital was timely as her institution had suffered a lack of specialists for about five years. In one of her hospital's departments, there was only one doctor, she said.
But while Jiading district's government-sponsored long-distance scheme has benefited local patients and community hospitals, some experts doubt its success will be reproduced elsewhere.
Bao Yong, a public health professor from Shanghai Jiao Tong University, said the project was more like a showcase and its future was not promising. He said big hospitals were not motivated enough to take part.
"Big hospitals have quite enough patients and they don't at all worry about business income," he said.
Peng echoed this, saying it was often difficult to enlist big hospitals. "Sometimes [they decide to help] by coincidence and sometimes it happens that the big hospitals' heads are good friends of our district's health chief," he said.
One doctor from Guangzhou's Nan Fang Hospital told Southern Daily that most long-distance consultations by the hospital's staff were done for free because the authorities had ordered them to help small hospitals.
Liao Xinbo, an inspector at the Guangdong provincial health authority, said many big hospitals in Guangzhou had their own long-distance medicine centres, although few of them conducted more than 150 such consultations a year.
"Doctors are too busy and the subsidies from the government - if there are any - can't lure the doctors to dedicate their time to the scheme," he told the Post.
"So in the Jiading district project, the government ordering the small and big hospitals to form alliances and paying big hospitals' doctors is against the market economy rule and won't last long."
Peng shared this concern, saying one of his priorities was to find a business model that was sustainable and could be duplicated in Shanghai and elsewhere on the mainland.
"It's impossible for the authorities to inject funds into this project forever," he said.


The online health consultations that could ease pressure on China's hospitals

Health 'screening': Farmer Xing Peirong, 68, and his doctor Li Xixu use an online video link to discuss Xing's diabetes with Dr Chen Yuhong, a leading endocrinologist at Shanghai's Ruijin Hospital. Photo: Alice Yan

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Long-distance consultations over the internet could be a shot in the arm for grass-roots medical facilities


Long-distance consultations over the internet could be a shot in the arm for grass-roots medical facilities.


The online health consultations that could ease pressure on China's hospitals

.css-1c6uqr6{color:inherit;font-weight:inherit;font-size:inherit;font-family:inherit;line-height:inherit;overflow-wrap:break-word;}Long-distance consultations over the internet could be a shot in the arm for grass-roots medical facilities

Long-distance consultations over the internet could be a shot in the arm for grass-roots medical facilities