The mainland's rural hospitals, facing a chronic shortage of medical staff, are struggling to treat a soaring number of patients, a national survey has found.
The findings raise concern that, as many rural doctors and nurses are lured to the cities with better-paid jobs, there will be little chance of meeting a national target to have 90 per cent of rural patients treated locally by next year.
Rising rural incomes and better health insurance mean more farmers can afford visits to local hospitals, but trust in local doctors remains low and patients prefer to seek treatment at urban hospitals that are perceived as better equipped and with superior staff.
Researchers from the Chinese Hospital Association, backed by the National Health and Family Planning Commission, found that more than 60 per cent of county-level public hospitals are short of doctors and nurses.
The survey of 86 hospitals in 30 provinces and municipalities found that nearly 9,400 medical workers had quit their jobs between 2008 and 2012, with each health facility losing from 20 to 30 workers a year.
More than three quarters of those who left were experienced or senior staff who took positions at upper-level hospitals.
Professor Wang Lingling , the deputy secretary general of the association who led the survey, said improving services at county-level hospitals was a prerequisite to realising the State Council's target of having 90 per cent of rural patients treated locally, instead of flocking to major health centres in the cities, by next year.
"Retaining skilled staff at county-level hospitals is one of the most essential aspects in this issue," Wang said. "As medical reform is carried out, county-level hospitals have been expanded or renovated, but frequent job-hopping by medical professionals persists."
County-level hospitals are categorised as those with between 100 and 500 beds. The national health authority has been trying to direct rural patients without rare or complicated diseases to county or lower-level hospitals, rather than major urban hospitals with at least 501 beds that are already overcrowded.
However, rural patients are avoiding the "tier-treatment system" in their counties, partly out of distrust of local doctors.
Professor Liu Tingfang, from the Hospital Management Research Institute at Tsinghua University, said the study confirmed that grass-roots hospitals were "generally and seriously" short of skilled staff, which made it difficult for authorities to convince rural patients to seek treatment locally.
Dr Xiong Xiaoyun, who has worked for three years at Anyuan County Central Hospital in Jiangxi province, said at least half of his colleagues who had quit the hospital were later hired by a bigger hospital in the larger city of Ganzhou. "The doctors were badly paid," Xiong said. "The working and living conditions here are boring and oppressive and I would definitely leave if I had the chance."