The doctor told Renee Gao’s parents that the tumour in their teenager’s chest was not disappearing. The girl would need a costly operation that could leave her sterile – if she survived. Then he ushered them out. Gao Jiang and Yu Wenmei had dragged their ailing daughter across Kunming in the southern province of Yunnan, then north to the best cancer hospitals in Sichuan province and Beijing. The family stood in hours long queues and called in favours from colleagues at Gao’s life insurance company to speed up the wait. But no one would tell them why the cure for their 16-year-old’s lymphoma might threaten her life. “I felt hopeless,” Gao said. So at a colleague’s suggestion, he turned to a Shanghai start-up called MediStar Health that paired cancer patients with foreign doctors via teleconference. They consulted with three American physicians, who recommended chemotherapy treatments instead. Two years later, Renee is in remission and preparing for college in Australia. China provides basic health care coverage to nearly all its 1.4 billion people and has spent almost a decade trying to upgrade services. But many Chinese continue to harbour deep distrust in an overstretched, underfunded health care system. “Doctors in China are like machines,” Gao said. “If you’re cured, it’s your luck. If you die, it’s your fate.” Such attitudes have fuelled the rise of companies like MediStar, which find opportunity in China’s struggling medical reforms. Several dozen new businesses offer second opinions from as far away as San Francisco and Boston to middle-class patients fed up with busy doctors and unclear guidance. China’s medical system attracted particular attention in recent years when patients started attacking their doctors. Within a month in 2014, frustrated patients beat a Heilongjiang province doctor to death with an iron pipe and paralysed a nurse in Jiangsu province. How can mainland China’s health care be improved? Hong Kong’s former finance minister thinks he has the answer The Chinese Medical Doctor Association reported that 13 per cent of 12,600 doctors surveyed in 2015 said they had been physically assaulted the previous year. The tensions have less to do with doctors’ skills than exasperation at a system that does not meet the needs of an increasingly affluent, discerning society. MediStar, an eight-person operation founded in 2014, seeks to bridge that gap. The team narrowed in on oncology – fuelled partly by China’s elderly population and large number of heavy smokers – and built a network of 400 physicians from across the US. The company charges about US$3,000, about a quarter of a household’s yearly median income, to translate hospital records and set up one-hour online consultations. Physicians do not prescribe medicine or examine patients; they offer expertise and time. Claire Wang, 29, who grew up in Kunming and attended Allegheny College in Pennsylvania, came up with the idea for MediStar with a former high school classmate. Both attended college in the US and were barraged with requests for help reaching American physicians. “We’ve seen so many cases of misdiagnosis or overtreatment,” said Wang, one of three co-founders. “We’re happy if we can help with one small step in the journey to proper care.” Experts estimate that Chinese physicians see up to four times as many patients a day as US doctors. But the majority get paid less than US$15,000 a year, according to Beijing consulting firm iResearch. That creates incentives to encourage multiple tests or push certain drugs, essentially a fee for service. China’s rich families are putting health before wealth, study finds The country also lacks well-trained family physicians at local clinics, a reminder of the “barefoot doctors” days during the Cultural Revolution when minimally trained farmers treated villagers. Many people now go directly to the hospital for flu or stomachaches, leading to crowded waiting rooms. “It’s not the doctors’ fault of course, it’s the system’s fault,” said Gordon Liu, director of the China Centre or Health Economic Research at Peking University and an adviser to the government. “Chinese people have begun to realise when we meet our doctor we are not only looking for the technical part of the service … but also for support, affordability and to feel more comfortable.” Leaders responded to growing outrage with a broad overhaul in 2009 and pouring US$900 billion into improving the health care system. China expanded basic insurance to cover about 95 per cent of the population, but struggled to strengthen primary care or establish better financing for public hospitals. Officials still have not fundamentally solved the problem of access and affordability, said Huang Yanzhong, director of the Centre for Global Health Studies at Seton Hall University. TreCare Medical Management, a health consultation company in Chengdu, markets those concerns about quality. “The probability of being misdiagnosed in China is much higher and hospitals are unable to provide viable medical advice,” its website says. TreCare began in 2015. The company partners with medical centres and charges at least US$3,000 for online consultations. Most patients suffer from cancer or seek fertility treatments, said Sophie Xie, TreCare’s director of overseas affairs. Oncology is one of the trickiest fields. Chinese doctors often tell a patient’s family about a cancer diagnosis before or instead of telling the patient, according to a 2016 study by Norwegian researchers. Relatives fear that acknowledging the disease will only make it worse, especially if patients cannot afford treatment. “If we do not consider the family’s opinion, the consequences can be very serious,” said a surveyed oncologist. “We may be beaten or scolded, or involved in lawsuits.” China’s National Health and Family Planning Commission, which oversees state hospitals, did not respond to requests for comment. China’s dire need to reform health care sector seen as opportunity for private hospitals Gao, the Kunming parent, spoke honestly to his daughter. He memorised the technical terms for her lymphoma and studied treatment plans. Gao remembers his last conversation, through a translator, with the American doctor they consulted most, Harvard-trained doctor Eddy Chen. Chinese doctors suggested Renee undergo an eighth round of chemo. “I asked him, ‘If it was your daughter would you do it?’” Gao said. “He said, ‘I wouldn’t’.” Chen, a Boston oncologist, teamed up with MediStar because he wanted to understand the role telemedicine could play in patient care. “What’s interesting is the care we provide for patients in China, I haven’t done in the US,” he said. “It’s really only starting in the US as well.” Renee Gao trusted Chen. She forbade her parents to take photos of her bald head during chemo, fearful they would be her last. Now, the 18-year-old sports a trendy bob and a wide smile. She wants to go to the US, partly because she loves Taylor Swift. But also, she said, to thank Chen.