Restoring Trust in China’s Physicians

In the coming years, China is facing significant challenges in the healthcare sphere and one of the most formidable will be public perception. A particularly pervasive and damaging perception in China is the distrust of physicians. Without well-established patient-physician trust, the mission of delivering quality healthcare is significantly set back.

DOCTORS ARE NEEDED, BUT NOT TRUSTED

Being a doctor is not as well-respected and desired a career in China as it is in many Western cultures. Currently, there is little standardization across provinces regarding medical education, and even less for physician residencies. Rural doctors may only have a primary school education, and usually have to work other jobs to support themselves. Medical schools struggle to recruit and retain students, and even when they do, medicine often was not their top choice.

In 2016, a survey of the career interests of the 36 top-scorers on the gaokao entrance exam put medicine at the bottom. People go to doctors when they have to, but there is little respect for the profession and those who choose it.

The Chinese healthcare system is underfunded and overcrowded. Hospitals are responsible for about 80% of their own funding, fueling a corrupt system desperately seeking new ways to cover costs. Interests are misaligned as hospitals operate on a fee-for-service model. Quantity becomes prioritized over quality, as service fees comprise nearly half of a hospital’s income.

This creates an incentive for doctors to recommend unnecessary medical tests, extend hospital stays, and overprescribe medications. Drug sales accounted for about a third of public hospital’s profits in 2016. Many physicians tend towards overprescription, especially when they know that insurance will be footing the bill.

A breakdown of Chinese public hospital income. Source: Oxford Health Policy and Planning (2013)

Many surgeons are paid per surgery done, encouraging unnecessary operations. One patient at Zhongshan Hospital in Shanghai even said, “Doctors are too eager to perform surgery to treat you. It’s like they’re slaughtering pigs.” Doctors are assumed to be pursuing self-interest over professional ethics and patient wellbeing, and are known for accepting hongbao bribes for better or faster treatment.

Nearly 95% of Chinese citizens are covered by some form of medical insurance, but not every procedure is covered, so patients end up paying out-of-pocket for unnecessary expenses.

This breakdown of trust can even become violent. Disgruntled or aggrieved patients and their families have been known to resort to physical assault. The Chinese Medical Doctor Association reported in 2016 that almost 60% of medical staff experienced verbal abuse, and over 13% had been assaulted.

These issues are exacerbated by a lack of education and training for rural doctors. Rural hospitals also tend to lag far behind in infrastructure and medical technologies. As one rural doctor put it, “Young doctors don’t want to choose to live in rural medical conditions and live in hardship, so they choose to work in large city hospitals.” As a result, rural patients flock to third tier hospitals in Beijing, Shanghai, and Guangzhou. Patients trust third tier public hospitals in big cities to have experienced doctors and the latest equipment thanks to government funding and affiliation to top universities. The crowding only compounds the struggles of these doctors, who often see 100-200 patients per day.

Negative views of doctors in China as incompetent, greedy, and overworked have become the dominant belief and placed incredible stress upon the system. Shifting public opinion will require a concerted effort from the government, the private sector, and hospitals to ameliorate the very real concerns patients have about their healthcare.

A photo of Zhongshan Hospital, a well-known third-tier hospital in Shanghai always crowded with patients from all over. Source: Collective Responsibility

COMING SOON TO A HOSPITAL NEAR YOU

Healthcare technology is a rapidly growing industry that will play a major role in revolutionizing the experiences of both patients and physicians in China. It will help to alleviate the workload faced by many doctors, allow for tier three hospital care to reach rural China, and provide patients a more holistic and personalized care experience.

Building confidence in China’s doctors will involve improving the capabilities of doctors and hospitals so that they are deserving of patient trust. Tools like Virtual Reality (VR) and Augmented Reality (AR) training for surgeries can prepare surgeons and provide experience without risk. Some hospitals have even taken this to the next level, with doctors helping out with surgeries from across the country using VR. This can assuage concerns from patients and give rural doctors experience while not overburdening urban hospitals.

Artificial Intelligence (AI) is already helping hospitals cope with the physician shortage by automating routine tasks and providing accurate medical diagnoses. For example, a lymphoma doctor in Beijing is collaborating with researchers at Tsinghua University to build a machine-learning algorithm that can use ultrasound data to identify blood clots caused by lymphoma treatments. If these clots are caught early on, treatment is fairly simple, but usually hospitals don’t have the resources or manpower to screen every single patient. AI can check medical scans faster and more accurately than an exhausted radiologist, making it a promising contributor to the future of healthcare. This gives doctors more time to approach the human aspect of medical care instead of having to rush from appointment to appointment.

Radiologists have to go through hundreds of scans, examining each for signs of cancer or other abnormalities. AI can be taught to do this with incredible speed and accuracy. Source: Medgadget

Another key aspect of this technological shift will be greater patient agency in their medical care. As the telemedicine network expands, more and more patients are able to consult with trusted doctors without making the trek into major cities. This can already be done on mobile platforms like Tencent’s WeDoctor. Patients are empowered to easily seek out second opinions and interact with doctors online to determine the best plan of action. They can self-diagnose and decide whether to go to a local community clinic or a larger hospital. The implementation of Electronic Health Records (EHRs) will help track a patient’s medical history. These are easily transmittable so that patients seeking consultations from different doctors have accessible records of their health.

Over-the-counter and prescription drugs can already be purchased via e-commerce websites like Alibaba, moving pharmaceutical sales into the retail space and away from hospital markups. Streamlining the process like this allows patients to seek care from their own home when possible, leaving hospitals and doctors with more resources to care for the severely ill.

For health technology to successfully scale to meet the needs of China’s 1.3 billion patients, it needs help from the national government. And while technology can compensate for many of the reasons patients don’t trust their doctors right now, ultimately the government has the strongest vested interest in turning the tide of public opinion and the greatest ability to resolve the deeper issues at hand.

TARGETING A HEALTHIER CHINA

With health already touted as a top priority, the Five Year Plan for 2016-2020 outlines plans to standardize physician education and residency at a national level, improve working conditions, and encouraging general practitioners as the local level of care for Chinese citizens. For a higher standard of healthcare in China, physicians need education, job security, and safety. This encourages more students to enter the profession and removes many of the drivers of corruption and burnout.

The uptake of health technology by hospitals, health professionals, and patients will require sizable investments in infrastructure by the government and the private sector. Hospitals need the internet connection and facilities to offer top-notch care, and physicians and nurses need the training to utilize cutting-edge technology correctly. Policy needs to balance the profit-maximizing instinct of corporations with the altruistic interests of medicine without sacrificing the practical needs of operating hospitals for over a billion people. Synergy between the government, hospitals, and companies will lead to the smoothest transition into the modern healthcare system.

An intersection of regulation and health technology could also be online ratings and reviews of physicians and hospitals based on quality of care and cost, as well as government audit status, available to users. This is a way to offer credibility to the hardworking physicians trying their best and help patients to navigate the healthcare system through both crowdsourcing and governmental review.

While all this goes on behind the scenes to make a healthier China a reality, public awareness and clarifying of public misperceptions will also be vital. Patients are reassured when they know their government is investing heavily in improving the healthcare system, curbing corrupt practices, and positioning China at the forefront of medical and technological innovation. A lack of faith in physicians underlies many of the broader issues facing China in the healthcare realm, from overcrowding in urban hospitals to understaffed hospitals. A healthy China starts with a healthy relationship between patients and their physicians.

To learn more about the challenges in Chinese healthcare, read our post Chinese Healthcare: Challenges & Opportunities.

For more information on the future of Chinese healthcare, keep an eye out for a full report that will be released in the coming months.


This article was researched and written by Anson Tong, Research Analyst at Collective Responsibility.

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