How Capitalism Ruined China’s Health Care System | NYT News


[music] This is Zhang Zhejun. Today, he’s making drugs. He isn’t a chemist
or a dealer. He’s making medicine
for his mother. She has stage 3
lung cancer. Zhejun earns $300 a month,
but the medicine needed to treat his
sick mother costs $2,000. Looking for options,
he turned online. Today, he’s making WZ4002. It hasn’t been approved
by Chinese or American regulators, and it doesn’t
have a commercial name yet. But he can still order
the raw ingredients for drugs like this
online at a fraction of their official prices. The Communist Party
of China says it provides close to universal
health care coverage. Nearly 95 percent of people
are insured here, including Zhejun’s mother. So why is he making drugs on
the floor of his apartment when his mother has insurance? It’s a symptom of a
health care system in crisis. To understand this crisis,
we need to rewind a bit. Under Mao Zedong,
the Communist state provided free
health care for all. Decades later, China adopted
a unique brand of capitalism that transformed the country
from a poor farming nation into an economic superpower. Life expectancy soared. But the introduction
of capitalism and the retreat of the state
meant that health care was no longer free. Hospitals became
profit-driven. And with limited
accountability, they were widely accused
of predatory behavior. A culture of mistrust
and inequality now plagued the system. Here’s what that looks like
today for ordinary Chinese. It’s 5 a.m., and
about 100 people have gathered in a line
in downtown Shanghai. This isn’t the line to the
movies or a holiday sale. It’s the entrance to
the Shanghai Cancer Center at Fudan University. Those who were willing to
lose a night’s sleep trying to get a spot in line now have
one question in their mind: “Will I be able to
see a doctor today?” The scalpers are
out, and they’re selling spots in line. China’s line scalpers
symbolize a greater dysfunction. The chance of seeing a doctor
here is directly related to how big your wallet is. Corruption is inherently
part of the system. And in rural areas, it’s worse. But leaving your home
in the countryside could have a profound
impact on what type of care you can get in the city. Despite its rapid
modernization, China still uses what is
known as the Hukou system. Your Hukou is defined
by your birthplace, and you’re only entitled
to social services within that region. Everything from the schools
your kids can go to, to what your
health insurance will cover is determined the
moment you are born. So if you get cancer
and live in an area without an oncologist,
you could be in trouble. Some here compare it
to a caste system. By 7 a.m., it’s one hour
before opening time. The line has tripled in size,
and then the news hits. Those are not good odds. But even worse,
they aren’t unusual. There are nearly 7,000 people
per general practitioner in China. To put this number
in perspective, the World Health Organization’s international standard is
one doctor for every 1,500 to 2,000 people. General practitioners
we talked to in China typically see 70 to 80
patients per day. Specialists said
they see up to 200, each just for
minutes at a time. The doctors we
talked to in the U.S. said they see fewer
than 30 patients a day. While rich Chinese will
pay for individual care or leave the country
altogether for it, the rest of the population,
those dependent on health insurance, end up
paying roughly 30 percent of their health care costs. Americans pay about 10. Numbers like these have added
up to a culture of conflict. With more and more patients
and underpaid doctors, violence has
become commonplace in hospitals across China. And with the state insurance
system not meeting the rising costs of
treatments and drugs, medical disputes
often play out in public on the
hospital floor. Violence in hospitals has
become so common in China, there’s a word
for it — yi nao. Roughly translated, it’s
medical disturbance. Back at the Shanghai hospital,
it’s opening time. Scalpers are making
a last effort to sell off
doctors appointments they secured in advance. Some that wouldn’t
wait, or couldn’t afford the scalpers’ tickets,
try to cut in line and are thrown out
by security guards. Once in the hospital, patients
will stand in another line. It’s the second, and
there are more to come. They scan the board of
available specialists, selecting one based on
their best self-diagnosis. If they’re lucky,
the one they choose will have time to see them. For those who
choose wrong, the cycle will begin again tomorrow. Others prefer to solve
their problems at home.

100 Comments

Add a Comment

Your email address will not be published. Required fields are marked *