Today was our first hospital site visit for Public Health. We got on our bus in the rain at 8:30AM and drove to the Peking University Health Science Center. Dr. Yi met us there, and we walked (outside and in the rain) to see the various buildings that make up the hospital campus. It takes up a few city blocks and has restaurants and shops interspersed with the medical buildings. We went inside the general hospital outpatient building, the mental hospital building, and the reproductive health building.
This hospital has many famous doctors in China, so people travel from other provinces just to be treated there. It is known for sports medicine (they were on call for the 2008 Olympics), eye care, and reproductive health (they were the first successful in vitro fertilization in China). The 2,000 doctors see 8,000 outpatients daily, and the inpatients are in different buildings from the general hospital we saw.
The general hospital has six floors (we rode a lot of escalators) with different wings that each have a specialty. The interior design is modern and clean, somewhere between the traditional hospital sharpness and the new style of holisitc decor to promote healing. Patients enter the hospital and go to the specialists they think that they need to see. They even self-diagnose if they think they need surgery and will go straight to see a surgeon. There are no appointments in the Chinese health system, so patients start lining up as early as 3AM to stand in line to get their name on the list to see the doctor they want to see. Then they are given a number and wait to be called.
Billing happens at the end, and the health insurance covers a percentage of the treatments, but Chinese health insurance (the country is 92% covered) has high premiums, co-pays, and deductibles. They get papers stamped for their reimbursements, see the pharmacists who have OTC drugs, prescription drugs (usually only the ones on the Essential Medicines List), and Traditional Chinese Medicine therapies. TCM at this hospital is on the sixth floor and was the least crowded of the waiting areas. Things are expensive at the pharmacy! I looked at the price of a One Touch Ultra Mini Glucometer, and it was 528 Yuan, which is $88 US. You can get one of these meters at CVS for $20, so I was shocked at the markup. Another flaw with billing in the Chinese system is the way fee for service works. The prescribing doctor gets a commission for each test he/she prescribes, and since the government has capped doctors' salaries, they use this part of the system to over prescribe unnecessary tests (which happens but cannot be proven) to increase their salaries. The waiting room for the lab was packed, and there are touch screen kiosks for patients to print their test results once they are available.
When you see a picture of a crowded waiting room, it gives you an idea of what you will see when you go to that kind of hospital. Being there in person and walking through and past the hordes of people trying to see a specific doctor (whether it's the appropriate person or not) is a totally different experience. The Chinese healthcare system is 100% about who the patients trust, so public hospitals like the one we visited today are extremely crowded and busy, while smaller clinics see very few patients because the doctors are not as famous.
As flawed as the American health system is (and I truly disparage the bureaucracy of our fee for service system), I think the Chinese system is worse. For a country with so much governmental control, I was expecting things to be more organized and less every man for himself. Our guide told us that there are people who will wait at the reproductive health center to get places in line and then sell them for 500 Yuan, and people pay because they want to see the doctors. She also told us about a trial for an online appointment system to see doctors rather than a walk in and wait system, but people booked many appointments and did not show up, so nobody got to see the doctor that day. There is a serious cultural shift that needs to occur for any of these health systems to work, and that kind of change takes a huge amount of public influence, and I am not sure anyone can be so commanding since Mao.
Having a walk in only system leaves many gaps. Not everyone gets seen, and since there is no general practitioner to recommend a specialist, the patients can go to the wrong person and not have time to see the proper person. Until today I did not think that GPs were a good feature of a health system, but now I think that it is very important to have an expert who can recommend the proper treatment path. If there are not enough beds, the patients are told to go elsewhere (no transport, and this even happens to women in labor). For chronic condition follow up appointments, the patients have to come in and hope that there's time for them to be seen, and they won't necessarily have the same doctor for consecutive appointments. There is no concept of having "your" doctor in China.
The mental hospital was interesting. It was an older building, still crowded, and the trivia there was that at exam time, students will check in because of stress and be fine as soon as the test is past. The reproductive health hospital was very crowded with both men and women. Because of education and salaries, people are starting their families much later in China, but children are still highly prized and valued, so being able to have a baby is very important. With age, both the men and the women may need interventions to aid conception, so this hospital is packed. Interestingly enough, abortion is legal in China and it happens quite often with younger women and girls who are not of family-starting age.
The hospital tour took all morning, and we re-joined our Political and Economic Development classmates for lunch (which was very late because the rain makes people order delivery, so it took longer than expected). After lunch, I went with Marissa and Maitreyi to the Zoo Market. There are clothing markets across the street from the Beijing Zoo, which has its own subway stop. We originally wanted to go to the zoo, but it was raining (did I mention the rain?), so we went to the indoor market instead.
It was HUGE!! It was also filled with things I did not want/need to buy, but I enjoyed the experience. I almost got another fanny pack, but I decided that the one I have is enough. All the stalls had the same type of merchandise, so after a while of looking at the same shirts, shorts, dresses, and shoes (there were multiple floors of shoes), we went home. I think the market was a good experience, but after the Pearl Market, it wasn't as exciting, particularly because I think Pearl Market had better stuff, or at least more variety. We were all interested in buying souvenir-type things, and this place did not have that.
I have started to recognize Chinese characters as we go around the city. For instance, I found "hao" on the subway. It feels really cool to be understanding things after just two weeks. I washed my sheets this afternoon, and there was a repairman working on the dryer, and he said something to me that included the word "meiguo," which means America, and that's all I caught from what he said, but I would not have gotten even that much last week. Unfortunately, I did not get to use the dryer, so I now have sheets hanging from my armoir doors in my room.
I had dinner with five other people from my program and two of the language partners. We ate at the noodle cafeteria on campus. Mine were slightly spicy and had peanut sauce. I also had an egg with them. It was tasty. After dinner, I came home. and wrapped up my day with some serious studying for tomorrow's Chinese test.
Today is awesome because it was all experiential learning.
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