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 Inside, beds line hallways and crowd elevator lobbies, while
relatives share gurneys with patients and doze in brightly lit
stairwells. The world's biggest hospital with about 7,000 beds,
Zhengzhou First Affiliated, in central China, is still not big
enough.
"My dad paid for a bed but still couldn't get one," said Ma Wenxiao,
a university student from the central city of Wuhan, whose father
waited two days for a bed after traveling to Zhengzhou for
chemotherapy.
Demand for healthcare is booming in China, driven by a growing
middle class, improved health insurance coverage and an aging
population. In response, some of the country's public hospitals are
adding beds by the thousand.
China now has 16 public hospitals with more than 3,000 beds. NewYork-Presbyterian,
the largest hospital in the United States according to Becker's
Hospital Review, has 2,478 beds.
But unlike the rest of the economy, where China wants growth, this
expansion has policymakers worried.
Hospital build-outs testify to a lack of public confidence in rural
healthcare. They add to local government debt and may not be
providing cost-effective care.
Last summer, Beijing issued a directive restricting expansion of
public hospitals, but hospital administrators appear to be finding
ways around it.
Hospitals' building binge, and the government's response, highlights
the dilemmas facing the country's healthcare system, experts say. In
China today, says Liu Tingfang, a professor at Tsinghua University,
"hospitals have to expand if they want to survive".
BIGGER IS BETTER
Despite government efforts to encourage patients to use smaller
local hospitals, most Chinese still feel safer being treated for
everything from ear aches to emphysema in major
university-affiliated hospitals in big cities.
Hospital heads, too, believe that bigger is better. Government
funding provides less than 10 percent of state hospital operating
budgets, and the state holds public hospital fees low to keep care
affordable.
As China has chipped away at the drug mark-ups they once relied on,
many hospitals see expansion as a way to raise revenues.
Big hospitals often have support from local governments, which
approve and help fund hospital expansion in part because they are
evaluated on their ability to drive growth.
China's big hospitals are now so large that some have their own
police stations. One doctor at the First Affiliated Hospital of
Wenzhou Medical University even briefly wore roller skates to get
around the wards faster after the hospital's expansion.
PATIENT-DOCTOR CONFLICTS
But even as patients flock to them, giant hospitals have become
magnets for controversy.
Patients come expecting to see top doctors, says Li Huijuan, a
Beijing-based lawyer who handles medical cases.
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But rapidly expanding hospitals have to hire less experienced
medics, says Li, creating a gap between patient expectations and
reality that "can cause or exacerbate conflicts between doctors and
patients". Rapid expansion can also increase pressure on medical
personnel, as increases in bed numbers may outpace growth in
staffing levels.
And as the recent MERS outbreak in South Korea showed, large and
oversubscribed hospitals can be conduits for infection and disease.
About half of the nearly 200 cases in the country were traced to the
1,900-bed Samsung Medical Center in Seoul, where long waits for a
bed are common.
"When you have a lot of people packed in a small area, it increases
the risk of transmission of infectious pathogens," says Neil
Fishman, associate chief medical officer at the University of
Pennsylvania Health System.
An official at Zhengzhou First Affiliated said the large volume of
patients was a reflection of demand, and that the hospital did daily
inspections to ensure patient safety. The hospital declined requests
for an interview. According to its website, it plans to add 3,000
beds at another location.
LOW RETURNS ON INVESTMENT
The problems that giant hospitals create ripple through China's
healthcare system. Some 60 to 80 percent of patients in big
hospitals could be treated at community medical centers, says Ma
Jingdong, associate professor at Huazhong University of Science &
Technology in Wuhan.
Big hospitals may have high cost bases and be poorly suited to
providing continuous care for chronic diseases. "We may be spending
a lot but in reality, we may not seeing the same level of returns in
terms of public health," says Prof Ma.
Chen Xiaoming, president of the First Affiliated Hospital of Wenzhou
Medical University, told Reuters that the number of beds at his
hospital - currently 3,770 at two locations - may decline in coming
years in line with government reforms.
But the public's faith in big hospitals may be hard to shake.
Standing in a swirl of people at the Zhengzhou hospital, a man who
would only give his name as Cai said he hadn't thought twice about
rising at 5 a.m. and waiting for several hours so that his wife
could see a gynecologist, perhaps for a minute or less.
"This is normal," Cai said, surveying the crowd. "Chinese people are
used to this."
(Reporting By Alexandra Harney; Additional reporting by Shanghai
newsroom; Editing by Alex Richardson)
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