In COVID China, a hospital bed can hinge on who you know, red packets
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[February 14, 2023]
By Engen Tham
SHANGHAI (Reuters) - Steven, a financier in his 40s, tested positive for
COVID-19 in Beijing at the height of China's outbreak in December and
felt fine until the eighth day, when his condition worsened.
His sister’s driver took him to a hospital. Barely able to walk and
fighting for breath, he was told there were no beds. They drove to
another; he was rejected again.
Increasingly desperate, he asked his sister to tap into her network of
contacts. After hours of frantic calls, Steven was taken to a packed
hospital and given oxygen and a bed in a children’s ward. His nephew's
classmate's mother worked there.
"If I didn’t have that connection, I wouldn’t have gotten a bed or
medicine,” said Steven, who was hospitalised for 20 days with what
doctors diagnosed as severe pneumonia. He declined to give his family
name because of the sensitivity of the matter.
As COVID ripped across China and filled emergency wards, privileged
patients cut hospital queues because they knew someone, offered a bribe
or paid people with connections, said three people who accessed care
through such means and seven doctors in six cities.
The practice has long been commonplace in navigating an under-resourced
Chinese health system that was severely stretched after Beijing abruptly
ended its zero-COVID restrictions in early December, with widespread
reports of packed hospitals and mortuaries.
China had only 4.37 ICU beds per 100,000 people in 2021, compared with
34.2 in the United States as of 2015, according to a paper by Shanghai's
Fudan School of Public Health.
Connections can take the form of the patient being a government
official, connected to one, or being related to a medical worker, the
doctors said.
"The higher and more senior your connection, the better the treatment,
or the easier the queue-jump. If you know the head of the hospital, then
there won’t be trouble getting a bed," a Shanghai doctor said.
Although China has tried to crack down on doctor bribery, the regulatory
focus has been on payments from pharmaceutical companies rather than
patients.
Nearly a decade ago, China banned doctors from accepting red packets
containing cash as part of widespread healthcare reforms, and in April
2022, the National Health Commission said authorities should step up
enforcement on doctors who accept such payments.
Doctors and experts said the use of red packets and "guanxi", or
connections, to gain access persists.
"Using connections to seek quality healthcare is very common in China,"
said Yanzhong Huang, a senior fellow for global health at the Council on
Foreign Relations in New York, adding that with the pressure COVID has
exerted on resources, connections could be even more crucial.
"Many of those rural patients, COVID patients, that had severe symptoms
would choose not to proactively seek care; instead they just die at
home," Huang said.
The National Health Commission and the Chinese Center for Disease
Control and Prevention did not respond to requests for comment.
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Patients lie on beds and stretchers in a
hallway in the emergency department of a hospital, amid the
coronavirus disease (COVID-19) outbreak in Shanghai, China January
4, 2023. REUTERS/Staff
China's initial surge in COVID
hospitalisations has peaked, but experts warn that further infection
waves are possible.
LOW WAGES, GREY INCOME
China keeps the cost of medical care low to make it accessible,
meaning many doctors are chronically underpaid and the profession
struggles to attract staff, which leads to longer queues for care,
experts and doctors say.
In 2020, 546,657 new medical workers joined the system, according to
the National Bureau of Statistics, the fewest since 2017.
"You get 10,000 yuan ($1,463.70) to 15,000 yuan a month; what kind
of money is that for the long hours and the expertise?" said a
trainee doctor in wealthy Shanghai, adding that physicians are often
in their mid-30s by the time they qualify for such a salary. "It’s
humiliating."
In smaller cities, new doctors can earn as little as 3,000 yuan to
5,000 yuan a month, said two doctors in a city in Sichuan province.
"If you can live and have enough to eat off your salary, then you're
already doing very well," one of them said.
Access-granting gifts such as expensive tea and red packets with
money are often given to the lead doctor, but also sometimes to the
head nurse and the person who made the connection. That can lead to
a total care bill that is double the official medical cost, said two
people who recently made under-the-table offerings.
"For many of the doctors in hospitals, their main income is not from
their basic salary, it’s from grey income, the red envelopes they
receive from the patients, despite the crackdown on corruption in
the healthcare sector," Huang said.
For those without connections, payments to middlemen, known as
"yellow cows", can help.
During China's recent COVID surge, social media was abuzz with talk
of agents asking 4,000 yuan to 5,000 yuan to arrange a hospital bed,
with comments on whether payment had been worth it and also on the
fairness of such access.
Doctor appointments are cheaper.
One agent who claimed in an advertisement to be able to access any
doctor in any Shanghai hospital said it would cost 400 yuan to jump
the queue for an appointment with a leading physician in a
top-ranking hospital.
Reuters was not able to confirm whether the agent would have
delivered that result.
($1 = 6.8320 Chinese yuan renminbi)
(Reporting by Engen Tham; Additional reporting by Kane Wu, Julie Zhu
and Sophie Yu; Editing by Tony Munroe and Gerry Doyle)
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