A very good article in the LA Times on the China health care system. The article describes one rural family’s struggle to get quality care as members travel to Beijing and wait in long queues at Beijing Union hospital. The general conclusion: China’s move from socialized medicine to a more privatized model has led to severe problems that are now being addressed by the central government.

Good stuff, and I agree with the conclusions. Of course the issue is much more complicated than can be adequately expressed in a short news article. Take a look at the gist of the article, then I’ll raise some additional issues below.

At a time when the United States is grappling to overhaul its healthcare system to provide more Americans with coverage, China is struggling with the fallout of abandoning its socialist model in favor of Western-style privatized medicine. Government efforts to modernize China’s healthcare system and reduce Beijing’s role have led to deep funding cuts for public hospitals. Rural clinics have been hit especially hard.

The results are familiar to many Americans: Patients with good health insurance or ample savings can get first-class treatment at the best medical facilities, while millions of the uninsured and poor live in dread of a serious illness that could bankrupt their families. Hospitals are focusing ruthlessly on the bottom line to stay afloat. Costs are soaring, in part because of perverse incentives that encourage doctors to prescribe pricey drugs and needless tests.

Concerned that its rickety healthcare system could destabilize social harmony, China’s central government has launched a $124-billion overhaul, chiefly to improve service in rural areas.

This is not exactly breaking news. The LA Times motivation for writing this story most likely rests in providing greater context for the US health care debate and has nothing to do with China coverage per se.

However, this is still a timely issue, and health care is indeed figuring prominently in current budget discussions and debate over matters like savings/consumption and China’s social safety net. Important stuff, to be sure.

As anyone who has gone to a hospital (for medical or dental issues) knows, the description of the long lines is certainly accurate. Most expats avoid this by going to the JV hospitals and clinics and never know the ‘pleasure’ of waiting in a long line of people, outside, in December, at night for the hopes of getting an appointment ticket with a doctor you can (sort of) trust. I’ve done this several times and it’s a horrible experience, particularly if you are experiencing physical problems at the time.

Why do people do this? Several reasons: 1) good medical care at affordable prices is a scarce resource; 2) many people do not trust their doctors, who have conflicts of interest and are not paid adequately; 3) hospitals are now much more interested in profits above all else; 4) there is no adequate remedy for medical malpractice. I could go on, but these are some of the big ones. If you think there is a good doctor you can trust somewhere far away and your life depends on it, you will go there and compete for a spot.

Rationing of health care is a complex matter that has no easy fix. The lack of quality care discussed in the article obviously requires substantial re-investment. We need more, better doctors and hospitals, and better processes for dealing with patients. The legal system, to name just one ancillary area, also needs to be revamped to address malpractice and patient’s rights.

Before all that can be fixed, though, you have millions on people who have inadequate access to high quality care. Ironically, at a time when information on doctors is readily available online, including comments and reviews by patients, there is a lot of distrust of doctors and therefore a stampede to the “best” institutions and physicians. I also think that the steady drumbeat of horror stories passed around online, anecdotal evidence of a system you can’t trust, feeds the cynicism.

In a country this large, therefore, those long lines should come as no surprise. I do realize that it will take a long time for modernization of the industry to kick in, so the question is whether rationing at the nation’s best institutions should really be a function of how long someone can stand in line?

To me, having old people standing out in the snow for a chance to see a doctor is an embarrassing state of affairs in 2010.

Appointments for the best doctors are normally snapped up before sunrise. Lines begin forming in front of the hospital’s six registration counters at least a day in advance.

[ . . . ]

The surge in demand feeds a black market for medical care. Packs of scalpers roam China’s major hospitals, peddling appointment tickets for hundreds of dollars — equivalent to months of earnings for a typical peasant. Despite periodic crackdowns by authorities, these hustlers operate freely outside Beijing Union’s registration hall, a squat one-story structure flanking the main hospital building.

[ . . . ]

[T]he hospital grants only 200 telephone appointments a day. An experiment with online registration ended years ago after patients booked half a year’s appointments in a matter of hours.

If you’ve been reading the news over the past few weeks, you will no doubt be reminded of the problem with train tickets and the current government efforts to fight scalpers. Same basic problem — demand is higher than supply and some very enterprising folks are gaming the system.

So the online and telephone registration systems didn’t work the first time around. I get it. But the response is to just give up? The long queue is something that a society in 2010 just needs to accept? I had a long discussion of this with my wife today. She gave me the usual “that’s the way it is” answer, which sort of pissed me off. There is no technology-based solution to this problem? The authorities cannot ensure that scalpers (and their inside men at the hospitals) are punished? I know this is all easier said than done, but I think some additional effort is warranted.

China’s population is aging rapidly. The government recognizes this, and has taken the first steps to revamping the health care system. Having these long lines is a symbol of everything that is wrong with the system. At the very least, you’d think someone could find a tech solution so that grandma and grandpa don’t have to wait out in the snow for five hours just so they can see a dentist.