In China, getting a hospital bed may depend on contacts or bribes

By Engen Tham

SHANGHAI, Feb 14 (Reuters) – Steven, a financier in his 40s, tested positive for COVID-19 in Beijing at the height of the outbreak in China in December and felt well until his eighth day, when his condition worsened. .

His sister’s driver took him to the hospital. He could barely walk and had trouble breathing. They took him to another hospital, where they sent him back again.

More and more desperate, he asks his sister to turn to his network of contacts. After hours of frantic calls, Steven was taken to a crowded hospital and given oxygen and a bed in a children’s ward. The mother of one of his nephew’s classmates worked there.

“If I hadn’t had that connection, they wouldn’t have given me a bed or medicine,” says Steven, who was hospitalized for 20 days with what doctors diagnosed as severe pneumonia. He did not want to give the name of his family because of the sensitivity of the subject.

As COVID spread across China and filled emergency rooms, privileged patients avoided hospital queues because they knew someone, offered a bribe or paid people with relationships, said three people who had accessed medical care for these reasons and seven doctors from six cities.

The practice has long been common in China’s underfunded healthcare system, which was hit hard after Beijing abruptly ended its zero-COVID restrictions in early December, with widespread reports of overcrowded hospitals and morgues. . .

China had just 4.37 intensive care beds per 100,000 people in 2021, compared to 34.2 in the United States in 2015, according to a study by the Shanghai Fudan School of Public Health.

According to the doctors, the links can include the patient working for the government, being linked to a or being linked to a health worker.

“The higher and more prestigious your connection, the better the treatment or the easier it is to skip the queue. If you know the director of the hospital, you will have no problem getting a bed,” says a doctor from Shanghai.

Although China has tried to crack down on doctor bribery, regulation has focused on payments to drug companies, not patients.

Nearly a decade ago, China banned doctors from accepting red packets containing cash as part of sweeping healthcare reforms, and in April 2022 the National Health Commission said that the authorities should strengthen enforcement of the law against doctors who accept such payments.

Doctors and experts said the use of red packets and “guanxi,” or logins, to access them persists.

“Using contacts to get quality health care is very common in China,” said Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations in New York, adding that with the pressure that COVID has exerted on resources, contacts might even be more crucial.

“Many of these rural patients, COVID patients, who had severe symptoms were choosing not to proactively seek care, instead they were just dying at home,” Huang said.

The National Health Commission and the Chinese Center for Disease Control and Prevention did not respond to requests for comment.

China’s initial spike in COVID hospitalizations has peaked, but experts warn further waves of infections are possible.

LOW WAGES, REVENUES IN THE BLACK

China is keeping the cost of healthcare low to make it affordable, meaning many doctors are chronically underpaid and the profession is struggling to attract staff, leading to queues longer for care, according to experts and doctors.

In 2020, 546,657 new medical workers joined the system, according to the National Statistics Office, the lowest number since 2017.

“You get 10,000 yuan ($1,463.70) to 15,000 yuan a month; what kind of salary is that for long hours and experience?” said a trainee doctor in wealthy Shanghai. , adding that doctors are often in their thirties when they can receive such a salary. salary. “It’s humiliating”.

In small towns, new doctors can earn between 3,000 and 5,000 yuan a month, said two doctors from a city in Sichuan province.

“If you can live and eat on your salary, then you are already doing very well,” said one.

Hospital admission gifts, such as expensive tea and red packets of money, are usually given to the head doctor, but sometimes also to the head nurse and the person who made the connection. This can lead to a total bill of twice the official medical cost, explained two people who have recently given such gifts.

“For many doctors in hospitals, their main income does not come from their basic salary, but from black income, the red envelopes they receive from patients, despite the crackdown on corruption in the health sector,” explained Huang.

For those without contacts, payments to intermediaries, known as “yellow cows”, can help.

During the recent COVID outbreak in China, social media was abuzz with comments about brokers asking for 4,000 to 5,000 yuan to get a hospital bed, with comments about whether payment in was worth it, and also on the equity of access.

Doctor’s appointments are cheaper.

An intermediary who claimed in an advertisement that he could access any doctor in any hospital in Shanghai said it would cost 400 yuan to skip the line for an appointment with a prominent doctor in a high-end hospital.

Reuters could not confirm whether the intermediary would have achieved such a result.

(1 dollar = 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, Spanish editing by José Muñoz in the Gdansk newsroom)