In China, the practice of medicine is a mixture of government, charitable, and private institutions, while many people rely on traditional medicine. Until reforms in the late twentieth and early twenty-first century, physicians were quasi-government employees and with little freedom in the choice of the hospital to work with. In addition, decades of planned economic policy discouraged physicians from opening their own clinics, and the practice of medicine was generally under the control of local units, such as factories, government, offices, or communes. The reforms created a largely private practice, and physicians now are encouraged to open private clinics and for-profit hospitals.
Chinese Medical Association The Chinese Medical Association is the largest and oldest non-governmental medical organization in China. It was established by a group of medical professionals in 1915 with an aim to uniting medical professionals, upholding medical ethics and advocating social integrity. It currently counts over 430,000 members and 82 specialty societies. It publishes over 70 medical journals WA (including the Chinese Medical Journal), as well as a medical bulletin and a medical education magazine. The CMA plays a leading and active role in the nation's medical education, training and professional exchanges.
Chinese Academy of Medical Sciences
From 1957, Peking Union Medical College is merged into the Chinese Academy of Medical Sciences as one single institution directly under the Ministry of Health, now the National Health Commission.
Physicians
Physician compensation At government-controlled hospitals, physicians are salaried employees. Salaries are based on working experience and professional level. Some hospitals also pay a bonus to physicians according to the hospital's operating performance and the physician's contributions. Physicians' salaries vary greatly. For those working at busy and well-known hospitals, their base salaries can be a few times as much as those of physicians working at low-ranking hospitals. Chinese hospitals are classified into three general levels, with level 3 at the top and level 1 at the bottom. Each level has sub-levels of A, B, and C. Some elite hospitals are even rated 3A+.
For many physicians, in particular those at big hospitals, specialty hospitals, or hospitals with large reputations, physician incomes can be larger than regular hospitals. Physicians, and in particular, surgeons, can augment their hospital salaries by conducting surgeries at hospitals other than the ones in which they are employed. Many physicians also receive commissions from prescribing prescription drugs and get "red envelopes" from patients (patients give money or gifts to their physicians for receiving treatment) or from sales representatives of drug companies. New regulations issued by the Health Ministry, however, remove physicians from the practice of medicine if they are found to have taken "red envelopes" from patients, and a hotline has been set up to monitor physicians.
Social status In China, physicians are well respected, but as a group they are not at the top of the social structure of the country because their incomes fall in the middle class.
According to a Ph.D. candidate at a U.S. Public Health School, who was a physician at a well-known 3A hospital in Beijing, like other junior physicians, she seldom received "red envelopes" from patients, and only senior physicians or physicians with fame would have such opportunities. The student said those senior physicians had become members of the high-income class. Like the student, many physicians, went abroad to study because they were not satisfied with their status.
According to a 2002 statistics from Beijing Physicians Association, between 2000 and 2001, in Beijing about 2300 physicians resigned, and most of them went to work as sales representatives of drug companies. Some still practice medicine but work with privately owned hospitals rather than public hospitals.
Competitive pressure for hospitals Influenced by a centrally planned economy, many hospitals were managed as government agencies rather than medical service organizations. Hospitals did not have competition pressures. The management team usually did not recognize the importance of developing and retaining high skilled physicians. Administrative personnel were more powerful than physicians at a hospital.
However, with the reform of the medical sector, Chinese hospitals are facing increasing competition from privately owned and foreign-investment-backed hospitals. Physicians are expected to enjoy higher legal income and better social status.
Physician training
To become a medical doctor, a person needs to study for 5 years at a medical school. For foreign or international students, the person needs to study for 6 years at the medical school, namely because the Chinese version is accelerated. Also, international students have to prepare for and take the Hanyu Shuiping Kaoshi for admission, and during med school, the Medical Chinese Exam. After graduation, the newly minted physician needs to complete 2–3 years of residency training, including training for subspecialty.
Upon graduation, the graduate must work as a resident physician for few years to be eligible to take a National Medical Licensing Examination (NMLE) for physician certification. This examination is conducted by the National Medical Examination Center (NMEC). Without approval of registration by the Ministry of Health one can not practice medicine in China as a physician or assistant physician.National Medical Examination Center, China
American type of residency training has not been implemented nationwide in Chinese hospitals though almost all hospitals require their physicians to be trained as resident for few years before promotion to attending. American type of residency program was launched in some University affiliated hospitals. These students will complete their MD study and have to pass the national certification test during the residency.
There are general hospitals and specialty hospitals. A medical graduate rotates through several departments and then assigned to a specialty department according to his or her strengths and the hospital's needs. Specialty physician usually are attendings who specialized in certain specialty during the training process in a specialty hospital or in a subspecialty at a general hospital. Some medical experts have called for a standardized training and testing system for specialty physicians in accordance to American system. The classification of specialties at a Chinese hospital is similar to that at a U.S. hospital.
Prescription drugs According to BCG's prediction in 2002, China's prescription drug market is expected to reach $24 billion and become the fifth largest market following Japan. AstraZeneca now ranks as the No. 1 foreign brand in terms of prescription sales in the Chinese market.
Physicians control the distribution of prescription drugs. Some hospitals and clinics stipulate patients must buy prescription drugs from the hospitals or directly from the physicians who make the prescriptions. Such a restriction aims to prevent the loss of sales on prescription drugs to retailers, but retailing drug stores are unhappy with such a restriction, and some of them have tried all means to lure away prescription drugs buyer from hospitals. For instance, they offer to pay drug buyers half a dollar for each prescription the buyers brought to the drug stores. Normally a prescription is effective on the day it is issued, but it can be effective within three days of prescription under certain conditions.
Hospitals Physicians used to be hired as full-time employees at a government controlled hospital. But with the reforming of the medical service sector, both physicians and hospitals have more freedom in choosing each other.
Young physicians usually have an employment contract with the hospital they work with, and a person can quit at will. The hospital can also lay off the individual if it is not satisfied with the employees performance or morality.
It is not uncommon for physicians to quit and take a different job. The top three reasons that lead many physicians in Beijing to quit include: doctors are not well paid; hospitals are poorly managed; and there are not enough personal development opportunities.
Management For a government-controlled hospital, the hospital is still operated and managed by a management team under the leadership of the president of the hospital, who is usually nominated and appointed by the healthcare department of a province, a city or a county. But for a private hospital or a publicly traded hospital, the ownership is the same as that of a private company or a public company.
There are two types of hospitals in China – for-profit and non-profit. Profit-oriented hospitals may distribute their profit. Non-profit hospitals are government-owned, and will turn earnings into additional infrastructure or hand them back to the respective government authorities. Non-profit hospitals also enjoy preferential tax treatment and several government subsidies. They also get low-cost financing from the government for their capital investment.
Number By the end of 2002, China has 306,000 healthcare and medical organizations, 63,858 of which are hospitals and clinics, 219,907 of which are nursing homes and 22,270 fall into other categories. Among them, only 1% are for profit, although all non-profit hospitals and clinics also rely on profits of selling drugs and treatments. Drug sales from hospitals account for 85% of total drug sales, with the remaining 15% going to drug stores.
Stripping out the government's subsidies, all government-subsidized hospitals would have been in the red. This poor operating performance can be partially due to that non-profit hospitals have little incentive to control costs, given the government's subsidies.
Private hospitals In 2000, a reform started to occur in the Chinese hospital system. Government owned hospitals are being restructured, some of them being sold to individual investors, and more and more private hospitals are founded.
In 2004, Beijing Aikang Medical Investment Company bought a state-run-enterprise owned AAA hospital (the highest standard), and the acquisition was the first of this kind in China. The investment company plans to buy 10 hospitals in the next three to five years. In Fuzhou, the capital city of Fujian province, four government-owned hospitals have been sold to private investors.
Nursing and support staff Nurses are normally well trained before being eligible for working with a hospital, but support workers are a problem. Some hospitals hire skill-less "underground" labors and after giving them some simple training use them as hospital support workers. These workers, mostly originating from rural areas, are poorly paid by those hospitals.
To secure the quality of hospital services, Beijing recently has passed a regulation on training and hiring qualified hospital support workers. In Tianjin, China's third largest city, about 1,000 unemployed people have been trained by local authority and passed hospital support work test. These people returned to work as certified support staff of a number of big hospitals.
Education One needs to study at a nursing school for around three years before being eligible to work as a nurse. Most nursing schools enroll middle school graduates (Grade 9) and senior high school graduates (Grade 12), and they run four-year and three-year programs respectively.
A bachelor's degree in nursing has been available since late 1980s and early 1990s in China. Many medical schools including the School of Medicine of Beijing University offer five-year programs in nursing.
Locations