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Chinese health care, better?

My sister-in-law Marie is a very cool lady. She's certainly a no-BS kind of gal with a golden heart. I respect her a lot. When I get to visit Pennsylvania and hear her thick western PA accent it feels like home. She asked me a good question related to my second visit to a Chinese emergency room and overall experience with Chinese health care. "Sounds like a better health system there, maybe?"

Better? I wouldn't go so far as to say that. Different, perhaps better in some ways. The first thing that stands out as different is the cost. I've had to pay for two trips to the emergency room out of pocket in that past year. I spent just over $150 on the two visits combined. The big question is... do you get what you pay for? My good friend Matt is an economist. He shed some interesting light on the topic for me recently. The reality is you get what you're paying for, but you have to question whether that's what you really want.

In the United States we have mountains of laws, regulations, requirements, and standards. Every time a legislature enacts a new law we end up having to pay for it in one way or another. Some examples...

  • Phlebotomist (the person trained to draw blood samples). How much training is enough? If they have to go to school and earn a certificate that job its going to require a higher salary. If they get trained in a day they might be earning minimum wage. In Washington state (and three other states) a phlebotomist requires a special state certification. Who do you want drawing your blood? And are you willing to pay more knowing that person has a special state certification?

  • What about a registered nurse? How much schooling is necessary? The more training the higher the salary. We as consumers are going to pay for that one way or another. Who do you want looking after your sick infant?

  • What about the facilities and the equipment? How much equipment does there have to be in an ambulance before it can be used to transport patients? Rules and regulations cost money. Again, we pay for that.

  • Cleanliness and hygiene in the hospital. What counts as clean and sterile? Again, money out of your pocket. Don't get me wrong here. I'm. not telling you the hospital facilities I've been in here in China are dirty. They've seemed plenty clean, but sterile? Not sure I know there.

Perhaps the largest difference here in China is the lack of a profit motive. Insurance is for foreigners, not Chinese citizens. However, when you remove the profit you remove the motivation to innovate and experiment. That's the rhetoric we get all the time in the states, but how much water does that argument carry? Honestly, I'm at a loss there. I'm not comfortable trying to attack or defend that statement. In general it's obvious to me that other countries benefit from the innovation that happens in the states.

I'm not comfortable making larger assessments of the entire Chinese health system. My experience is limited to one large university hospital here in Hangzhou. There are more people in this city than the entire state of Washington, so this particular hospital is super busy. However, I do feel confident in my assessment that the people here are more healthy than those in the states. Obesity is nearly nonexistent here, even among the more wealthy citizens. According to data I find online the US has a longer expectancy (79.9 to 78.9). That really surprises me. True for both men and women. But when graphed against GDP the states look terrible. I saw this from Nate Silver this morning. Wish I knew where China is in this graph. My guy tells me they are above the regression line, but that wouldn't jive with the lower life expectancy.

We produce a lot, but certainly don't live longer for it.

My overall feeling is that health care in China is similar to driving. They have rules, but ignore them a lot and just fall back on what we would call common sense. Americans first jumping into a taxi here would be afraid. They don't appear to follow any rules and it feels a bit crazy, but they're all on the same page and the cars perform a sort of dance all over the roads. This common sense thing seems to hold true in health care too. Watching a nurse fix my IV drip last week felt sketchy, but at the same time she knew what she was doing.

The downside of health care for me here was a loss of personal touch. I felt like I was on a production line going through their system here each time. The language barrier could have also been something that made me feel like I was in an automated system. I do feel like I've been taken care of well, and the cost was MUCH lower. I guess the price for that is a higher chance of mistakes being made. And here, nobody is suing a hospital for minor malpractice. Look, there's water on the floor. You stepped in it and fell. You were injured. In a court room here the judge is going to look at you and ask why you stepped there. Case dismissed. Liability gets measured differently here. It's a different world.

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