The Ministry of Health announced findings from a national survey on health literacy (Less than 10% of Citizens Have Health Literacy). Separately, a commentary argues for an overhaul of the current thinking on healthcare communication in order to enable health literacy (Health Literacy: Rethinking Patient Communications in China).
Minister of Health Chen wrote an article to highlight the mutual interests shared by doctors and patients. The article proposed improvements in public education as a way to promote a positive atmosphere in public opinions, among other government measures (Minister of Health Chen Zhu: Irrational System Reason for Doctor-Patient Standoff). In response, a blog urges the government to focus on capital investments in the sector as talks of mutual interests between doctors and patients would not yield changes in the short-term (Doctor-Patient as a “Collective Interest Body” is Easier to Understand than Implement). Along a similar theme, a commentary proposes changes to the compensation system for doctors (Let Doctors Live with Dignity).
The Beijing court system estimates that two-thirds of medical disputes in the city may be attributable to doctors and hospitals failing to adequately explain the treatment processes to patients (Two-thirds of Physician-Patient Disputes Due to a Lack of Communication). Such situations may find relief through a clinical path treatment program pilot that the government is launching (Treatment Models Available for 112 Medical Conditions).
The government supports a plan to roll out the hospital volunteer program originally started in Peking University People’s Hospital (China to Implement Hospital Volunteer Program Nationwide). Separately, Shanghai announces plan for standardized training for resident physicians (Shanghai Explores Standardized Trainings for Resident Physicians), while a hospital introduces an assessment system in the emergency room as a majority of patients use the ER for non-critical conditions (Assessment System Introduced for Emergency Room Care).
A researcher at the Chinese Academy of Social Science proposes the introduction of public policies to address issues in housing, education, and healthcare (The Next 10 Years: Public Policies Expected to Remove Obstacles in Housing, Education, and Healthcare). The Ministry of Commerce in the meantime announced plans to further liberalize the medical education and service sectors to promote foreign investments in these areas (Ministry of Commerce: Further Liberalization of Foreign Investment in Medical Education in 2010).
Two-thirds of Physician-Patient Disputes Due to a Lack of Communication
A number of medical disputes have drawn widespread public attention recently. The number of cases in the judicial system in Beijing is estimated to be more than 1,000. During a recent discussion seminar organized by the Beijing Second Intermediate Court, a judge noted that from his observations, two-thirds of all cases are due to a lack of communication between physicians and patients. He further commented that in many cases, patients sue because they do not understand the process of therapies provided by the hospitals. In the lawsuits, patients often complained of the indifferent attitudes of medical staff, which led the patients to believe that hospitals do not care about patients’ welfare. (Link to full Chinese text)
Healthcare companies in China would benefit strategically from improving the health literacy of their patients. The traditional communication approach—promoting disease and therapy awareness — engaged by healthcare companies in China often fails to address a current gap in healthcare communication in China: the lack of an enabling communication system that promotes patient health literacy. An overhaul of the thinking processes guiding current patient communication would offer an opportunity to strongly position these companies as a vital and beneficial force for the next stage of market developments. (Link to full text)
The number of patients visiting hospital emergency rooms has steadily increased in the city recently. The limited space and medical resources in these emergency rooms have further aggravated the doctor-patient relationship. The No. 3 Hospital in the city has taken the lead by introducing a grading system for diagnosis and treatment of emergency cases. This would allow hospitals to attend to patients requiring the most urgent services. According to the director of emergency room service at the hospital, the hospital admits about 200 emergency patients per day. However, most of the patients suffer from non-urgent conditions such as colds and stomach flues. Based on the research conducted by this journalist, only about 10% to 20% of emergency patients require emergency care. The high number of emergency room patients, along with a shortage of medical staff and the anxiousness of patients’ families, has contributed to the chaos observed at emergency rooms in hospitals. (Link to full Chinese text)
Let Doctors Live with Dignity
Within a span of three weeks, three medical dispute cases in three regions in China have drawn widespread public attention. While the nature of each medical dispute case is different, public opinion is surprisingly unanimous: Doctors and hospitals have killed the individuals [involved in the cases] and should assume full responsibility. Based on this reaction, we can conclude that there is a heightened state of public mistrust towards doctors and hospitals, which has given rise to the strained state of relations between doctors and patients. The root cause is distortions in the medical management system that has distorted the compensation system for doctors. This writer believes that compensations for doctors must take into consideration the need to preserve doctors’ professional dignity. If the compensation practice treats hospitals as administrative organizations or corporate businesses, the public will continue to remain suspicious of doctors’ professional integrity. (Link to full Chinese text)
The Peking University People’s Hospital effectively improved physician-patient relations through a hospital volunteer program. Officials from the Ministry of Health have explicitly indicated that such a program will be launched nationwide. In addition to having mastered professional social work knowledge, hospital volunteers are skillful in identifying the social, psychological, and physical factors of those they serve. Hospitals also provide training in preventive care, assessment of frequently seen medical conditions, and risk management to volunteers. Certificates are issued to qualifying volunteers. Since the official start of the first group of volunteers in April, in addition to their regular duties of assisting patients, these volunteers have proposed 99 recommendations for improving physician-patient relations. (Link to full Chinese text)
The Minister of Health Chen Zhu wrote in an essay published in People’s Daily that the true nature of doctor-patient relations is one of “collective interest body.” The root cause impacting doctor-patient relations is the lack of a rational system which has diluted the public interest nature of hospitals and pitted the economic interests of physicians against those of patients. To address the issue, Minister Chen wrote that work in four areas will be needed, including strengthening of government functions in public service and increasing investments in the healthcare sector; improvements in medical professional ethics; improvements in the system for mediating medical disputes; and improvements in public education to promote a positive atmosphere in public opinions. (Link to full Chinese text)
The Minister of Health Chen Zhu recently claimed that the nature of doctor-patient relations is one of a “collective interest body.” It is true that doctors and patients share the same interest. Ultimately, patients’ level of satisfaction with treatment outcomes impacts doctors’ interests. However, in some areas, doctors are indifferent to patient benefits. Moreover, hospitals and doctors place their own interests ahead of others. Many doctors will not change their minds just because the minister has spoken. Similarly, patients will not change their views of doctors just because of a slew of news reports. In this writer’s view, investments in healthcare hardware facilities remain the prerequisite for improving doctor-patient relations. (Link to full Chinese text)
The Ministry of Health plans to identify 50 hospitals to implement a pilot clinical path management program by the end of the year. Clinical path management method means the use of a standardized treatment protocol for a certain disease. Patients will now be able to refer to the method to understand the flow of treatment process. According to Ma Xu-dong, director of the Medical Administrative Department of the Ministry of Health, under the current system, doctors rely on experience to administer diagnoses and treatments. With the clinical path management program, hospitals across the board can reference standardized protocols for treatment plans. Most ideally, patients now have access to a standardized treatment flowchart so they can anticipate the treatment process and estimate treatment budgets. The new model can be expected to improve physician-patient relations. According to Ma, 80% of all medical disputes reported to the Ministry of Health are due to miscommunication. The clinical path management program provides the transparency required to facilitate improved doctor-patient communications. (Link to full Chinese text)
On December 18, the Ministry of Health reported results from the first national survey on health literacy of Chinese residents. The survey was conducted between June 2008 and August 2008 and covered 31 provinces and regions. Close to 80,000 individuals between age 15 and 65 participated in the survey. The survey found that only 6.48% of those interviewed have basic health literacy. Health literacy refers to an individual’s ability to acquire and comprehend health information and the ability to use the information to care and promote his or her own health. Mao further commented that “in the past, we were used to using quantitative measures to assess our work in health communications, for example, the number of health seminars conducted, the numbers of people attending, the number of posters plastered, the number of pamphlets printed. We are now more focused on assessing the actual results of health education. He concluded by saying, “We should all remember: Every person is the primary responsible party for his or her own health.” (Link to full Chinese text)
According to Shanghai municipal public health departments, Shanghai has launched standardized trainings for resident physicians that are in line with the national medical reform plan. Thirty-nine large- to medium-size hospitals have been identified as training hospitals. Standardized training for resident physicians is a widely used practice internationally for training medical clinical talents. The United States, the United Kingdom, Australia, and other developed countries, as well as China’s Hong Kong and Taiwan have established government-led, thoughtful, standardized training systems that effectively guarantee the professional standards and quality of clinical practice. (Link to full Chinese text)
According to the Minister of Commerce Chen Deming, the government plans to target healthcare, training, and other related services as areas for liberalizing foreign investments. The government plans to proactively and steadily open the markets in services including encouraging foreign investments in healthcare organizations and occupational training institutions. Such a policy perspective follows the framework drawn up in the medical reform plan released in 2008. Since the mid-1990s, foreign investments have been made in the areas of special clinical service and medical equipment. However, since 2005, the implementation pace for foreign investment in the sector became more restrictive. The new medical reform plan in 2008 explicitly proposed to “encourage and guide private sector capital in the development of the medical and healthcare sectors, aggressively promote the development of non-public healthcare institutions, and facilitate the formation of multi-source investments to the sectors.” (Link to full Chinese text)
Housing, education, and healthcare are necessary goods for citizens. In recent years, prices for these goods have escalated at an increasing rate, resulting in a drastic increase in economic burden for people. Since the underlying nature of these products is largely that of a public good, it is difficult to effectively guarantee adequate supply of these goods by relying only on market mechanisms. The problem is the lack of public policies for these sectors. These sectors have only departmental or sector policies. Healthcare in particular is considered by many a “pseudo market.” The lag in fiscal investment has led to hospitals relying on prescription sales to raise funds for operation. Moreover, policies have obstructed the entry of private sector capital into the healthcare sector. To resolve issues in the provision of these goods, public policies must be introduced and established. (Link to full Chinese text)