Article by XIANEASE
Given the recent outbreak of COVID-19, many people have been left wondering how exactly the medical system here in China works. There is a certain amount of anxiety centered around the unknown when it comes to health. If you are ill, what can be done about it? How reliable is the healthcare here? What are the costs? The questions mount. Add into this the occasional horror stories that you sometimes hear of the conditions in some places and you might be tempted to just sit at home and try to ride out whatever illness that you might have. You shouldn’t do this though, as it may not be the best for your health.
So, in order to de-mystify the process, and make it a bit easier to head to the hospital, we have put together this guide to help you through the process.
Step 1: Choose a Hospital
There is a huge number of hospitals in Xi’an, spread all over the city that vary in their capacity and medical ability. Choosing a hospital to go to can seem quite an intimidating task. However, when choosing a hospital, you can look at the following factors:
• Reputation – There are a number of well-known hospitals in the city that have built their reputation over many years. These hospitals are usually the largest and best equipped. These institutions are also able to attract some of the top talents from around China, meaning that they will have some of the most proficient staff. Examples of hospitals with excellent reputations include The Second Affiliated Hospital of Jiaotong University(交大第二医院), Xijing Hospital(西京医院), and Tangdu Hospital(唐都医院). Often times these hospitals will be tied to a medical university, meaning that they will be on the cutting-edge of research.
• Specialization – Another way to choose a hospital is by the specialization of its staff. Though many hospitals will have a full set of medical departments, sometimes there are particular doctors at particular hospitals that are simply the best at what they do. Whether your issue is minor or major, chances are that there is a doctor who specializes in that particular thing somewhere in the city. Some examples of this would be the Spinal Surgery Center at Xijing Hospital or the Ophthalmology Department at Xi’an No. 4 Hospital.
• Urgency – Large hospitals with good reputations do not only attract the best talent and equipment. They also attract huge crowds of patients. Seeing as hospitals in China generally do not take doctor’s appointments, this means that you might be waiting in line for quite some time trying to get service in these places. Smaller, less famous hospitals will have shorter lines and more freely accessible equipment, meaning that the total time you spend at the hospital will be significantly shorter. In fact, if you are looking for a diagnosis, it is best to go to a smaller hospital first to see what is wrong before attempting to tackle the crowds of a larger hospital.
• Location – In an emergency, the best hospital is the closest one. It pays to know which hospitals are in your area, in case you have need of one. Being registered at a local hospital (more on that in a bit) will greatly shorten the time it takes for you to receive treatment when going to these hospitals.
• Privacy – One thing that you might notice in many hospitals in China is the open nature of hospitals. Often you will find other patients standing near you, staring at you while you get your diagnosis. Due to the crowded nature of hospitals, this is often inevitable. If you are one that prefers privacy, you might consider using one of the ever-growing numbers of private clinics that have opened over the last several years. They often are populated by top-level doctors that have moved into private practice, so the level of care will often be equivalent or better than the services in some hospitals. Just remember that there is typically a premium price placed on such service, and these may or may not work with your insurance.
Step 2: Getting to the Hospital
Ambulances in China tend to be reserved for the most serious of traumatic incidents, or for patients who need extra care on the way to the hospital, such as the elderly. In addition, these ambulances are not typically part of the hospital, but are run by separate companies or run directly by the government. If you call the emergency line 120, they can dispatch an ambulance to your location, but the times may vary, depending on the time of day. Traffic is not always willing or able to part for an ambulance, even when the sirens are running, meaning that you may have to wait quite a while for the ambulance to arrive, and an equally long time to arrive at your destination hospital.
In addition, ambulances charges, while not extraordinary, are not the cheapest method of transportation. They will charge you for both the ride from and to the hospital as well as for any medical services they perform while you are on your way. The bill typically comes out to around 200-300RMB, but can get much higher depending on the particular situation (for example, bringing you out on a stretcher goes up in price for each floor they need to bring you down).
Typically, if you are not in serious condition or bleeding heavily, it is best to take a taxi or have someone drive you to the nearest hospital. It is faster and cheaper than most ambulance services.
Step 3: See a Doctor
Most hospitals in China do not have any type of appointment system, which means that in most cases, you can expect to do a lot of waiting. Some places will operate on a ticketing system, similar to waiting in line at the bank. In others you may have to wait in a physical line in order to see the intake doctor. Either way, before you can see the intake doctor, you will need to register for a card at the hospital. This is done by going to the registration desk, usually located at the front of the hospital in the lobby, presenting your ID, and putting money onto a card.
This card is going to be very important, as it is the only way to obtain medicine and track your information on the hospital systems. Every place that you go within the hospital will ask for this card. If there is no money left on the card, you will need to go and recharge it before you can receive more treatment.
After getting your registration card, you will see the intake doctor. They will ask for your symptoms, take a few measurements, such as heart rate and blood pressure, and then give you a rough approximation of what might be wrong with you. And then the tests begin.
Step 4: Examinations
After the initial intake examination, the doctor will typically refer you to different departments for a battery of tests. This can run the full gamut, including blood tests, urine tests, MRIs, and so on. All of these will typically take place in different parts of the hospital, and there are rarely personnel available to guide you to the next test. If you do not have a strong command of the Chinese language, it is highly suggested that you bring someone who does, because navigating everything that you need to do can become quite complex.
Depending on the size of the hospital, each of these tasks may take anywhere from 10 to 45 minutes or more, so budget more time than you think you would need. Many of the staff at the hospital will take the normal 2-hour break from noon to 2PM as well (sometimes longer), so you may arrive at a testing station only to find no one on duty.
If you need a blood test (and they almost always have you do a blood test), then they typically ask that you do it on an empty stomach, so if you are planning to go to the hospital, it’s best to do so in the morning. Bring a snack and some water as well, because there is typically only one shop in every hospital and they are usually overpriced and poorly stocked. Tests generally are not that expensive, with blood test typically being under 100RMB and MRIs for a few hundred.
Step 5: Diagnosis and Treatment
Once you have completed all of your tests, you will usually go back to the intake doctor that you saw at the beginning will your results. They will pull up what information that has been reported on the computer and give you a more thorough diagnosis of what ails you. If the issue requires more specialized treatment, they will direct you to the appropriate department. If they have a diagnosis for you, they will give you a prescription for medicine. Remember that in hospitals in China, traditional Chinese medicine and Western medicine are held in the same regard, and often the prescription from the doctor will contain both. Many times they will recommend that you have an IV drip as part of your prescription, often a saline or vitamin drip, though other medicines are also dispensed this way. Pills and other medicines can be obtained through the hospital pharmacy, though sometimes the medicines can be had at a cheaper price in pharmacies outside of the hospital.
If they doctor is unsure of your diagnosis or if your diagnosis requires it, they may suggest that you stay in the hospital overnight or for several days in order to observe you. It is not always necessary to do this, and you can refuse to stay if you don’t feel it is necessary. Fees for the bed can range from 20-30RMB for a bed in a shared room up to 800RMB+ for a VIP room. This price does not include any other amenities besides the bed itself. It is typically expected that family members will take care of patients, so there are no food services or other types of products available. Tissue, toilet paper, and toiletries will need to be brought from elsewhere by others. There are also typically no shower or bathing facilities available either, so keep that in mind. If you have visitors while you are in the hospital, they often will not have any place to sit, with the exception of a lone stool that accompanies most hospital beds. People staying overnight will need to either sleep on that stool or in the bed with you. Most hospitals are designed for space efficiency and not comfort.
Step 6: File Your Insurance Claim
All Chinese citizens have access to the medical insurance through the National Social Insurance Plan, which covers some of the cost of healthcare throughout China, though in recent years the private healthcare insurance industry has been growing rapidly. If you are working in China, your company should provide you with health insurance. If you are a student, you are required to have medical insurance to study in China and there is often a group option purchasable through your educational institution. If you are not covered by an employer or school, it is advisable to purchase a health insurance plan from a private provider.
Most insurance plans will only reimburse if your bills go over a certain minimum limit. This can be as low as 2000RMB, but you should check your insurance plan carefully, as it will differ from company to company. It can sometimes take several months to be reimbursed by the insurance company, and in the meantime you will need to foot the bill. Sometimes, the company that you work for will help you pay for the bill, but they are not necessarily required to do so. Though medical costs are not generally very high, it is generally advisable to keep some money in reserve for medical emergencies while living in China to ensure that you can get care should you need it.
The specific method of reimbursement will depend on your insurance provider. Some of the larger companies operating in Mainland China are Ping An Insurance, Kunlun Insurance, PICC Insurance, Taiping Insurance. Some international insurance companies will also cover your care while in Mainland China, but it is rare for hospitals to recognize private insurance, so you will still need to pay the costs up front before receiving care. Once your request has been processed, you will receive a direct deposit to your mainland bank account.
We hope that this guide has alleviated some of the worry that of comes with going to the hospital. Remember that there are many possible options and, in many situations, you will get top quality care. To assist you in finding the appropriate hospital, we have put together a chart of some of the top hospitals in Xi’an and their associated specialties.
If you have something that you would like us to investigate in future issues of XIANEASE, questions or concerns about healthcare in China, or anything else that we might do to assist you, let us know by contacting us at firstname.lastname@example.org or by scanning the QR code and following our official account.