Doctors' Service Fees Have Risen—but Not Nearly Enough

Beijing's healthcare reform has finally begun: registration fees have been abolished and a medical service fee introduced, though the internet is full of curses.

My title and content may both attract abuse, but I do not care. For Chinese medicine to advance, we must respect knowledge and respect medical staff—and this respect must show up in economic returns.

Raising doctors' service fees, so that they can live openly by their knowledge and skills, lets them survive without relying on selling drugs and ordering tests, without becoming people patients loathe and they themselves detest.

In China's current consultation fees, the value of the doctor simply cannot be seen; even under the new reformed pricing system, the true value of doctors still cannot be seen. Compared with foreign peers, the gap is enormous. Yet even so, the reform has been cursed to high heaven.

Changing this will take decades. China's doctors' consultation fees will, over the coming decades, gradually rise until they reach a reasonable price level, and only then will truly high-level medicine be achieved.

On the registration fee, we still carry the thinking habits of the "big-pot-rice" era, assuming that doctors ought naturally to be cheap and ought, nobly, to serve all of society without regard to compensation.

Making one doctor noble is easy; making millions of medical workers nationwide noble is impossible. Improving medical care can only rely on institutions and pricing systems, not on moral exhortation.

China has a huge shortage of medical personnel. Relative to its enormous population, we are far short; worse, China's best talent mostly refuses to enter medicine.

Medicine is the hardest discipline in the world. In developed countries, only the top students can get into medical school, yet our top students go into more profitable majors. A major reason is that medicine is unattractive: low pay, heavy workload, high occupational risk.

When I was in school, few of our best students entered medicine; it was the middle or upper-middle students who studied medicine. To put it bluntly, such gaps in talent cannot be made up by hard work. If this continues, Chinese medicine will remain at a low level.

In my own middle school days, I was a well-rounded top student; had my mother not been in poor health, I probably would not have studied medicine. At school I was the master of the hardest final "finale" problems; every exam had a couple of them, which, according to my teachers, were written especially for me, to see if I could solve them.

Back then I often felt elated after solving some math, physics, or chemistry finale problem, thinking myself extraordinary. The Huanggang region's exam questions were famous worldwide for being fiendishly hard; solving them gave a student real satisfaction. Now that I practice medicine, I find solving each patient's problem far harder than those finale problems ever were.

Researching medicine requires intelligence, and raising a country's overall medical level requires a cohort of high-IQ people to enter the field. If a country's medicine is so bad that high-IQ people shrink from it, that country's medical level cannot rise, and in the end all citizens suffer. Without high-level medical skill, how can we safeguard life?

We have no tradition of respecting knowledge. In China, piracy is no big deal and intellectual-property awareness is extremely low. Intellectuals like doctors, who must read enormous amounts, ought to receive due respect; yet in reality, our doctors' registration fees are so low that this respect is invisible. Not only that, the current climate in China mostly heaps humiliation and abuse on doctors.

I ask you: in such an environment, would a person with any sense of shame really want to be a doctor? Don't think a few empty slogans can coax people into this bitter, tiring, worrying work. Smart people can make money doing anything; why would they choose this exhausting, undignified job?

If doctors could earn a decent living with dignity, I do not think they would brazenly prescribe expensive drugs and tests for commissions.

Chinese residents also have no habit of buying medical insurance. I once saw a post on a forum where someone railed against how much the rural cooperative medical scheme now costs. Frankly, I know that area's rural income well: families with savings under 50,000 yuan are few, yet a thousand-yuan-per-year family insurance premium arouses public outrage.

By our habitual way of thinking, residents should get free medical care, and doctors' service fees should be low enough to be negligible.

I worked at an American-style clinic in Beijing and saw the consultation fees charged by American and Japanese doctors practicing in China—astronomical sums to Chinese patients. A colleague of mine, an American dentist, did a two-hour dental implant procedure on one patient and charged 260,000 RMB.

I thought these doctors charged a lot, but they were long used to it, because that is how they charge in the US and Japan. So although this clinic was in Beijing, it served only foreigners and wealthy Chinese. Their medical skill was genuinely good and they were extremely thorough; a patient rarely left in less than half an hour.

While I worked there, one of the investors, an American doctor, lamented that my service fee of a few hundred to over a thousand yuan an hour was far too low; he thought it should be at least five to ten times higher. Yet I had already attracted a storm of abuse for charging so much.

Once a rhinitis patient found me online; I told him my rates, and he erupted in curses. Still not satisfied, even months later he periodically comes back, through various channels online, to curse me. I can only wish him a speedy recovery from afar—and am glad I never treated him.

I have always held to the principle of prescribing only, not dispensing. By the way, American-style clinics have no pharmacy; doctors only write prescriptions, and patients buy medicine themselves at drugstores. For a healer whose only income is this fee, I do not think my charges are high. I know that most of my domestic peers create income through other channels during treatment and earn far more than I do.

The total cost at an American-style clinic is not higher than at domestic hospitals; some patients who go abroad for treatment even spend far less than at home. The reason is simple: doctors' transparent income is already sufficient, so they do not extort patients over drugs or tests.

I focus on cancer research, and the prescriptions I write are cheap. At current prices, few patients spend over 5,000 yuan a month on medicine; most average 1,000 to 3,000 yuan a month, and some spend less than 10,000 yuan a year. For minor ailments, I often prescribe a few yuan per dose, sometimes even a few mao per dose.

I personally think this is a very conscientious price, but many people are still frightened off the moment they hear my service fee. There is nothing I can do about that.

We Chinese have hardened into a mindset that things are precious and people are cheap; correcting it will take a long time. If one hour of a doctor's time is worth less than a sweater we buy in winter, that can only be called a tragedy for our nation.

China's shortage of medical personnel is a fact. In today's Chinese healthcare, bad money drives out good in a serious way. If I were the health minister, even at the risk of universal condemnation—being cursed to death by the whole country, even losing my head—I think I would still push through a series of doctor-centered reforms that overcorrect, respect and protect medical staff, build a good practice environment, and draw outstanding talent into medicine. That is the key to raising Chinese healthcare.

As for me, no matter how many people curse me, I will keep to my current model, and if possible promote it. Because I know this is the right medical service model.