Docs of Shanghai

They're short on status, pay, and respect, but China's young doctors hold keys to the world's fastest growing pharmaceutical market.
Aug 01, 2005

In China, almost every trip to a doctor involves waiting in line at a hospital. Hospital lobbies stretch out like train station waiting rooms, filled with row upon row of benches for patients who arrive in the early morning, without an appointment, to see their doctor of choice. Large modern hospitals in Beijing and Shanghai list the names of the physicians on duty in giant LED displays on the wall, like so many travel destinations. It isn't always clear how many patients a doctor can see—doctors tell me that 50 in an eight-hour shift is common—but those who arrive at the appointment window late in the day may find their preferred physicians fully booked. Friendly hospital assistants walk the aisles between benches to check on the crowd periodically, but no referral is necessary. Anyone who thinks he or she needs to see a doctor in any specialty can get in line. Outside of the emergency room, the hospital performs little triage. More frustrating for those with chronic diseases, no patient who has seen a particular doctor before can be guaranteed another appointment with the same physician.

Yao Qiang, MD
If the system seems a bit haphazard, it provides a democratic distribution of one of China's scarce resources: physicians. The country has less than two doctors for every one in the United States, and they serve a population close to five times as large. In the United States, 780,000 doctors treat a population of less than 300 million, which comes to around 265 doctors per 100,000 people. In China, there are about 12 doctors per 100,000 people—roughly 1.5 million doctors for a population of 1.3 billion. Even so, as China transitions into a market-driven healthcare system, challenges of economic disparity and sheer geographic size dwarf day-to-day problems like getting a doctor's appointment. But even as the system evolves, opportunities abound in this rapidly growing market. For pharma, the physician is the point of entry to this market, so tapping the enormous opportunity begins with understanding the practices and values of Chinese doctors.

A Brief History of Chinese Healthcare

The Pharmacist in China: New Legislation and New Roles
A brief look back at history sheds light on the culture of medicine in China today. Western medicine was introduced to China at the turn of the 20th century, and many prominent medical schools today date back to that era. 1949 ushered in a new era. The People's Republic was a sprawling planned economy, in which the government owned and delivered all healthcare services. Most urban citizens received care from government hospitals, which offered inpatient, outpatient, and pharmacy services. As government employees, physicians earned a standard, uniform salary like every other worker. Private citizens paid a nominal fee (the equivalent of a few US pennies) to come to a hospital, see the doctor, undergo treatment, and receive medications from the hospital pharmacy. To improve healthcare in the rural areas, the state deployed hundreds of thousands of doctors and healthcare workers with various levels of training to work as "barefoot doctors" in free clinics. These rural outposts provided basic healthcare, educated the public on hygiene, and delivering babies, and promoted birth control. Devoting resources to rural areas nearly doubled life expectancy in China, greatly reduced infant mortality, and controlled the most prevalent infectious diseases by 1975.

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