Chinese Doctors Tell Patients To Pay Upfront, or No Treatment

Parents of Boy With Leukemia
Scramble for Cash to Cover
New Chemotherapy Round
Threat Seen to Social Stability
By ANDREW BROWNE
Staff Reporter of THE WALL STREET JOURNAL
December 5, 2005; Page A1

BEIJING -- As soon as the money dries up, doctors warn, so will the drugs that could save the life of Cui Guangshun's 7-year-old son, Dejie, in the leukemia unit of Beijing Children's Hospital.

Such are the rules of China's pay-as-you-go health system: cash upfront, or no treatment.

Mr. Cui's wife, Yang Deyin, traveled more than 300 miles by bus to Beijing from their small farm on the grasslands of Inner Mongolia to be near her only child. For weeks, she camped out on a blue plastic chair in one of the hospital waiting rooms to save money on lodging, like dozens of other parents.

Back home, her husband pleaded with relatives and village neighbors for more loans to keep the boy's care going. Most nights, the mother queued up in a drab hospital lobby, littered with food wrappings and possessions, to use a touch-screen computer that told her how much of the family's cash was left. Sometimes the number flashed red, meaning the family was in arrears and prompting a frantic call to her husband.

In the past few weeks, Mr. Cui and Ms. Yang have been forced to accept a terrible reality: Even though their son's leukemia is considered highly treatable, they may never raise enough money to cure him. The hospital's estimated fees of $18,500 to complete an initial 6½-month course of treatment are impossibly high set against the family's annual income of less than $350. Like two-thirds of China's population, they don't have health insurance...

Full article here:

http://online.wsj.com/article_email/SB113373075798913517-lMyQjAxMDE1MzAzNjcwMzYwWj.html

This is where the US could be headed. Hospitals already are profit driven even if they are incorporated as not-for-profits. They have to pay staff and maintain the buildings--that much is true. New medical technology costs a lot as well--but is THIS where you want to be in 10-15 years????

Universal health care has GOT to become a priority if we want to avoid this scenario here someday. National action has not enjoyed widespread support in the past, but it needs to. When you vote, remember--ask about the candidates' views on single payer/national health care.

Sorry to preach--but this story REALLY got to me.



Laura

very bad
And to think, this is what Tom Delay and Bush have been praising... makes me want to barf. At least in Russia they had a socialist economy while under communisism...

Doesn't mean dick in a police state like the old USSR. There were no advantages to the old USSR, it was a failed state.

the old Police state commie & socialist USSR
OR
the Police State commie & absolute capitalist China?


at least in the USSR you got bread, even if you had to wait hours in line for it...

Yeah, that Lenin, what a genius, let me tell you...

:eyes:

Hey - they've got OUR health care system! Here in Utah, that's exactly how it is if you don't have insurance. It's pay the doc up front, or no treatment. In theory, you can get treatment at the emergency room, but the reality is patients get dumped all over the place, and even if you're seen and admitted, the hospital stay is very brief.

If they lived in the US, they wouldn't be any better off in trying to get their son treated when they don't have health insurance. That's the sad reality of our health care system.

working for a wage, it's that citizens don't have coverage for their medical bills.

Think of the 200 billion we pissed away on over throwing Saddam and what that might have meant for health care and patients.

...and basically worked for free. And people didn't die if I didn't help them, either.

Doctors make $$$ large, but the concept of volunteering and giving back to the community is largely gone.

Hospitals USED TO BE a service to the community, not a $$$ making machine for greedy corporate types.

IMO, coverage for all is the solution. But it's also my opinion that a lot of doctors have some ethical issues they should think seriously about. Hospitals have even more. Of course, those very few doctors left who DO give back are exempt from this condemnation, and they have both my admiration and utmost respect. If there's a hospital that doesn't fit the bill, I haven't seen one.

When did it become OK to just let people die because they're poor and can't pay? When did being a doctor become more about $$$ and less (almost nothing) about saving human lives?

http://www.nhpf.org/pdfs_bp/BP_PhysicianVolunteerism_3-04.pdf

Necessary but Not Sufficient?
Physician Volunteerism and the
Health Care Safety Net



You gave certain people big "discounts"? How did you select them? Was it by need or was it marketing- a loss leader?

I am assuming you mean: when you gave those big discounts, you basically worked for free on those occasions, but you are not saying you always basically worked for free at all times? That’s not a great business model.

Either way, you are also saying it was voluntary and not imposed or expected of you.

I am going to limit my comment to the US and not the Chinese doctor in this case, because I know nothing about his situation.

Are you saying that doctors should see any patient for free at any time?
No choice in the matter?

>Doctors make $$$ large, but the concept of volunteering and giving back to the community is largely gone.<

Really? In my community there is a FREE clinic for the poor and indigent, and doctors of all specialities volunteer and treat patients for FREE. They don't brag about it, it just gets done- quietly. Those not in the clinic treat 10% uninsured patients anyway, that is the annual, write off. 10%!

Several friends quietly and with out fan fare go abroad and perform orthopedic and plastic surgery on kids and adults in the most needed parts of the world.

"Giving back is largely gone" ?? On average, 10 % of a medical practice income is written off for uninsured and indigent patients.

"Doctors make lot's of $$$"- hmm?
Let see, the nurses, billing and coding staff, receptionists, x-ray tech's, medical
transcriptionist also agree to work for free? Not really.

And I guess they are giving malpractice premiums out for free these days?
In Illinois a spine surgeon pays over $100,000/year for malpractice coverage.

I know those fat cat Doctors can just walk right into Sears and demand new car tires, and appliances for free! because they are "doctors" and of course doctors don't put kids through school, pay mortgage, health insurance, phone bills, food and clothing?

Yea, those are big bucks doc's make, after a quarter of a century of education, student loans, deferred income, night call, week end call, holiday call, and on average 60- 80 hour work week.

Why compared to the "underpaid" professional athletes, those highly educated, dedicated, roll models who get a measly $40 million to $120 million contract, those over paid doctors make $13.33/day for a total hip replacement surgery, including pre-op history and physical, the surgery itself, every single hospital visit, all follow up visits for the next 90 days, the office facility and office staff and even dressings and supplies are all thrown in! That $13/day is big bucks!

And when called in to the emergency room at night, say 2:00 AM on Christmas, the on call physician does not and cannot ask about payment mode or insurance status, they just go in and take all comers and treat the patient. Uninsured patients are mostly a write off- not that they can’t sue a doctor. But that is not giving back to society, I guess?

Hey, how about the influx of cheap foreign "labor", grads brought in by hospitals, paid a low wage, and placed on the medical staff to be yes men to unbridled corporate hospital greed. After all, why have the kids of American teachers and plumbers get some aid in going to med school when we can bring foreign grads in cheaply from over seas, and get a company toadie to boot!?

On the other hand, there are huge "non-profit" hospitals that never pay taxes, expand everything from their taj majhal parking lot to parquet floors on a patient unit, pay their mercenary CEO’s hundreds of thousands per year, and still, turn indigents over to collection agencies, or have them sign over their home. I guess charity stops just past the chapel in these money makers.

How about those poor drug companies and their CEO's and their bonuses?

Of course, let's not forget the insurance companies and HMO's, the less they provide to patients and the less they pay doctors, the bigger the year end bonus for execs.

Don’t want to forget the attorney’s that make 33% for suing doctors.

Medicine in America is a sham. A Potemkin village. Neither patients nor doctors are the least bit happy. But hospitals, HMO's, and pharmaceutical love this system.

>>When did it become OK to just let people die because they're poor and can't pay? When did being a doctor become more about $$$ and less (almost nothing) about saving human lives?<<

The story was about China! Do not confuse this story about Chinese doctors with American doctors. The irony here is that China is a communist country that is supposed to care for the masses, to “each according to his need.”

I have never seen a doctor in America walk away from a patient and let them die because they can’t pay. I have seen doctor’s begging hospitals to allow their indigent patients in for care, and I have seen doctor’s in America pull their hair out fighting insurance companies to cover proper treatment- because the hospital bill is usually 10X the doctors bill, and doctors are front line in getting coverage approved for their patients in the first place–even if they themselves never get paid.

Volunteerism for physicians is a noble concept, but think of this example: A patient is treated for free by a local doc. No problem there. But now, let’s say that patient needs x-rays for the low back pain–> $450. Or so. How about P.T.? $500. Down and charged at $125./hr. What about that MRI? Good luck. That’s about a $2,200. Propositon with the test and radiologists fee. So while local docs may open their doors to the poor, and many charge a discounted fee, $10. Or $15. Per visit, ie. A couple packs of smokes, there is only so much that docs can do when the high cost of the high tech care is not under the docs control.

http://www.princeton.edu/~paw/web_exclusives/plus/plus_041002Reinhardt.html
April 10, 2002

How healthy is our health care?

By Professor of Economics Uwe Reinhardt

Detroit Receiving. Unfortunately, they are always staving off bankruptcy, as medicaid will not cover every patient they get. DRH treats most of the gunshot wounds, the overdoses, the mental breakdowns and all of the usual inner-city maladies. They do it well, too.

They can't pay. They get no service. The whole basis of being a capitalist is to be in a state of ownership over the means of production. Why would one want to control that? To make money.

You don't like that? Might want to talk to those socialists on the left that are always on the margins here in the US.

2 years ago, Christmas Eve, my friend's family was told "pay up or die" by an American surgeon for the father who was waiting for open heart surgery. $50K or no surgery which was scheduled for 12/29. He was uninsured.

We're not "going" there - for the uninsured the US healthcare system has been there for years.

I'm not trying to cast gloom and doom prophecies here, but I also have been talking to health care finance analysts and the future for health care in the US is looking even worse than it appears right now.

Docs are pulling out of hospitals and are opening "clinics" and surgi-centers in profitable (read affluent) areas. In-patient care is soon gonna be even MORE of a "pay as you go" thing because those same surgi-centers are taking money away from hospitals--who will then become even MORE draconian in collections and billing.

Access to money is gonna become the biggest factor in hospital management in the next ten years unless we change the system. The only way it will change is if we make enough noise about it, thus I'm out here beating the drum.

We are on the same side, I think.



Laura

within days so he could be treated. People who can't pay are turned away for treatment every day in this country. We must have universal health care.

story like that one? I have seen MANY fund raisers for families of children in need of treatment. And then there are those who do not have the ability to organize fund raisers and their kids just die a slow death, with no one careing. Like someone said an emergency room, yeah, but that is NOT emergency room treatment that is long term treatment. Maybe if they could move to France they could get treatment. The WSJ writes this up as if it does NOT happen in the good old US of A! :grr:

like crazy.

They bought out the community hospital and so no tubal ligations, of course no abortions, they bought out a large clinic and the next day stopped all vasectomies.

The CEO is a beast.

Uninsured patients have to sign a loan with the frigging bank to get care.

Also, hospitals pay for uninsured losses by "cost shifting" mark ups to insureds. While a doc going out on a winter night to the E.R. to treat an uninsured patient may never get paid, for that care or follow up office care, but cannot cost shift.

http://www.nhpf.org/pdfs_bp/BP_PhysicianVolunteerism_3-04.pdf


Corrected for the usual typo's.

I had not seen that paper, and it is something I sent to a few more people who have been working on the health care issue both locally and nationally. Thanks so much for sharing it.

I have never doubted that the Docs DO charity work, nor have I ever really doubted that they would be better off in the long run with a national health care system (commonly known as single payer.)

Think about this: If you are a small businessperson (and many Docs are) would you be willing to take a bit less in fees if you knew you'd actually get paid without having to file a metric ton of paperwork to do it? I think many probably would LOVE to see a reduction of paperwork in return for less headaches (sorry--bad pun.)

We are absolutely screwed here where I live, because 90% of the Docs are affiliated with two major clinics--neither clinic is accepting new medicaid patients... If you are unemployed or have no health insurance you are left to go to the one free clinic that is unable to take on many more than are currently going there. If you have any kind of chronic condition (say High blood pressure) that requires meds and regular monitoring you either let it go or you wait and go to the ER when it gets so out of control you collapse. THEN the bills start adding up...

Docs know this kind of stuff is going on--they know it all over the US. Take a look at this article in the WSJ today. It was a companion piece that ran with the story I linked in the OP:

http://online.wsj.com/article_email/SB113380885158514268-lMyQjAxMDE1MzAzNjgwMDY4Wj.html

Patients Struggling to Manage
Without Their Health Insurance
December 6, 2005

We think of those in need of food and shelter around the holidays. There are others who have unmet healthcare needs.

I have a daily awareness of the widening gap of those who can afford health insurance and those who can't.

The difference between being middle class and being among the working poor is affordable health coverage. For a number of people in my practice, health insurance has become a luxury they can't afford...

Regards!


Laura

Docs are being herded into big corporate entities.

Our large multispeciality clinic went belly up. 60 docs, and they were going bankrupt. Half of the docs left town.

Partly mismanagement, partly because this is a blue collar, semi-rural area which has seen the few small manufacturing industries go to Mexico or China and take good paying jobs with health benefits and workers comp with them, leaving folks either unemployed or working at Wallymart, etc. without much pay and no benefits.

So the metastasizing non-profit bought up the clinic and others around here, now docs are no longer what shrub laughably calls, "entrepreneurs"- the docs have virtually no say in their own practice as hired employees of corporate America.

A few mavericks can buck the system here in town, but with this new corporate behemoth practice I am not sure how much charity the big clinic docs will be allowed, because scheduling is done centrally and people are screened per St. Misery's guidelines, before the doc ever sees them.

In general, most physicians would welcome a fair system of health care, one payer with less paper work, and equitable income and reasonable working hours.

Doctors are by nature and training independent, and must be confident in solving problems on their own as individuals. Taking such personalities and herding them into these large group practices instead of leaving smaller offices in place and helping them thrive will not be good for medicine. You don't want a doc with a 9 to 4 mentality. But, rather than solving the plight of solo docs, health care like agri-business has become corporate. Now, patients will be centrally screened and the non-for profit will play hard ball with the uninsured patients, no pays will be turned away, and men and women now have no reproductive choice, as even vasectomies are verboten.

BTW- as a maverick, this bluedawg still sees uninsureds, and still spends 30 to 60 minutes with each person. But then, old dogs have their ways.

Good thread, thought provoking.

regards-
bluedoggy


more typo corrections *sigh*

I guess they are communist in name only. This is very sad. It's too bad that one of our faith based charities couldn't get up the air fare to bring the kid and his family to St. Judes hospital for treatment. They don't turn any kids away regardless of their economic circumstances from what I hear.

As did Russia. The quality varied, but they did get care.

Now they have the freedom to die for lack of money.

By the way, I'm surprised that no one has yet brought up our recent experience with Andy Stephenson, who needed to raise $50,000 up front to get possibly life-saving surgery.

thus ruining the quality of life for middle class America, while, apparently doing nothing in the "colonies."

I am starting to understand what colonialism meant.

I figured that on an average reported income in 2004 of about $190,000/year pretaxes and then the average hours worked per week being 60 hours.

That comes out to $30./hour, that's $35./hour less than my plumber charges me.