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China implements 10 rules for hospitals

The requirements, published last week (27 November) in the communist party's mouthpiece, the People's Daily, give some indications of the problems besetting a cash strapped medical service that is having to adjust from a socialist to a market driven economy. The 10 rules will at first apply only to 10 of the biggest urban hospitals in China and will gradually be phased in at other medical facilities. These flagship "enlightened service model hospitals" will supposedly be supervised and inspected to ensure compliance.

One of the 10 rules calls for the elimination of the "three longs and one short"--long queues for registration, paying of pharmacy bills, and collection of medicine, but a very short time spent with a doctor for diagnosis. Other edicts ban the over-prescription of medicine for the hospital's profit, the use of "shoddy, bad quality and out of date medicine," and widespread overcharging.

In reality, shortage of money and trained staff will make it difficult even for the 10 relatively well placed hospitals to meet the new targets. Low salaries for doctors and inadequate state funding mean that China's hospitals are often more concerned about raising revenues than improving health care. Free medical care is a thing of the past in China, and patients these days find themselves subject to a bewildering array of bills covering doctors' fees, registration, medicine, heating, and electricity, as well as the expected under the table bribes to medical staff to secure proper service.

Delays are a major impediment to proper care. The fifth of the 10 rules states that treatment must start within five minutes of an emergency case reaching the hospital. Doctors who are called to attend an emergency case "must be present within 20 minutes," says another requirement."

As always in China, there is likely to be a large gap between intention and reality. Last week's report called on patients at the 10 named hospitals to lodge any complaints with the Ministry of Public Health's "rectification of incorrect work style" office and provided a telephone number to call. Two days later nobody was answering the telephone.--RICHARD TOMLINSON, medical journalist, Peking

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