China Healthcare: Local vs International Healthcare

Tell expat friends that you use local, rather than expat-orientated hospitals in Shanghai, and you’ll raise a few eyebrows. Actually use local healthcare, and you’ll risk more than public embarrassment, you’ll risk your health too.

At least, that’s a popular opinion, but is it true? I recently got attacked by a case of conjunctivitis so severe it forced me into almost every kind of clinic the city offers. Here’s what I found out.

Queues and crowds

Local:
I visited the Renji Hospital in Huangpu district on a Monday lunchtime. The hospital was about as busy as line 2 on the subway at the same time.

If you speak Chinese, or are with someone who does, the process is quite simple. Pick up a patient record book from one counter, pay 16 RMB at another, and head off to the relevant department. No appointment necessary.

Myself and my blazing red eye were sent to the ophthalmology department. An unsmiling woman in a hairnet ignored me for thirty seconds before sending me to sit on the edge of a bench; every few minutes, we shuffled up the bench, one seat closer to the doctor’s room.

‘Conjunctivitis,’ said the doctor, after a brusque examination. ‘I’ll give you two drops and an eye cream. Be careful not to give the infection to other people. Come back in a week if it’s not better.’

I left quickly, and the next patient shuffled off the bench into the doctor’s room.

International:
If you’ve been to an international clinic in Shanghai, you’ll know to expect a clean waiting room with one or two other patients at most. The receptionist will welcome you in English and you’ll be escorted to a courteous doctor within minutes. You’ll need to make an appointment, though.

When my single red eye had become two red eyes, and walking out into sunlight a shock so severe I had to hold onto a door for twenty seconds before the darkness abated, I made an appointment with an eye specialist at a well-known clinic.

I left his office knowing more about the eye (and what had happened to mine) than when I went in. He handed me his card as I left. ‘Let me know if you have any questions, you can send me a short message.’

Treatment in translation

Local:
Not much English was spoken during my appointment at Renji Hospital (the doctor said ‘look down,’ and ‘look up’ while examining my eyes).

To make matters more unintelligible, the doctor was an older Shanghainese man with thickly accented Mandarin. ‘You didn’t bring anyone to interpret,’ he admonished me. It might have been a good idea.

International:
It’s not just the lifting of the language barrier that makes interactions at expat clinics easier. Without a benchful of anxious patients sniffling outside, doctors are less stressed and have more time ( which is why I got to learn about the various kinds of conjunctivitis, over a relaxed twenty minute period). No matter how good your Chinese is, if you need information, and not just a quick prescription, you need a clinic where the doctors have time to talk to you.

Diagnosed and disorderly

Local:
If you’ve read the many news stories about patients attacking doctors you won’t be surprised to see the security guards that stand on watch at local hospitals.

The presence of security guards didn’t stop me seeing an altercation between two sets of patients waiting to pick up their medicine at the Renji Hospital. It was a loud dispute, with plenty of finger pointing and zero violence. One of the security guards ambled over to watch, but despite all the posturing, nothing happened in the end.

Chinese medical personnel protest against patient-doctor violence

International:
At an international clinic, I watched a man who might have been overseas Chinese switch between English and Mandarin as he threatened the staff.

‘I will sue you, and your doctor,’ he said, stabbing the air with his finger.

It was hard to work out why he was so angry, but it had something to do with the treatment of his baby; hospitals are places where emotions run high, and where every day is a battle for life and death, so it’s no surprise that disputes sometimes escalate.

Overall

Local
Local hospitals aren’t the place to go for emergencies. For important health issues, why wouldn’t you choose the best and fastest care available?

For minor complaints, if your health insurance doesn’t cover outpatient services, a local hospital may sometimes be enough. Go at off-peak times and make sure someone in your party speaks Mandarin.

As local hospitals are more crowded, there’s more chance of infections being spread from patient to patient.

International
The standard of care at international hospitals and clinics is generally excellent.

No language barriers and a familiar style of treatment are comforting when you’re sick.

Costs are high at Shanghai’s top clinics and hospitals, which is all the more reason to get a decent insurance package.