I spent the morning with a Chinese resident on our team who knows the local system well, and one of the recent foster children and her caregiver getting some tests done.
HX actually got there around 7:15 am to decide which specialist we should see, pick a number (like we do at the post office or immigration bureau) and find us outside at 8:00 just in time for our number to be called.
We went to a huge hospital, that has all manner of departments, specialties, and tests available.
All you need is money.
As we roamed around from the pediatric deparment to CT to EEG to surgery and some more, I was amazed at the rows of ATM machines everywhere.
All major corridors had them lining both sides, and others were strategically located right next to the check in desk for the various departments and services.
And the masses of humanity utilizing the services.
Health care here in China is at its very core different from in the US.
The first difference I already alluded to, which is self-triage.
You, the layperson, decide if you need to see the cardiologist, surgeon, urologist, pulmonologist, oncologist.
That, in fact, is maybe changing in the future as family medicine training gains more of a foothold here.
But for now, you pick ’em.
Secondly , in the States we imagine that we are entitled to see a doctor, demand treatment for an acutely ill person, and get services done.
Quickly, with lots of techs and assistants taking you everywhere.
The financial piece is, well, sometimes vague.
I can remember several times when we got a bill for a service done many months or a year or more ago.
Insurance and third party payers, file this, appeal that, blah blah.
Sometimes we finally paid our share of something so much later we barely remembered what it was for.
Not so here.
You pay, you get seen.
You pay, you get x ray.
You pay, you get admitted into the hospital.
Some of the charges are minimal, like about $1 to see the doctor.
Don’t worry, they get paid in other ways. But more on that another time.
The tests are not always that expensive either, nor the admission, compared to the US.
The difference is that you have to fork over the cash pronto.
Emergency or not, cash first.
The other difference is a lot of the services are, well, self-serve.
To get a CT scan of the head, we had to go to the pharmacy and pay for the syringe and tube containing a mild sedative.
The foster mom and I waited with the kid in the stroller while my colleague went and purchased the stuff, then we handed it to some nurse looking types who did the actual administering (rectally).
The first round went not so well–the activity triggered release of gas and a bowel movement, and all the medicine spilled out on the treatment table.
We had to clean him up while my colleague went to buy another round, and move away while the masses crowded around to have their kids done.
Then we had to carry him down a couple of corridors (not just next door) to the CT place, and line up in the hall for a few minutes until it was our turn.
We were told to come back and pick up the finished CT in 2 hours.
After an EEG done immediately afterwards, in the other building (go out in the rain across the plaza), we went back up to the doctor.
She recommended IV fluids and certain medications.
With the prescription book in hand, my colleague went to another dispensary on that floor and came back with 5 separate bags and vials of fluid and medicines–a bag of sterile water, a bag of glucose, a vial of a liver medication, a vial of antibiotic, and a vial of sodium choride that were apparently going to be mixed by somebody and placed into the child.
Then we took it all to the place where other nurse types sit and place the IV and get it going.
At that point I had to leave to be the “carpool” and pick up 6 kids from school so I missed the rest.
I remember hearing a story about a woman who was going to have a C-section and they began to cut–without anesthesia.
The husband did not realize he was supposed to go and buy his wife’s anesthetics to give to the doctor.
The plus side of this system is that I can march down to my corner pharmacy and buy any oral or injectable antibiotic and treat myself whenever I want for that viral infection, no permission from a doctor needed.