Is China ready for private healthcare?

Shanghai, China – If there’s one thing that China’s overstretched and under-resourced state healthcare system provides without fail, it’s a rich seam of worrying anecdotes.

Liu from Suzhou remembers how he once waited several days to see a doctor at his local hospital, and was still unsuccessful.

“Eventually someone I knew helped to arrange a meeting with a doctor in that hospital for me. But even though I had the connection, I still could just stay in hallways in the hospital and could not get a bed,” says Liu, who asked to be identified only by his surname.

Yet despite such experiences, the 46-year-old father of two refuses to entertain the idea of seeking out private healthcare facilities. And his reasons aren’t purely financial.

The McKinsey Patient & Physician Survey 2012 confirmed about 30 percent of China’s urban population currently possess some kind of private health insurance, while another 20 percent are planning to buy some in the near future.

But many Chinese people still prefer to wait for hours in a highly regarded state hospital to spend five minutes with a trusted physician, rather than risk their luck at a private clinic.

“The private hospitals have worse facilities than state-run hospitals. Doctors are not as highly skilled as those in state-run hospitals,” Liu says. His attitude is not uncommon.

According to Joshua Kurtzig, director of special projects at United Family Healthcare, part of the Chindex group, while the private sector serves an increasingly important role in China’s healthcare industry, it doesn’t have the best reputation among consumers.

“Early players in private healthcare often focused on volume over quality, and that led to the perception that private healthcare might not be as good as the public system. That perception is now starting to change, but it has taken a long time.”

Yet signs suggest attitudes are starting to change, at least among the younger generation.

A ‘cultural change’?

American healthcare company Chindex, which specialises in general hospitals offering integrated care in China, has added more than $40m to its balance sheet in the past three years.

According to Kurtzig, demand reflects the “beginnings of a cultural change”.

“There’s such huge demand among the younger, upper middle-class demographic that we’re expanding quickly. In particular, there’s growing demand for primary-care services, and even secondary and tertiary care that can be hard to access in the state system.”

Kurtzig points out that in the past, the vast majority of his customers were foreign. But by 2013, United Family Health had reached an equal split between Chinese and foreign customers.

Moreover, as incomes rise, the higher costs in comparison to state services – with many procedures costing 10 times as much – are slowly becoming less of an issue.

“We’re starting to open hospitals in second-tier cities, as we see the rise of the middle class and the strength of their spending power,” says Kurtzig.

At present, United Family serves just a fraction of the population. But, as long ago as 2007, the government signalled its desire to see the private sector play a significant role in reforming the healthcare industry, and tackling the endemic shortage of provisions.

China now provides the funds for basic medical coverage to 97 percent of it population, according to accounting firm PriceWaterhouseCooper’s 2013 report, Investing in China’s private healthcare system. It also decreased  individuals’ share of out-of-pocket payments for healthcare services from 60 percent of total costs in 2001 to 35 percent in 2011.

Now there is a need to tackle the chronic lack of hospitals and clinics to deliver these services.

Just this month, the government announced that seven private hospitals, solely owned by foreign investors, could open in seven cities and provinces in China.

Increased awareness

Benjamin Shobert, founder and managing director of Rubicon Strategy Group, says Chinese people have a more sophisticated understanding of how to best manage their own health than they have been given credit for.

“Not only do they have a history of having to pay for almost all of their healthcare costs out of pocket, but we’re seeing a middle class that’s starting to ask different questions about what it means to be healthy. There’s more desire to access preventative healthcare and ask what primary care is on an efficient basis, rather than an emergency basis,” says Shobert.

Many Chinese prefer to wait hours at a highly regarded state hospital, rather than in a private clinic [AP]

As urban Chinese begin to change their habits, preventative healthcare company iKang has reported revenue growth from $68.23m in 2011 to $202.3m in 2014.

Zhang, a 23-year-old female postgraduate student from Shenzhen, says her family benefits from annual checkups arranged by her parents’ companies – precisely the kind of service iKang provides.

She uses mobile health products to inform her of healthcare choices.

“My friend and I both downloaded a health app and we compete with each other to see who did more exercise within a week,” says Zhang, who also asked to be identified by her surname only.

On the surface, younger peoples’ attitudes towards health services appear to be transparently more pragmatic, critical and market orientated.

Little faith

Fang, a 22-year-old female postgraduate student from Suzhou, has little faith in the state healthcare system.

“I don’t feel secure when I am in a hospital. Once I had some problem with my left ear. I went to a hospital and the doctor prescribed some expensive medicine to treat the problem. After I took the pills, I felt dizzy and discontinued them. Then I went to another hospital and they examined me. The doctor told me that my ears and nose are perfectly fine.”

Fang, who also asked to be quoted with one name, said if private hospitals were “better and trustworthy”, she would use them instead.

However, no matter what the person’s attitude, the cost of private healthcare is the ultimate key to getting the Chinese consumer to go private.

Although the Chinese are used to topping up the state’s financial contribution to services with their own money, they still prefer to take advantage of government subsidised services – traditionally only available in public hospitals.

However, foreign-invested private hospitals have started to find ways around this problem.

Healthcare provider Columbia China, which already has 25 hospitals across Southeast Asia, has plans for two general community hospitals in Wuxi and Changzhou, to be completed in four years’ time.

According to Bee Lan Tan, president and group CEO, these hospitals are definitely not only for rich expats or the Chinese elite. “We want to provide basic healthcare to the community, that’s always been our approach.”

Both hospitals will have 300-500 beds, offer general services to an “upscale domestic and expat population”, with the Changzhou site incorporating services for seniors. 

However, the most significant aspect is these hospitals are not just aimed at servicing the needs of an increasingly wealthy middle class, but also to bolster China’s healthcare infrastructure. The hospitals will accept state-insured patients, and both intend to employ the best doctors from the state sector and provide them with state-of-the-art medical equipment.

“In China, private healthcare is not as popular as in Western countries. But we have a group of top physicians who work in the public sector, but are looking for a platform out of the public system to see more patients and focus on patient care,” Bee says.

Such an approach could be the change that’s needed to transform the market for private healthcare in China.

Follow Sarah O’Meara on Twitter: @sarahomeara