I grew up in China - these are the difference and similarities between British and Chinese healthcare systems

The healthcare systems in the UK and China, though vastly different in structure and funding, face strikingly similar challenges in ensuring timely access to medical care. 

In the UK, NHS is struggling with growing waiting lists, leaving patients waiting months, if not years, for essential treatments. Meanwhile, in China, ticket touts are exploiting those in urgent need of care by selling hospital appointment slots at exorbitant prices.

Growing Waiting Lists and Staff Shortages in NHS

Long waits for treatment in the UK are not new. The latest report from the British Medical Association shows that as of April 2024, the waiting list includes 7,572,563 people, with about 6,327,245 patients awaiting treatment in England.

Moreover, about 3.16 million patients have been waiting over 18 weeks. The 18-week commitment in the NHS Constitution aims to ensure timely treatment for every patient, but this target hasn't been met since 2015. Shockingly, over 302,600 patients have been waiting more than a year for treatment.

The NHS is also facing a staffing crisis. In September 2023, the overall NHS vacancy rate was 8.4%, significantly higher than the UK average of 3.4% in 2022/23. Retaining staff is another challenge, with 10.7% (154,000) leaving their NHS roles in the year ending September 2023. 

Meanwhile, World Health Organization data highlights a notable disparity in physician density between the UK and China. In the UK, the density of physicians was 32 per 10,000 population in 2022. In contrast, China's physician density was 25 per 10,000 population in 2021. If the UK, with its relatively higher number of doctors, is struggling with long waiting lists, we can easily imagine how much more challenging the situation is in China.

Overcrowded hospitals in China

Unlike the UK's National Health Service (NHS), where patients must first see a general practitioner (GP) before being referred to a specialist, China allows patients to choose their healthcare providers freely. While this flexibility seems advantageous, it has led to severe consequences that strain the system. 

China's healthcare system is organised into three tiers: primary hospitals, generally referred to as community healthcare centres; secondary hospitals, which are typically at the county levels; and tertiary hospitals, which are usually at the municipal level and above. Many people would bypass primary care and go straight to top-tier hospitals, as top-tier hospitals have more resources, including advanced equipment and highly skilled specialists. This causes overcrowded urban hospitals and long wait times. 

Although the government has been working for years to implement the Hierarchical Medical System (HMS), aimed at streamlining patient care and optimizing resources, it is facing significant challenges. Under this system, patients are encouraged to voluntarily seek basic care at primary hospitals to reserve tertiary hospitals, which are equipped to handle severe and complicated conditions, for those with serious diseases.

However, due to the drastic variation in the quality of care between top-tier urban hospitals and smaller rural facilities, the proportion of visits to primary healthcare centres continues to decline year on year, leaving large public hospitals increasingly overcrowded.

For example, Beijing, one of China's major urban centres, has the highest number of tertiary hospitals in the country. According to a WHO report, while Lhasa in Tibet has only three top-tier hospitals, Beijing boasts 81. The Beijing Municipal Health Commission reported that in 2023, the city's medical institutions saw a total of 2.90881 billion patient visits, averaging about 7.97 million visits per day. This marks an increase of 598.57 million visits from the previous year. 

We can imagine from these figures how Beijing's major hospitals are frequently overwhelmed by the sheer volume of patients, leading to long wait times for appointments and treatments.

The rise of ticket touts

In China, patients can theoretically book a doctor's appointment through online systems. However, the reality is far more frustrating. Many people find that even if they attempt to book the moment appointments are released, they often encounter a system that crashes almost immediately. The system typically stays down for about ten minutes, and by the time they manage to re-enter, all slots are taken. 

Aside from the high demand from patients, another leading cause of this phenomenon is ticket touts. Some of these touts use homemade robocall software to hack into hospital registration systems, grabbing and hoarding appointment slots. Others claim to have connections within hospitals that allow them to secure extra slots.

As a result, they exploit desperate patients by reselling these slots at exorbitant prices, further complicating access to essential medical care. 

Ticket touts guarantee a slot but normally demand payment upfront. Many people have reported being scammed, with touts failing to book the desired appointment or any appointment at all, and then refusing to issue refunds. 

The fees for booking a doctor's appointment directly from the hospital range from £5 to £10, depending on the doctor's level. However, ticket touts normally charge exorbitant 'service fees' of £100 to £200. For a slot with a senior expert, the fee can even reach £2,000.

However, despite the risks of scams and higher prices, with official channels often crashing under the weight of demand and the anxiety of long wait times mounting, a strange phenomenon has emerged: many people are still seeking out so-called "reliable ticket touts" on Chinese social media.

While any form of ticket touting violates the Chinese Public Security Punishment Law, the criteria for enforcement are stringent and rarely met. Currently, there are no regulations explicitly addressing ticket touts, nor specific legal provisions deeming the practice unreasonable.

This legal grey area allows ticket touts to exploit desperate patients without facing significant legal repercussions. As a result, the practice continues to thrive, exacerbating the challenges patients face in securing timely medical appointments and further straining an already overburdened healthcare system. 

Ultimately, it all comes down to an insufficient healthcare system. If people could access healthcare when they needed it, the "ticket tout" industry wouldn't exist. If the NHS had more staff, the waiting lists might not be so long. Addressing these issues is crucial to providing the healthcare that everyone deserves. Both countries need better resource allocation, more staffing, and stricter regulations to ensure timely and equitable healthcare access for all.