Wednesday, April 11, 2012

The good midwife of Sichuan

Private health providers, won’t make a killing
By The economist

The scene at the women’s and children’s hospital in Chengdu could be in any well-appointed modern maternity unit. Doting fathers stare at newborns dozing on crisp bedding as masked cleaners keep the corridors spotless. The Angel hospital in Sichuan’s capital is part of a wave of privately owned hospitals, catering to patients fleeing crowded state clinics.

The patients here are well-off locals, paying from 20,000 yuan ($3,200) for a Caesarean delivery and the latest drugs. Rooms cost extra, including suites for families to host postnatal banquets.

The roots of private health care in Communist China go back to clinics that treated venereal disease. In other respects, the taint of private care has gone, and foreign investment is encouraged. Over 30 joint ventures have been approved; many more are in the pipeline. The country’s new five-year plan endorses private-sector investors as part of the solution to the country’s shortage of affordable health care. Health spending has soared in recent years and is set to top 700 billion yuan by 2015.

The authorities also think the private sector can serve as a model for public hospitals dogged by poor administration, demands for patients to pay cash up front, and bribes by pharmaceutical companies to prescribe their drugs. Liu Shuyan, the Angel’s chief doctor, talks of “patient pathways” and “mother-centred care”: the kind of jargon that accompanied the drive for health reform in Britain a decade ago.

Political sensitivities meant private care began only slowly in China. An early crop of joint-venture hospitals sprouted at the start of the 1990s. But the number of beds was restricted, and pioneers such as Chindex International (whose chief executive is the wife of one of The Economist’s Beijing correspondents) served mainly expat patients. Now, two-fifths of Chindex patients are Chinese.

The new openness to private care is attracting fresh interest. An American group, CHC Healthcare, holds the controlling stake in a general hospital being built in Cixi in coastal Zhejiang province. Tim Perry, its legal adviser, is not taken by the new commitment to allow full foreign ownership. Better, he thinks, to have the assurance of a trusted Chinese partner holding a minority stake.

Local authorities hold sway over how joint ventures fare. For instance, state-insurance payments for treatments are modest, though being knitted into the Chinese system of payments can give operators greater stability. John Porter, who runs SinoCare, with four hospitals in China, has just been allowed to expand his hospital in Chengdu’s high-tech belt to 500 beds. He says the authorities are keen on outside providers, if profit margins are not excessive (ie, about half those in the West).

Opportunities for scale can compensate for such irritations. The population over 65 will rise by 8m a year for the next five years, so nursing homes will become an increasingly tempting business. For all the constraints, China looks set for a larger dose of healthful capitalism.

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