Health Care Rises in the East
Posh Private Clinics Crop Up
In China, Filling Demand
For Western-Style Services
BEIJING -- A wealthy senior partner at a big law firm here says he barely blinked at spending $70,000 on an imported BMW and more than $12,000 on a gold Jaeger-LeCoultre watch.
But last year when the attorney, Mr. Zhuang, was suffering from migraine headaches, he had to brave long lines and brusque service to see a doctor at a state-run hospital. The cost? Six dollars.
Mr. Zhuang, who declined to give his first name because of concerns about notoriety, would have jumped at the chance to pay a lot more for medical care that was more convenient and more comfortable. So late last year he did: He signed up for a private health program offered by Beijing Universal Medical Assistance Co., a unit of China Healthcare Holdings of Hong Kong. Now, he pays an annual fee of $3,700 and in return gets regular checkups, appointments with private physicians and, when necessary, access to some of the country's best hospitals -- all extraordinary luxuries compared with what is available to most people in China.
Many inpatients stay in swank rooms at the private Beijing United Family Hospital.
Crowded, dingy rooms and hasty exams at state hospitals were once the only option for rich, poor and middle-class patients alike in China. But now, private health care is starting to gain a toehold here, available to those wealthy enough to afford membership programs and high fees at for-profit clinics and hospitals.
"A growing number of well-to-do Chinese want international-standard health care and are prepared to pay handsomely for it," says Roberta Lipson, chief executive of Chindex International Inc., a Bethesda, Md., company that operates two swank, immaculate hospitals, in Beijing and Shanghai, under a joint venture with the Chinese government. Chindex's Beijing United Family Hospital, which opened in 1997 to serve the expanding population of expatriates, derives more than a third of its $22 million in annual revenue from Chinese patients, Ms. Lipson says.
For the most part, private clinics and hospitals don't yet offer big-ticket procedures, such as heart surgery or cancer treatment. For these, even wealthy patients continue to rely on state hospitals. Beijing United, for example, has only 50 beds and refers candidates for brain and heart surgery to local state-run hospitals.
But when it comes to primary health care, the state hospitals can't compete with private providers for wealthy patients. "The basic medical services cannot satisfy the needs of the rich people," says Steve Chen, a 35-year-old Beijing lawyer who says he earned about $250,000 last year. He recently signed up for a Beijing Universal Medical Assistance program offering him and his family primary medical care at an annual cost of around $12,400.
RELATED ARTICLE
? More Chinese Treat Their Aches and Pains at Drugstores
"The demand is there," says Robert W. Pollard, director in China for the health-care arm of Synovate, a global market-research firm.
China's health-care system once was a standout in a sea of communist failures, delivering basic, near-universal care. But today, its state-run hospitals are ill-equipped to deliver the kind of private, convenient primary care that patients in the West take for granted.
On a recent afternoon at Peking Union Medical College Hospital, one of Beijing's best-known state hospitals, hundreds of people waited in a tangle of long lines, maneuvering around a woman lying motionless on a stretcher on the floor. A sign on a wall listed prices: one yuan (12 cents) to see a regular doctor, 10 yuan for a specialist.
Appointments at state hospitals are rare. It isn't uncommon for wealthy patients to have assistants or drivers camp out overnight for a good spot in line.
In contrast, Mr. Zhuang recently headed to a medical appointment at a posh Beijing clinic outfitted with faux French paintings, a giant flat-screen TV set and a miniature waterfall. "I need to stay healthy to make more money," he says. At such high-end facilities, patients sometimes pay with bags of cash.
The view outside the private Beijing United Family Hospital.
For Western companies, the barriers to entering the Chinese health-care market are considerable. Foreign investors may own as much as a 70% stake in a Chinese hospital, but they have to navigate a maze of regulatory obstacles before breaking ground on a new facility. Only 11% of China's 12,902 general hospitals are run for profit, and the vast majority of these operate under government-imposed price caps with local Chinese owners and without foreign investment.
But as Beijing relaxes investment restrictions, opportunities for private providers could multiply. Total health-care expenditures in China exceeded $80 billion in 2003, according to the Ministry of Health. Out-of-pocket payments by individuals are a growing portion.
Cindy He, a 34-year-old manager at the Beijing office of a U.S. company she declined to name, is a client of China's new high-end providers. She came of age in the aftermath of the Cultural Revolution in Xi'an, where her mother worked in state-run factories. Now, Ms. He reads Vogue and spends $100 for a perm.
She recalls the time she got a fish bone stuck in her throat and paid a doctor at a state hospital a little more than a dollar to get it out. Two years ago, when she found tiny spots along her jaw line, she had to wait all morning to see a doctor -- only to discover, upon entering the examination room, that the session would take place in front of other patients.
So Ms. He decided to try Beijing United Family Hospital, even though the cost of a doctor's visit would be more than 50 times that at a state-run hospital. "It's not just that I can afford it," Ms. He says. "There's something intangible. It's a bit about the status." On a recent dentist visit at the hospital, she bumped into a Chinese pop star.
Suning Fang is married to an investment banker at Goldman Sachs Group and pays $18,000 a year to send her 5-year-old son, Wesley, to kindergarten. She recently took him to a private hospital to be circumcised and have his tonsils removed. The bill came to more than $7,000 -- a significant sum, even for someone of her means. She paid with a credit card.
But when she discovered a lump in her breast and required surgery, she checked into a state hospital. "It's fine for me," Ms. Fang says. "But for my son, no way. I don't care how much it costs."
中国私立医疗机构风头正劲
作为一家大律师事务所的高级合伙人，庄先生说，他可以很轻松地花7万美元买一辆进口宝马(BMW)车，或12,000多美元买块Jaeger-LeCoultre金表。但去年，当这位律师患上偏头痛时，他却不得不排著长队，忍受著粗暴的服务，到国营医院去看病。而费用仅仅是6美元。
因为是有钱人，庄先生没有透露他的全名。他说宁愿多花点钱，也希望享受到方便舒适的医疗服务。去年底，他终于如愿以偿了：他申请了中国卫生控股有限公司(China HealthCare Holdings Ltd.)的子公司北京环球医疗救援有限责任公司(Beijing Universal Medical Assistance Co., 简称：环球医疗)的私人医疗保健计划。现在，它每年支付3,700美元的年费，就能获得定期检查、预约私人医生，并可在必要时方便进入中国最好的部分医院──同大多数中国人就诊的国营医院相比，这一切都格外豪华。
国营医院中拥挤肮脏的诊室和潦草的检查曾经是中国人的唯一选择，无论对富人、穷人还是中产阶级都是如此。但现在，私立医院和私立诊所开始进入中国，向能够负担得起高额年费的会员提供医疗服务。
美国美中互利工业公司(Chindex International Inc.)首席执行长李碧菁(Roberta Lipson)说，越来越多中国成功人士希望获得国际标准的医疗保健服务，也准备为此付出昂贵的支出。该公司同中国政府合作，在北京和上海经营著两家时髦精致的家庭医院。李碧菁说，美国美中互利工业公司的北京和睦家医院(Beijing United Family Hospital)于1997年开业，主要服务于中国越来越多的外籍人士和归国人员，其2,200万美元的年收入中约有三分之一以上来自于中国患者。
大部分的私立诊所和医院还不能进行心脏手术或癌症治疗等大病的服务。如果患上这种重病，即使是富人也仍要依赖国有医院。比如，北京和睦家医院就仅有50个床位，需要把心脑手术的患者推荐到本地的国营医院。
但在基本医疗保健方面，国有医院就无法同私立医院竞争了。北京律师Steve Chen说，基本医疗服务无法满足富人的需要。他说，他去年的收入约为25万美元。他最近为本人和其家人申请了环球医疗的服务，会员费为每年12,400美元。
全球市场研究机构Synovate旗下医疗子公司驻中国的主管波洛德(Robert W. Pollard)说，市场的需求是确确实实存在的。
中国的医疗保健体制在提供基本医疗服务方面一度表现不俗。但现在，设备陈旧的国营医院难以提供这种西方很普遍的便捷私人基本医疗服务。
近日的一个下午，在北京国营医院之一的北京协和医院(Peking Union Medical College Hospital)，数百人排著长队等在挂号窗口前。墙上的牌子标著价格：普通号1元（0.12美元），专家号10元。
在国营医院预约彷佛是件遥不可及的事。乘坐保时捷车(Porsche)，拎著Prada皮包的患者让他们的司机或助手彻夜在国营医院外排队。
而在某个下午，庄先生来到了预约好了的一家北京私立诊所，房间里面挂著法国油画的仿制品、摆著大屏幕平板电视，还有微型的瀑布。他说：“我需要保持健康的身体，来挣更多的钱。”在这样高级的设施内就诊的病人有时需要成捆地花钱。
希望进入中国私立医疗保健市场的西方公司面临著巨大的壁垒。海外投资者最多可持有中国医院70%的股份，但他们在兴建新设施前必须突破众多监管关卡。中国12,902家普通医院中只有11%是盈利性机构，绝大多数都按照政府制定的价格上限由中国当地所有者经营，没有海外投资。
但随著中国政府放宽海外投资限制，私立医疗机构的机会不断涌现。根据中国卫生部(Ministry of Health)的数据，2003年中国总医疗支出超过800亿美元。其中60%，即480亿美元是个人自费的，而且这一比例还在增加。
美国某公司驻华办事处经理Cindy He今年34岁，是一位典型的中国高端医疗提供商的客户。她回忆起有一次她咽喉卡了鱼刺，到国营医院以稍高于1美元的价格就取出了鱼刺。两年前，当她发现下巴附近出了些小点，结果要等一个上午才能进行检查，并且在进到检查室后才发现，要当著其她患者的面接受检查。
因此，她决定试一下北京和睦家医院，尽管在这里看病的价格是国营医院的50倍以上。Cindy说：“不仅仅是我能承受这个价格，还有一些无形的东西。”在最近到医院看牙医时，她还碰上了一个中国明星。
方苏宁（音译）嫁给了一位高盛集团(Goldman Sachs Group)的投资银行家，她5岁的儿子Wesley每年在幼儿园的费用是18,000美元。最近，她带Wesley到私立医院做了包皮手术，并割除了扁桃体。全部费用是7,000多美元，即使像她这样的人也认为这不是个小数目。
但当她发现乳房有个肿块需要做手术时，她还是选择了国营医院。她说：“对我这就够了，但我儿子不行。对他，我不在乎花多少钱。”
