July 2005 - The Hong Kong College of Anaesthesiologists

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Bull HK Coll Anaesthesiol Volume 14, Number 2 July, 2005Featured articleOutside Qualified Anaesthesiologists Working In China (1)1Anne KwanDepartment of Anaesthesia, United Christian Hospital, Hong Kong Special Administrative RegionBull HK Coll Anaesthesiol 2005;14:67‐70After 1997, it has become a reality or evennecessity for the medical professionalqualified in Hong Kong to engage inclinical work in China. The healthcaredevelopment in Hong Kong has followed theBritish system closely and a lot of adjustmentsare required for the Hong Kong trained doctorsto practice in Mainland. The differences inhealth care are the result of the unique nature ofthe political system in China, the vastness of thecountry, the extremes of wealth distribution andthe language medium in teaching and day today communication.Despite the introduction of Closer EconomicPartnership Arrangement (CEPA), medicalprofessionals qualified in Hong Kong are notgranted with recognition and full registrationwith the relevant medical bodies in China.However, it is still possible to perform clinicalwork in there by having limited registration.The registration can be arranged by a receivingunit. The unit which is usually a hospital or theRed Cross, after vetting the qualifications of thedoctor then issues a letter of invitation. Theletter of invitation would specify the name of theinvitee, nature of the work and the period. Mostof the work is on a voluntary basis as the pay of1MB BS, FANZCA, FHKCA, Dip Pal Med, Dip PainMgt (HKCA) FHKAM (Anaesthesiology), Dip Epi &Biostat, Dip Acup, M Pal Care, Consultant and Chiefof Service. Department of Anaesthesia United ChristianHospital.Address correspondence to: Dr Anne Kwan,Department of Anaesthesia, United ChristianHospital, 130 Hip Wo Street, Kowloon. E‐mail:askkwan@yahoo.com.hka doctor in China is still not attractive ascompared to that in Hong Kong. Before onecommences work, it is sensible to obtain medicalprotection cover for clinical malpractice. Thecover can usually be arranged by theindividual’s own medical protectionorganization such as the Medical Defense Unionor the Medical Protection Society before leavingHong Kong. If the duration is not too long, theadditional cover is usually provided free as partof one’s existing insurance package.Despite Putonghua being the official spokenlanguage, it is likely that one would come acrossmany local dialects and communication can be areal problem even if you are proficient inPutonghua. The official written language issimplified Chinese characters. It is not unusualfor the local to look puzzled when traditionalChinese characters are used. The staff at themajor teaching hospitals in the big cities wouldknow English but on the other hand having aninterpreter around could be helpful. It is also agood idea to learn about the hospital one isgoing to work in. Apart from the physicalenvironment, it is important to know thequalification and experience of the staff. Theinformation on availability and charge of themedical equipment, drugs and blood and/orproducts are also helpful for one to get to knowthe system quickly.Although most parts of China are still ratherslow and under developed, rapid progress isbeing made in improving the living standards ofher people. The improvement in the health caresector is noticeable but the downside is that ofhigh health care cost. Health care service inChina is not free. Patients are paying an67
Bull HK Coll Anaesthesiol Volume 14, Number 2 July, 2005escalating fee for the service. In order to avoidpayment defaults, a deposit of substantialamount is required on admission to the hospital,including emergency admissions. The cost iscalculated on the number of days stay, the typeof hospital ward, the use of drugs and otherequipment, the number of investigationprocedures and nature of operation. The totalcost can mount up to an astronomical amount.Some patients actually opt not to be treatedbecause of the high and unaffordable cost.My interpretation of the Chinese medicalsystem may not reflect the places I have notbeen to as China is obviously a vast countrywith varying health care set ups and clinicalpractices. I would like to also mention that thereare a few anaesthesiologists in Hong Kong, whogo up to China to observe, work, and help withthe training of local specialists for short periodsof time on a regular basis like me. Although thehospitals we went to might be similar, we mighthave slightly different experience and interpretour experience in a different manner. I wouldlike to further point out that most of thehospitals I worked in were in the Henanprovince. Henan province is the second largestprovince in China and it has a population of 100million. Before I go on to share my limitedexperience of my clinical practice in China, Iwould like to briefly explain the few uniquesystems in there. China has unique setup for thehospital system, the training of specialists, andthe billing of patients. Also, one must appreciatethe special Chinese social culture in order tomake your work and stay more enjoyable there.The hospital systemThere are different types of hospitals in China.Although the hospitals are not classified intopublic and private hospitals as such, they are allessentially private hospitals as all patients arebilled for the health care services they receive.All the services are itemized and I would furtherexplain how billing is done in the other sectionof this article.Generally, there are two types of hospitals,the Western medicine hospitals and the Chinesemedicine hospitals. However, it is notuncommon to have a department of Chinesemedicine in the western medicine hospitals andvice versa. Some of the pharmacy departmentshave two divisions, namely the western drugdivision and the Chinese herbal division. If onewonders around the hospitals, be it named aswestern or Chinese medicine hospital, one canfollow the smell of herbs and find clay pots withherbs on the hot stoves. Some hospitals offerhigh tech herbal medicine dispensing bypreparing the herbs in electrically heated urnsfor the patients before hand and have themdistributed in plastic containers to take home forconsumption.The other naming system one often finds isthe use of names such as people’s hospital,military hospital, factory hospital, unionhospital and Red Cross hospital. All thesehospitals are public hospitals (or should we callthem private hospitals). The names reflect theassociation of the hospitals with the foundingorganizations. The association could have beenbroken some years back and the name remains.Hospitals called by the name of the city thenfollowed by a number (first, second or third etc.)are hospitals built by the government or theywere renamed after the culture revolution. Somehospitals are run by the locals with a team ofmedical experts from overseas and they arereferred as the collaboration hospitals.The clinical classification of the hospitals ismost easily understood by the ABCcategorization. All hospitals are categorized intoone of the followings: AAA, AAB, AAC, ABB,ABC, ACC, BBB, BBC, BCC, or CCC. “A”denotes the best in its class and “C” the lowestlevel. A major teaching hospital must be anAAA institution and a local small hospital withonly a few run down clinics would be a CCChealth care centre. The hospitals have to meetthe performance targets before they are grantedthe level of competence they claimed. Inspectionis carried out periodically to see if the criteriaare met. Some of the criteria the authority looksfor are the provision of accident and emergencyservice, cardiovascular surgery andneurosurgery. Other criteria are the processionof hardware such as all sorts of endoscopies, CT68
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July 2005 - The Hong Kong College of Anaesthesiologists

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