TCM

Western medicines are making China's ancient medical practices increasingly redundant, but their high price tag is also pushing millions further into poverty. The proportion of Chinese using Traditional Chinese Medicine in the formal medical sector fell from 25 per cent in 1991 to 14 per cent in 2004, according to a survey published in Social Science and Medicine last July. A century ago there were 800,000 practitioners of traditional medicine in China, but the numbers have steadily fallen. In 1999, the Government introduced licensing for practitioners and the number dropped to 200,000.

Western medicine comes with a Western price tag and high health costs are forcing increasing numbers of poorer workers into poverty, amounting to 2-3 per cent of the population every year. Between 1993 and 2003 costs rose six times for out-patients and four times for in-patients. Patients in hospital still check their bills daily and, if their money is running out, discharge themselves early.
China is a nation hooked on the idea that any illness can be cured with the right drugs – and the bigger the dose the better.a young man with his eyes closed, wearing a blue face mask, is also being treated with intravenous antibiotics for a cold. In the West such treatment would never be countenanced – colds are caused by viruses and antibiotics, which tackle bacteria, are regarded as rarely necessary. Moreover, intravenous administration of drugs is reserved for the most seriously ill patients.

Donald Li, a Hong Kong GP and adviser to the Shanghai government, says Chinese patients are sceptical of the value of advice given by doctors, but place great faith in the power of medicinal drugs."The belief is that there is a therapeutic value from the drug, but no value in telling me what I should do. Injections and intravenous treatment are liked. This is a culture that seeks intravenous treatment," he says.

But economics plays a part, too. Charges levied by hospitals are set deliberately low by local councils, often too low to cover the cost of the service. Hospitals have to make up the difference in the cost of drugs and diagnostic tests which are not controlled. They charge heavily for them – and encourage patients to have more. The situation is aggravated by doctors' poor rates of pay. They depend on bonuses paid by hospitals from the income generated by drugs and tests. All the incentives in the system are thus aligned, but towards the wrong objectives."There is over-diagnosis, over-treatment and bad practice," said Professor Li. "It all comes back to doctors' low salaries. If they were properly paid they wouldn't need to do these things."