Why can’t we have this in the USA?
I saw four doctors today in Shanghai.
Not because I’m sick, but as I’m leaving China to move back to the USA next month, I needed a couple annual exams, a few follow-ups, and to get final advice and prescriptions for a variety of things. I’ve been here 15 years so I have lots of medical things to organize, and I dread finding new doctors in the US, mostly because medical care is so good and easy here.
Earlier this week I simply scheduled all these appointments for the same day, at the same clinic. Sometimes it’s hard to get appointments the day I want, but it’s almost always possible to schedule them within a week of when I want to be seen. This is true for nearly any specialty, from cardiologists to pediatricians to dermatologists, even neurologists.
I hear it’s not as easy to schedule appointments in the USA — not by a longshot. A couple years ago, when I needed a follow-up appointment with an eye doctor in San Francisco, I was told they had a slot in two months. In Shanghai, two weeks would be annoying.
Big City Medicine
Shanghai is a big city of 25 million people, with an extensive medical industry. Within this industry, a niche market caters especially to the 150,000+ foreigners here, plus to well-heeled Chinese. Typical Chinese citizens usually can’t afford these facilities — and local government-run insurance programs won’t pay the higher rates these niche places charge.
When I moved here, there some hybrid facilities plus a single foreign hospital and small network of these upper-class clinics. This has blossomed into many hospitals (and wings of hospitals), numerous clinics, and other services focused on this wealthier market. Though medical facilities vary in quality, there are now a lot of them, in every part of town.
The result of this growth and competition is high-quality medicine, technology, and services available whenever people need them, as should be the case. I understand many places in Europe are similar, with easy-to-make appointments. But, alas, it’s not so easy in the USA.
Electronic medical records (EMR) are standard here, even at very local Chinese hospitals serving thousands of people per day. Everything is fully computerized with same-day digital lab results are emailed to patients. We’re lucky that the Chinese medical system has no legacy systems nor old technology to deal with — they went straight from paper to modern EMRs. The USA transition is ongoing and much more painful.
Did I mention many of my appointments last 30 minutes to an hour? There’s no such thing as a 15-minute appointment slot here in Shanghai, and there’s always enough time to discuss any given issue — a luxury given how overloaded and short-of-time US doctors seem to be. And frankly, doctors and patients often need ample time to discuss complex treatments, testing, or drug plans.
Patient appointments often include real-time EKGs, ultrasounds, X-Rays, and etc. — on the spot and as needed. Ultrasound and X-Ray techs are literally on-hand at the clinic in case they’re needed. The same is true for lab technicians, as most clinics have labs, too.
For more complex tests or sophisticated imaging such as CT scans or MRIs, they are usually provided by local hospitals and shared-service imaging companies, and usually take a few days to schedule. Costs vary, but local hospital CT scans cost $50 and a recent 3rd party MRI was $250 or so. Not bad, compared to American costs.
Many clinics and others also allow patients to schedule appointments by website, mobile app, and especially by WeChat (a very nice WhatsApp-like chat app). Chat is super helpful and efficient working on the best appointment times, offices, and things like prescription refills. It’s especially helpful as the chat team cheerfully organizes and coordinates many things without requiring phone calls or placing patients on hold — fully interactive medicine.
Why can’t we have medicine like this in the USA?
I’m sure one reason the USA lacks such an efficient medical industry is because of America’s absurdly high cost of delivery, even though, I suspect, doctors in Shanghai are paid similarly to those in the USA (and have far less stress and limited paperwork).
In fact, many doctors in Shanghai are American or European, though most clinics also employ top Chinese doctors who earn a lot more money than they would at clinics serving primarily local citizens.
Also, most clinics’ equipment is top-of-the-line American, Japanese, and German gear, so they’re not saving money that way. In fact, nearly all these clinics’ medical equipment is brand new, as are the operating theaters, office suites, and nearly everything else.
Of course, the support staff, admin teams, and especially nurses must be much less expensive in China — perhaps a third of what they might earn in the USA — and this certainly helps profit margins.
How does all this get paid for? Insurance, of course. Chinese citizens have free or nearly free government-run medical benefits and services, but their benefits don’t include high-end clinics that cater to foreigners.
Still, I’d say about 50% or more of the patients in these higher-end facilities are Chinese citizens. I suspect they pay for services directly and avoid going through insurance, though there are several local add-on insurance plans available, too.
Our insurance is expensive by global standards, but not by American ones. My CIGNA plan, one of the best, covers 100% of everything, with zero deductible or co-pay, and costs $450 per month for me. There are many less expensive plans than mine. And most plans are direct bill, so I just make an appointment when and where I want, see a doctor, sign the bill, and that’s it. I never, ever pay for anything.
Surgeries and expensive procedures like colonoscopies or cardiac catheterizations do need pre-approval, but I’ve never had one denied. In fact, my insurance has a specialist who visits patients in the hospital just to make sure they’re getting quality care. I learned this when I was an in-patient for a few days last year. Imagine that in the USA!
Why can’t we have this in the USA?
So here in Shanghai, we have American doctors, using American equipment, with American software and standards, delivering American-level healthcare at or below American prices. Usually, patients can be seen the same day, and almost always within the same week. For 30–60 minutes. At American prices or better.
Why can’t we have this in America?
Originally published at https://mushnet.substack.com.