Doctors, not debt collectors(2)

Finally, the hospital decided Wu should pay a minimum of 30 percent of Chen's medical fee, deducting the sum from his wages.

For Wu who earns around 70,000 yuan a year and provides for his wife, children and parents, this was a great burden.

Wu's case sparked a huge public outcry. Some criticized the hospital for being "inhumane" in punishing a good doctor. But this problem is not likely to go away.

The inability of patients to cover their medical bills has become the major cause of hospital arrears.

In Hangzhou, a construction worker who had a heart attack fled hospital in July last year after he accumulated more than 30,000 yuan in medical fees in Hangzhou No.1 People's Hospital. In Dongguan, cumulative medical arrears amounted to 239 million yuan in 2011.

"Huge medical debts have exposed China's weak social security system, as in many cities like Dongguan where migrants make up the majority of the total population, medical fees cannot be fully covered by the healthcare system. So, without a strong income, they don't have the money to pay," Lei Xiaodong, an associate professor from Southern Medical University told the Global Times.

China's healthcare system does not encourage people to seek medical treatment in non-local hospitals, as it is more than difficult for patients to get their medical fees reimbursed by social insurance in other cities.

Over-treatment is another reason for soaring medical bills. "Some hospitals have linked doctors' performance with bonuses so that many are inclined to prescribe more expensive pills and apply costly treatment to patients to treat benign conditions," Lei said.

Vagrants and beggars who are sent to hospitals by emergency services and car accident victims that dispute who should be responsible are among the main groups of fee-dodgers. "They come in through the emergency department, and we cannot throw them out. Eventually, the hospital has to cover the medical fees by itself," Wang Maolin, doctor of Kaifeng Red Cross Hospital in Henan Province, told the Global Times.

When asked how he covers these vast amounts, Wang said the hospital could not and faced a mountain of debt.

Bailiffs and courts

As early as 2001, many hospitals in municipalities and provinces including Beijing, Shanghai, Tianjin, Hubei and Guizhou selected staff among their doctors and nurses who were trained to retrieve these arrears but this achieved very little.

Collecting debt is one of the main tasks for Wang Ding'an, director of the Hefeng Central Hospital in Hubei Province. He says he would never consider hiring professional debt retrieval companies as bailiffs are too expensive. His hospital has arrears of more than one million yuan, with 400,000 yuan being added to the total last year alone.

In a case from December, a minivan carrying more than 20 students crashed into a car with the minivan's driver and 20 students being hospitalized in Hefeng Central Hospital. Their collective treatment cost over 200,000 yuan but none of them could pay when pressed.

Wang Ding'an negotiated with the drivers, the parents of the students and the school, but they all refused to pay. "Both drivers and the students insisted they were incapable of paying, while the school said the minivan wasn't an official vehicle and so they bore no responsibility for the car accident," he told the Global Times.