Doctors, not debt collectors(3)

Wang explained that the last resort might be appealing to the county government to see whether some money can be allocated to fix this financial hole.

Forcing families to pay up is a very challenging task. "When you step foot in their house, you realize how poor the family is and it is difficult for you to open your mouth and ask them to pay back the money," Wang Ding'an said.

Sometimes, he asks the village heads to lobby patients to pay back the money, but he has no recourse if they refuse.

No regulation or law exists to outline what actions hospitals can take if patients default on their medical bills. Some hospitals have resorted to legal means.

In 2009, a patient who refused to pay more than 100,000 yuan was sued by the Civil Aviation General Hospital in Beijing. The hospital won the case and the court ordered the patient to pay back the money.

Wang complained that hospitals are not philanthropic organizations and that the government should not abandon hospitals to solve the problems of medical arrears on their own.

For a long time, public hospitals largely depended on financial allocations from central and local governments to maintain operations.

But in recent years, the government has greatly pushed for hospitals to eliminate this dependency and cope on their own, while scaling back its allocations to public hospitals.

By 2008, these subsidies made up for only 7 percent of the income of public hospitals.

Wang Ding'an warned that, if allowed to continue unchecked, these arrears would place an economic burden on hospitals that would eventually rebound against patients. "The hospital has been unable to bring in cutting-edge medical equipment for years, which is not good for the patients," he said.

In some hospitals, attending physicians and nurses have to bear responsibility for the medical arrears caused by patients they treat.

Wang said that faced with poor patients, the hospital sometimes become the disadvantaged party. "You cannot throw them out onto the street. You have to treat them, and doctors and nurses buy them free dinners paid out of their own pockets," he stated.

Hippocrates would be proud

Instead of urging a man who fled hospital to pay his bill back, Hangzhou No. 1 People's Hospital posted a message on Sina Weibo to remind the man to take his pills regularly and seek medical treatment at the nearest hospital.

The problem could be solved from two aspects, Yang Yansui, an expert on public management at Tsinghua University, told the Global Times.

"On one hand, local and central governments should set up a medical aid. Any hospitals and medical institutions that meet the conditions of accepting government assistance, can apply for this medical aid," Yang said.

"On the other hand, we should implement a credibility system within the medical system saying that any patient who even once dodges medical fees will no longer be treated at hospitals, unless they pay in advance," Yang concluded.