Treat now, pay later medical scheme trialed

The Ministry of Health (MOH) said Tuesday that the country is promoting a new medical payment system which would allow patients to pay after they receive medical treatment, but noted it is impossible to implement the so-called "pay after" system across the country this year.

Jiao Yahui, an official with the MOH medical administration department, told Xinhua that more than 20 provincial regions are carrying out the payment program in local hospitals on a trial basis.

But Jiao denied an earlier China Central Television report, which said the pilot system would be carried out across the country this year, noting that the conditions are not ripe.

She said a "pay after" method will not be adopted nationwide in the short term due to an immature social credit system and insufficient medical insurance.

Currently, Chinese citizens must pay first before receiving an operation or treatment. Patients must pay their bills and then apply for a reimbursement covered by medical insurance, usually more than 70 percent of the total treatment fees.

In August 2011, there was nationwide public criticism after a night-shift doctor in Hubei Province removed the stitches on the split tendons of a patient's hand as the patient did not have enough money to pay the medical fees.

Once the new system is implemented, patients, especially those suffering extreme conditions, will receive treatment first. After treatment, patients will only pay the part that is not included in their insurance. The rest will be paid to hospitals by the government.

Jiao said the "pay after" method was first tested in a hospital in Beijing in 2009 and was well-received by patients.

Shandong Province has taken the lead in the trial program. In Jining city, over 30 local hospitals and clinics have adopted the method since November 2011, said Wang Zhitong, a vice president with the Jining Traditional Chinese Medicine Hospital.

Wang told the Global Times that the method reflects the concept that patients are respected and hospitals are prompted to provide better services. It ensures that patients with severe conditions are treated in time, and helps alleviate their economic burdens, added Wang.

But Wang noted that the program carried out at his hospital currently only applies to inpatients, and that patients who don't have medical insurance or who got injured as a result of fighting or accidents are not covered, due to concerns over legal issues.

The pilot program has raised concerns that some patients may avoid paying their bills after they receive treatment, which would add to the financial burden of hospitals.

If a runaway patient is covered by the country's medical insurance, hospitals can get compensation from the government, but if the patient did not buy any medical insurance, the hospital will not be able to get the money back, Jiao told Xinhua.

In Wang's hospital, this doesn't seem to have been a problem so far. The hospital has a record for patients who benefit from the program. "Any patient who doesn't pay for the treatment would lose the right to use medical insurance or the new rural cooperative medical system," said Wang, adding that the hospital will keep a patient's social security card and a photocopy of his ID card until he pays the bill.

As to the reason why the model is mainly being trialed at local hospitals and clinics instead of well-known hospitals in provincial capitals, the authorities have their concerns.

A doctor surnamed Liu from the No.2 Hospital of Shandong University in Jinan, told the Global Times that patients who visit local hospitals and clinics usually require a high proportion of their payment to be reimbursed via insurance anyway, thus diminishing the risk of bad debts.

Experts also called for the authorities not to embrace the new scheme too quickly. Zhu Hengpeng, a researcher specializing in healthcare reform with the Chinese Academy of Social Sciences, told news portal sohu.com that temporary successes in certain areas are no guarantee it will be successful once adopted across the country, considering the different levels of economic development.