By Yu Fei (China Features)

A patient Dong Mei used to pay scalpers 300 yuan (about 47 U.S. dollars) to obtain a registration slip to consult with a specialist at the Beijing Friendship Hospital, as it had been almost impossible for her to get one the legitimate way, which involves queuing up overnight. .

But recent reforms initiated in the hospital, one of the best in Beijing, have made it easier for her to consult with specialists. The hospital eliminated the mark-ups on medicine prices, but introduced a new fee for medical service.

It needs just 2 yuan to consult with ordinary doctors, while specialists can cost as much as 60.

The differentiation has encouraged patients with minor health issues to see ordinary doctors instead of needlessly occupying the time of specialists. Visits to ordinary doctors have surged 20 percent since the reform was introduced.

"We don't recommend that all patients see specialists, because they are limited resources. The price gap caused by the variable medical service fee acts as an economic lever to divert some of the patients," said Wang Yu, head of the hospital's medical department.

The variable medical service fee reform may be introduced to other public hospitals in Beijing if it proves successful at Friendship Hospital.

China’s medical reform has been deliberated by authorities ever since 2006.

But, not until 2009 did the central government launch the new round of healthcare reforms to improve access to affordable medical services and reduce soaring medial fees.

Between 2009 and 2011, the central government spent 450.6 billion yuan (70.79 billion U.S. dollars) to establish a basic medical insurance system, build a basic medicine system, and improve services of grassroots medical institutions.

Currently, the reform has entered a "crucial stage," with difficult issues constantly emerging, said Chinese Vice Premier Li Keqiang recently. "Priority should be shifted to the improvement of medical treatment and service quality."

Health Minister Chen Zhu said reform of public hospitals is of great significance to solving the acute problem of "poor access and high fees" for the public to see doctors.

Experts say one of the biggest challenges facing healthcare reform is improving the efficiency and performance of public hospitals, where most of China's best medical facilities and doctors are concentrated.

The uneven distribution of medical resources between rural and urban areas has also been a subject of public complaints. Nearly all of the country's best doctors and most advanced facilities are located in urban areas, causing patients to scramble for limited medical resources.

It is also difficult to see specialists, with many patients forced to line up late at night, buy registration slips from scalpers or forge personal relations with hospital staff in the hopes of getting preferential treatment.

Although the Beijing Health Bureau launched an online registration system last year to alleviate the problem, only a small quota of appointments can be made through the system and elderly patients are often unaware of its existence.

"After hours of queuing, my doctor gave me only three minutes and was reluctant to explain my illness in detail," said Fang Xin, a patient who recently saw a specialist at Beijing Union Medical College Hospital.

Sometimes, the tension caused by limited medical resources leads to violence. A doctor was stabbed by a patient at the Peking University People's Hospital in April, allegedly because the doctor failed to treat the patient properly. Last September, a patient stabbed a surgeon at Beijing Tongren Hospital following a medical dispute.

In China, doctors often work long hours for little pay. Their relations with patients are strained, as many patients are dissatisfied with high medical fees and poor access to treatment.

Huang Jiefu, vice minister of health, said the tension between doctors and patients is a reflection of China's defective medical system. The uneven distribution of medical investment, resources and talent causes patients to crowd into larger hospitals.

“How could a doctor keep a good attitude for all day long even with no time to take a rest to drink and go to the toilet? Of course, the doctor would say as little as possible,” Huang said.

Experts say 80 percent of outpatients of the big hospitals don’t need to have their first diagnosis in big hospitals. Instead, the first diagnosis could be done in grass-roots hospitals.

Fang Laiying, chief of the Beijing health bureau, said people should seek medical treatment from lower-level hospitals and community clinics instead of swarming larger hospitals.

"What we need to explore in the future is the establishment of a smooth referral channel between large hospitals and community hospitals," Fang said.

Before an effective referral channel is established by the government, a famous website HaoDF.com has attempted to establish such a channel. The website provides referral services to patients according to the severity of the illnesses, with a "triage team" made up of medical professionals analyzing information submitted by patients and passing their recommendations on to specialists, who decide whether or not to meet with the patient. The service gives priority to the most seriously ill patients.

Nearly 6,000 specialists across China are cooperation with the website to set up appointments, with more than 230,000 patients successfully meeting with specialists, according to statistics provided by the site's operators.

HaoDF also functions as a review platform, with more than 300,000 doctors in 3,000 hospitals receiving reviews from their patients regarding their professionalism and attitude.

Li Huajun, deputy director of the department of gynecology and obstetrics at Beijing's China-Japan Friendship Hospital, makes two appointments on HaoDF every week. He also replies to patients' inquiries on the website.

"After one of my patients created a personal home page for me on HaoDF several years ago, I started to pay attention to the site," said Li, who sets aside time each night before going to bed to answer patients' questions.

“If I can give a hand to someone through the Internet, then why not? Many patients don’t know which doctor they should see. Every doctor has his or her own specialty. The online referral service could help divert those patients with illness that I’m not good at treating,” Li said.

"Online communication with patients is advantageous in that it is not limited by time or space. I can read patients' information whenever I have a free moment. However, the online descriptions and photos are not enough to make a complete diagnosis. We still need face-to-face communication and examinations," said Li.

He mentioned that when people say it’s difficult for Chinese to see doctor mainly refers that it’s difficult to see well-known experts in well-known hospitals. “Many patients seek treatment by specialists blindly.”

"The key problem is that we lack a good referral system. If patients can receive their initial treatment at community-level hospitals or get transfers to bigger hospitals, it would no longer be difficult for them to get an appointment," Li said.

Experts say the establishment of a referral system will require community-level hospitals to improve the quality of their doctors. Community-level doctors are poorly paid, deal with difficult working environments and have few chances for promotions.

"A scarcity of the best minds is the bottleneck preventing the construction of a community-level medical system. I do not believe the best doctors should go to the largest hospitals, while low-level doctors end up in community hospitals," Huang said.

"A doctor should be judged not by where he works, but by how many patients he cures.".

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