The Aravind system was brilliant; it works by offering a double standard. Patients who can afford it pay extra for special treatment—higher quality lenses, 5-star hotel type rooms, complementary service…and the profit is funneled back into subsidizing the cost for patients who can’t afford it, who get the same treatment, minus the special add-ons, for free.
Unfortunately, the Chinese as a people have this concept that they shouldn’t receive secondary treatment just because of their ability to pay. Even more, the Party officials will demand both free treatment and top-notch treatment—and if you don’t comply, they’ll pull some strings and close down your hospital, or at least have you replaced. Even tiered pricing systems such as the one carried out by Orbis in Xiangyun are a perilous setup at best, one that is propped up only because Orbis went to the local government and MOH and pushed through a government decree allowing it. Even still, doctors have to tread a very fine line in China (even more so that in the U.S.), especially regarding quality of treatment—having no such thing as malpractice insurance makes it extremely easy to be sued.
The concern about quality is pervasive in China’s healthcare system. People tend to believe that public hospitals offer higher quality treatment than private ones, and so choose to crowd into the public ones. A ZMC friend lamented the fact that patients have an even worse impression of community hospitals and health centers, thinking they’re essentially quack doctors…yet according to the grad student I’m working with, their skill is often pretty shoddy.
In the end, it all comes down to government policy. Since the 1980’s, the amount of healthcare spending supported by the government has dropped from 42% to 17%. Lacking sufficient government financial support, many hospitals have to struggle to stay afloat and can’t help but turn away patients who can’t pay. With an economy that has only been “half opened up”, hospitals are stuck trying to ensure their own income while still forced to work under central government management with very little competition amongst equipment suppliers. Everything is highly intertwined with politics in China.