Doctor Xu Xiangming examines 6-year-old Liu Kai. The boy had heart surgery at the Affiliated Hospital of Jining Medical College in East China's Shandong Province.  

JINING, Shandong: In the cardiac surgery ward of the Affiliated Hospital of Jining Medical College in East China's Shandong Province, 6-year-old Liu Kai plays with his toys happily. He underwent surgery about a week ago, and the boy from Ulanhot of the Inner Mongolia Autonomous Region seemed to be recovering steadily.

The boy was found to have congenital heart disease at 3. His parents took him to many hospitals across the country in search of treatment. But most demanded 30,000 yuan (US$3,699) as a deposit before talking about further treatment. Liu's parents couldn't afford it.

"We saw on television that this hospital only asks for 10,000 yuan (US$1,233) for an operation of the heart. We were thrilled and rushed here," said Wang Lianhua, Liu's mother. "Besides the low costs, the medical conditions here are also excellent."

Liu Kai is one of many patients who have benefited from the medical reforms carried out at the Jining hospital.

Important reform

In April 2004, the hospital in Jining was the first in the country to launch a charging system that puts an upper limit on the fees for treating 69 kinds of illnesses. In 2005, the number increased to 128, accounting for 70 per cent of the common diseases.

This system applies to the entire treatment of a patient from the time the patient is diagnosed and hospitalized to the time when the patient is cured and discharged, explained Wu Guanghua, 54, MD, professor of surgery and director of the Affiliated Hospital of Jining Medical College.

Taking congenital atrial septal defect (ASD) for example, the treatment cost was lowered to 10,000 yuan from 17,580 yuan (US$2,168), a decrease of 44 per cent. On average, the treatment cost on the 128 kinds of diseases has been lowered by 33 per cent.

By the end of 2005, the hospital has treated 4,200 patients in the limited cost category. These patients saved 8 million yuan (US$986,400).

"The practices in the past two years have proved the success of our reform, which has solved many tough issues," said Wu on March 26, when directors from some 300 hospitals across the country gathered at the hospital to get first-hand information on lowering medical costs while maintaining or even improving services.

Wu's achievements were highlighted on the night of March 15, Consumers' Day, when he received the "March 15 Outstanding Contribution Award" during a live show on China Central Television (CCTV) watched by millions. Out of 245,000 valid votes cast by the nationwide audience, 112,000 went to Wu Guanghua.

Throughout the country, a number of hospitals have followed the Jining example. Starting from this month, 443 hospitals in Henan Province capped medical costs for treating 282 common diseases, according to a report on the China Youth Daily.

Reducing costs

The Affiliated Hospital of Jining Medical College is located in the southwestern part of Shandong, where farmers make up 85 per cent of the population.

Wu remembers clearly that in 2003, an old man in his 70s came to the hospital from the mountainous regions of Sishui County. He brought a bagful of peanuts and asked the doctors if they could treat his ailing eyes and he paid in peanuts.

There were many similar patients who had to leave the hospital disappointed when they heard of the treatment cost, which was astronomical for them.

As the son of a farmer's family, Wu clearly understands the grave consequences for the farmers if a serious illness is left untreated.

A reform would mean challenging the established medical system, unspoken rules and many people's personal interests. But Wu chose to go ahead.

"I saw the problems. This is like when I walk and find a rock obstructing the road. I must remove it. I won't consider what costs I'll pay for it, or whom I might offend. Even if I couldn't remove this rock, the people behind me will still face the task," said Wu, who has been the head of the Jining hospital for a decade.

From early 2004, Wu and his colleagues at the hospital studied thousands of medical records of 69 diseases from 2001 to early 2004 and finally launched the reform in April.

To lower the cost, Wu asked the finance, auditing and other departments to strictly calculate every item of expenditure during each patient's treatment. For each kind of illness included in the reform, the hospital has a list of medicines that can be used. Expensive medicines are strictly controlled.

At the same time, the hospital went for public bidding to purchase medicine, equipment and consumable materials.

The cost of cardiovascular intervention materials, for example, dropped 40 per cent after the public bidding was introduced. The price of an imported stent was lowered from 16,500 yuan (US$2,035) to 8,500 yuan (US$1,048). Thus the cost of stent deployment in the percutaneous coronary intervention was lowered from 40,000 yuan (US$4,932) to 23,000 yuan (US$2,836).

"As a doctor and a leader of a hospital, my greatest wish is to provide access to timely treatment to as many patients as possible," said Wu.

Obstructions and benefits

No reform can proceed smoothly. Jining Hospital was no exception.

The first department to experiment the reform was cardiac surgery. Congenital heart disease and a few other common illnesses were chosen for cost evaluation. From an average cost of 17,000 yuan (US$2,096), the cost of these illnesses was limited to 10,000 yuan (US$1,233).

But the first operation after the reform exceeded the limit by 2,000 yuan (US$247). Wu, who is a cardiac surgeon himself, gathered the medical stuff in the cardiac surgery department to closely examine the procedure of this operation. They soon found that some medicines were totally unnecessary.

"In the past, 50 to 70 per cent of the cost for a cardiac operation was taken up by medicines," said Xu Xiangming, director of the cardiac surgery department. "Now, medicine only takes up 15 to 20 per cent. We have crossed out expensive medicines and materials."

Because of the reform, the cardiac surgery department lost some 300,000 yuan (US$36,991) in the first half of 2004. Through modifying the reform measures, the department was able to gain profits in the latter half of 2004. The experience of this department was soon followed in other sections of the hospital.

"Any reform will have risks, but we must persist with the reform," said Wu.

While lowering the cost, Wu insists on providing first-rate service to patients. "We forbid repetitive physical examinations. While we prohibit any unnecessary treatment, we won't omit any necessary items."

The reform encountered obstructions. A doctor who administered expensive medicines and took bribes from patients was suspended from his duties for three months. A few section chiefs, head nurses and purchasing directors who wouldn't follow the reform measures were removed from their posts.

"If I knew a staff member's conduct would affect the patients' health and did nothing to stop it, it would be like letting a killer continue the crime," said Wu.

As time goes by, the hospital staff also tasted benefits of the reform.

According to Wang Zhongyun, head nurse of the cardio and cerebral surgery department, the number of beds in the cardiac surgery ward has increased to 113 from 31 over the past two years. The number of inpatients here every month equals that of the entire year before the reform.

Although everyone is much busier than before, no one complains. The bonus is now over 10 times that before 2004, said Wang.

"Our hospital used to be regional, now patients come from 29 provinces, municipalities and autonomous regions for cardiac surgery. Our hospital has become one of the five leading cardiac surgery centres in the country," said Xu Xiangming, the head of the department.

Free service

May 27, 1999 was the day of rebirth for Hou Mingyi. On that day, Wu Guanghua performed a heart transplant operation for Hu, who was suffering from dilated myocarditis, which meant the terminal stage of heart disease.

Hou was first diagnosed with heart disease in 1990. Unable to pay for operation, he delayed treatment until the fast deteriorating condition forced him to go to the Jining hospital. To his great surprise, Wu offered to carry out the operation free of charge.

"Director Wu saved my life," Hou told China Daily. "I'm living a happy life with my wife and our child. All this is given by Director Wu and the good doctors. I shall repay these good people with my life!"

Hou was the first heart transplant survivor in Shandong and has recovered well from the operation. Jining hospital has hired him to check mails at the reception office.

Hou is just one of many poor patients who can't afford the medical treatment. Every year, 150,000 people are diagnosed with heart disease. If they can have timely operations, these people have a good chance at full recovery. Left untreated, they could be taken away by death at any time.

In 2005, Wu and his colleagues furthered their reform by taking out 1 million yuan (US$123,300) out of their administration expenses to set up a charity fund. Last year, 100 young patients aged between 3 and 15 suffering from four types of congenital heart diseases received operations free of charge.

This year, another 100 young patients from poor families will benefit from this charity fund.

"We are committed to the health and well-being of people in our region, including those who otherwise would not have access to good healthcare," wrote Wu on the introduction to the hospital at its website http://www.jyfy.com.cn/.