Taking their cut

Do you trust your doctor? Most people do – they are the experts after all. But what if his paycheck depended on your undergoing a risky and expensive surgery? Medical professionals in China are warning that just such a conflict is behind the country’s rapid rise in caesarean-section births.

China now leads the world in c-sections, according to a recent World Health Organisation survey. It found that as much as 46% of Chinese mothers opt for a surgical birth – versus just 5% in the 1970s. The report warned that surgery for non-medical reasons posed a real risk to mothers’ health.

So why go under the knife? One new mother told the China Economic Weekly she was afraid after doctors said her age made a vaginal birth risky. “Afterwards I felt very angry,” explained the 31 year-old, “if age were a problem, why were my prenatal checks normal… I think the hospital just wanted to make more money.”

The experience of Dr Guo adds weight to those suspicions. “If all mothers chose natural delivery, we’d go bankrupt,” the Henan-based doctor told the magazine. The charge for a caesarean birth is twice that of a natural birth at his hospital. “The state has not given us financial support for many years,” he said, “Healthcare workers have to earn their own income.”

Most of China’s public hospitals are chronically underfunded, and have to resort to prescribing more profitable procedures and medicines to make ends meet. That financial pressure is prejudicing the advice many doctors give to their patients, according to Dr Gao Ling, chief obstetrician at the Beijing Amcare Women’s and Children’s Hospital. “[Caesarean births] offer a much higher margin than natural delivery,” Dr Gao told the China Economic Weekly, “Doctors can use much more medical equipment and medicine.”

Giving birth naturally can also take much longer caesarean and involves more manpower. Both factors can have an impact on doctors’ recommendations. “The more natural births healthcare workers perform, the more tired they get and the less money they get,” one doctor told the magazine.

Some physicians are also encouraging mothers to choose surgery to try to reduce their legal liability. They believe the faster procedure leaves them less open to charges of malpractice if there are complications with the birth. “The treatment of medical disputes lacks a reasonable process,” complained Zhao, head of a Shandong hospital, “a patient who makes no trouble won’t receive a penny of compensation, but the more trouble he makes the greater he’ll be compensated.”

But worrying though it is, profit isn’t the only reason more mothers are picking surgery. “We cannot but all the blame on hospitals and doctors,” explained Dr Gao, “There are also social factors.” Some mothers fear the pain involved in labour, and others choose to have a c-section for cosmetic reasons.

Another factor is the country’s 32 year-old one child policy. Many mothers are willing to take on the risk of surgery because they believe it’s safer for the baby. “[The child] is so precious that either expectant mothers or doctors will tend to choose cesarean sections,” Zhao told the magazine.

And proving that the old ways die hard, some parents choose to have a surgical delivery in order to get the best ‘feng shui’ for their baby. Traditional Chinese geomancy is especially popular in Hong Kong, where many believe the time and date of your birth can bring either good luck or misery. Cecilia Cheung, the singer wife of local heartthrob Nicholas Tse, recently gave birth to her youngest son by c-section. He was born at 9pm on May 12 – a fortuitous time according to feng shui experts, who reportedly predicted him fortune and fame.

Whether financial or cultural, the statistics have alarmed policymakers in several provinces. Although some have followed bureaucratic tradition and simply issued a mandatory reduction target, Tianjin’s social security department has gone further and nearly doubled the compensation for natural birth. More widespread improvement, however, will require a major investment in public hospitals.

© ChinTell Ltd. All rights reserved.

Sponsored by HSBC.

The Week in China website and the weekly magazine publications are owned and maintained by ChinTell Limited, Hong Kong. Neither HSBC nor any member of the HSBC group of companies ("HSBC") endorses the contents and/or is involved in selecting, creating or editing the contents of the Week in China website or the Week in China magazine. The views expressed in these publications are solely the views of ChinTell Limited and do not necessarily reflect the views or investment ideas of HSBC. No responsibility will therefore be assumed by HSBC for the contents of these publications or for the errors or omissions therein.