Several years ago, I was asked to performa virtual consult on a 48-yearoldChinese business man with acomplex hilar tumor in a solitary kidney.He was advised by some of the best specialistsin his country that the only option wasnephrectomy and hemodialysis. Four yearsafter successful nephron preservation andrecuperation at our center, I visited himand his country. Together, facilitated bythe Champions of Medical Advancement,an American-based organization dedicatedto improving Chinese health caredelivery, we live streamed our experienceto more than 50,000 viewers as I gainedinsight and appreciation for medicine inthe world’s most populated nation. 

Visitors to Shanghai and Beijing will quicklynote a remarkably modern and orderly managedsociety. Its economy is incredibly industrialistand quickly catching up with the rest ofwestern world. Medicine in China is a unique amalgam of both Chineseand Western practices. Its hospitals are large, modern, and complex,typically with 4000 to 10,000 inpatient beds, advanced imaging, robotictechnology, and impressive research facilities. Operationally, no appointmentsare necessary and everyone receives care: just show up and wait. 

For some specialties, queuing begins the night before as physicians see80+ patients per day (3 to 5 minutes per encounter). Under their socializedmedical system, everyone is covered and care is always delivered. Aquick glance in the outpatient “VIP patient lounge,” however, suggestsimproved access to even more advanced equipment, medication, andspecialists are available to those who demand higher quality. 

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Their socialized health care system, like so many others around the world,is undeniably tiered. Perhaps the most troubling aspect of these arrangementsis that these systems risk the trust that sets the foundation for ahealthy physician-patient relationship. When trust erodes, so too can quality. 

It is obvious that Chinese physicians and researchers care deeply abouttheir mission and the welfare of their patients. Despite limited resourcesto care for over a billion citizens, they are doing their best to searchfor solutions that deliver optimal care while recognizing the complexand myriad variables that may lead to unequal care despite their bestintentions. Although the solutions are complex, the architects of ourevolving health care delivery system should take note.