A Shanghai hospital stay is nothing to fear. Read our tips before you're admitted
The quality and choice of health care for Shanghai expats has been improving rapidly over the last few years.
It wasn't long ago that expats from all over China, including Shanghai, would travel to Hong Kong or further afield to get good care, but now many expats from other parts of China will travel to Shanghai instead.
The main choices for Shanghai expats' medical care include the standard care provided by a public state-run Shanghai hospital, the VIP care available at some public or private Shanghai hospitals, the high-end care provided by foreign managed international hospitals and clinics, or a hybrid of the above.
In this article we shall take a look at hospital care provided in state-run or private Shanghai hospitals. For health care provided in foreign invested international hospitals and clinics in Shanghai, you can read our related article.
We have a list of Shanghai hospitals as well as useful resources and related news items below. Click here to skip directly to the lists.
Shanghai's hospitals and clinics can be a maze of confusion for expats
Public state-owned hospitals are the heart of the Chinese healthcare system.
Unlike in the West, where we commonly use primary care services such as family GPAs or neighborhood clinics, most Shanghai hospitals are set up to offer basic consultations, as well as emergency and surgery services.
Some are general hospitals offering all types of medical care, whereas others are more specialized hospitals focusing on just one or a few types of health issues, such as the Shanghai Chest hospital for heart issues, or the Shanghai Skin Disease and STD Hospital where you can get tested for STDs in Shanghai.
There are some small neighborhood clinics and more and more local private healthcare providers around China, but most Chinese people believe the public hospitals’ doctors are more qualified, and their equipment superior.
Both of these conceptions are basically true, based on how the Chinese healthcare system developed in the last 30 years. It has led, however, to over-crowded hospitals and poor preventative care, which the Chinese government is starting to tackle through a wide variety of reforms which you can read about in the links below.
Although some Shanghai hospitals offer appointment booking services, they are not easy to use, and most often people will just show up at a hospital, find the required department, register on the spot, receive a number and then sit in the waiting area for their number to be called.
Each department could have both general physicians as well as more experienced 'specialists' (Zhuānjiā yīshēng 专家医生). The specialists are usually on duty only one or two days a week at certain times, so people will arrive very early in the morning on those days to wait in long lines for an appointment.
If you have a health problem that you
have not been able to cure even after several visits, trying to see a
specialist could be a good idea, but otherwise the general physicians
are very qualified. The registration fee is normally US$2-3 for a basic
consultation, US$10-40 for a specialist.
When your number is called, you will enter a small room to meet the doctor. After a quick chat to find out what is ailing you, the doctor will do a few checks with their instruments.
If they don't find anything serious, they will give you a prescription. If the doctor thinks you might have an infection, or more serious problem, then they could order some bloodwork and other tests.
With the order form from the doctor, you will then go to the specific counter to first pay for the tests, and with your receipt head to another section where tests are carried out. There you will hand in your form and receipts, and wait for your name to be called.
Basic blood tests could cost US$10-40, and other tests are also quite cheap relative to Western standards.
You can get the results for many of the tests within one hour, but some will require you to come back another day. As hospitals take lunch breaks, you might also end up having to wait until after lunch to have the test, or get your results.
If you get the results quickly, you can find your doctor and without waiting in line again see if he will check them and give you a prescription, or tell you what the next step will be. If you need to come in another day for the results, then you will have to register again to see a doctor; usually a different one.
Once you have your prescription you will find another counter to pay the medicine fee, and then wait in the waiting area for your number to be called.
In some hospitals you need to hand in your receipt at the hospital pharmacy counter for them to start preparing your prescription, while others will automatically send the order message to the pharmacy once you have paid.
In some hospitals there are separate counters for Chinese and Western medicines. Note that China also has specialized Traditional Chinese medicine hospitals (中医医院, Zhōngyī yīyuàn), but even in the more common Western medicine hospitals (西医医院, Xīyī yīyuàn) they will sometimes prescribe Chinese medicines to go along with the main Western medicines.
If the doctor finds out you require hospitalization and/or surgery, then they will check when a bed and surgery slot is available. You will then need to pay a deposit that will more than cover all the potential fees in order to confirm this appointment.
Before you become an inpatient, you should pick up some extra clothes, toiletries, reading materials and other supplies that public Shanghai hospitals do not provide. Most Chinese patients will have relatives or friends visit them daily in the hospital to bring supplies.
There is normally a food service, and someone will come by to take your order each day, although there is usually little choice.
When taking advantage of the cheap rates for standard care, you will probably end up sharing a room with other patients. You could choose, however, the VIP service (discussed below) which will be much more expensive, but allow you to have a private or semi-private room.
Most expats who have had surgery in the larger well-known Shanghai hospitals are quite impressed with the very clean and modern surgery rooms, and high quality of imported and local medical equipment used.
The pharmacy payment counter: here you will need to settle up for any medication you have been prescribed
Shanghai Doctors come from the top medical universities in China. They go through long University and residency training before getting their license to practice.
Previously each hospital had their own residency training program, and only the doctors at the top Shanghai hospitals received the best on-the-job training. Since 2010, however, all new Shanghai doctors, regardless of where they end up, will go through the same standardized three-year residency program at one of the cities top hospitals before getting their license.
After becoming a Shanghai doctor, they will deliver hundreds of general consultations and many surgeries every year. Due to this intensive experience, their skills become quite good very quickly.
Although they might not always use the newest and most expensive foreign drugs and equipment, foreign companies provide plenty of training and materials to Shanghai doctors, so their knowledge is quite up to date.
Although a public Shanghai hospital will not normally accept overseas medical insurance for direct billing in their standard care facility, you can usually get reimbursed with your receipts and doctor's diagnosis forms afterwards.
Be sure to check what your medical insurance policy covers, and what documents are required to get reimbursed, before you use any services.
If you do have an emergency, the first thing to know is the emergency hotline number, 120. They can send an ambulance to pick you up at your home. Otherwise you can also go to the emergency ward at a Shanghai hospital, day or night.
One local hospital, Xinhua, has also launched a hotline with English service; 2507 8999
Although Shanghai expats can enjoy the relatively cheap and subsidized service available from a public Shanghai hospital, they will need to accept its flaws, some of which are described below.
Although these problems are still common, it is important to note that they have improved a lot over the last 20 years. Shanghai expats who have been here a long time will be more impressed with the many improvements than new expats.
Long waiting times
Shanghai is a city of more than 23 million people, all sharing a limited number of hospitals. Most of them are attracted to use the same well-known Shanghai hospitals as expats might be when they get sick.
You will end up waiting during many stages of your hospital visit, and many of these waits could last more than one hour. You might have to miss a whole day or more of work just to complete your consultation and tests.
Since the good reputation of Shanghai hospitals extends to smaller cities and towns nearby, some people from neighboring areas will also come to Shanghai for their health care, thereby increasing wait times.
Most of the local Shanghai doctors can speak some basic English and read and write even better, but only a few will be fluent. In the hospital you will also need to deal with many other staff while you register, pay for medicine, take your tests etc, and they will speak very little English.
The nurses are usually very kind and do their best to help foreigners, but they are also very busy, so you need to be very patient and not have high expectations. Having a Chinese-speaking friend to go with you, therefore, would be very helpful.
With the huge number of patients and visitors, a Shanghai public hospital is not only crowded, but also less clean than Westerners are accustomed to.
Occasionally you will also see people smoking on hospital premises. A law banning smoking inside hospitals and schools in Shanghai was enacted in 2010, but sometimes it is difficult to enforce.
Lack of privacy
During the consultation, tests and other interactions at the hospital, don’t expect much privacy. Sometimes the doors will stay open and other patients and staff will enter frequently.
Lack of personal care
In the West, it is common to use the same family doctor and clinic over many years. They will learn about your family medical history and your overall health issues, in addition to your current ailment. They will keep your records for many years and consult them each time.
At a Shanghai hospital, however, you will rarely see the same doctor twice, and even if you do they probably won't remember you, due to the huge amount of patients they see each day.
You will receive a small record booklet when you register, in which the doctor will fill in their diagnosis. You can bring this record booklet with you for future visits, but the new doctor usually only consults this if you are returning to discuss the results of recent tests and treatment. (Sometimes they can't read what a previous doctor wrote in the booklet.)
Each patient will only get a short amount of time with the doctor, as there are so many people waiting.
Shanghai doctors might give you some general preventative health care advice, but this is usually no more than "Stop drinking and smoking and go to bed early." So although the physicians’ medical skills cannot be questioned, you might come out wondering if they should be checking more thoroughly, and making sure they are giving you the most appropriate treatment for your long-term health.
Unlike Western doctors, Chinese doctors don't have the time to give you the peace of mind which can be important for your overall health and well-being.
Over-prescription of drugs, tests and treatments
This is a big item in the Western news recently, due to the GlaxoSmithKline bribery scandal, but actually it has been a common complaint of Chinese people for many years.
There are a number of factors involved. One is the huge pressure on Shanghai doctors to see many patients in a short period of time, while still being responsible to make sure they cure each patient's ailment.
Some doctors think it is safer to over-prescribe antibiotics and other medicines in order to ensure any infection is quickly cured, to avoid being accused by a patient of not taking their ailment seriously enough.
It is also acknowledged that many hospitals get over half their income from prescribing drugs, which contributes to salaries and bonuses earned by staff.
It is common for Chinese doctors to prescribe intravenous (IV) for minor ailments. If you are prescribed the IV, then you will have to sit for a few hours in a special room with many other patients, and possibly need to come back a few days to complete your treatment.
IV is usually only used in the West to deliver antibiotics and other medications quickly into the bloodstream for seriously ill patients, or when patients are dehydrated from serious diarrhea or vomiting. Normally oral antibiotics are just as good and save time.
Although this custom does seem to be changing in Shanghai, it is still common around most of China. Many people claim it is to increase revenues for doctors, but sometimes the IV can actually be a cheaper solution.
You can always tell the doctor your time is limited, so you prefer oral medicine. If they insist you take the IV, however, there could be legitimate reasons.
Huashan Hospital is one of the largest in Shanghai
Some public Shanghai hospitals have established international VIP wards, especially for expats and wealthy locals. Some of these are joint-ventures or in cooperation with overseas medical companies or investors. The first to do so was Huashan hospital, when it set up the Huashan Worldwide Medical Center in 1989.
These facilities often make use of the same Chinese doctors and equipment from the public hospital they are connected to. They will choose, however, doctors whose English language and other skills and experience are superior. The nurses and other staff also speak better English than those in the main wards.
You can sometimes book appointments in English over the phone, although it is sometimes difficult to dial in, so you might have to just show up and try to get an appointment in person.
When you go to this special section of the hospital, you will not have to wait in long lines, as they will arrange a doctor to see you quite quickly.
The consultation rooms are much bigger and you will have more privacy. Some simple tests might be delivered in this section directly, but for more complex tests you will be escorted by a nurse back into the main section of the hospital, where you will usually be taken to the front of the line and have the tests done immediately.
If you require hospitalization, then you can get a comfortable private or semi-private room, and you will have doctors and nurses visiting you more frequently than in the standard section.
For such special care, you will pay a lot more. The consultation fees for such clinics are quite similar to those at the foreign hospitals and clinics in Shanghai, and all the tests and treatments you receive will cost several times the price charged in the standard hospital section.
Some of these clinics have cooperation with overseas medical insurance companies allowing direct billing, but you should always make sure of this first. If direct billing is not available, then make sure what you are covered for and what documents you require for reimbursement after treatment.
In July 2013, the Shanghai government announced that public hospitals would close their VIP wards by 2015, and concentrate only on standard care. High-end medical services will be transferred to two new international medical centers currently under construction, The Pudong International Medical Center and the New Hongqiao International Medical Center.
It is unclear if this will lead to the closure of all or some of these current international clinics, some of which are merely VIP wards, while others are more independent branches of the public hospital.
The Chinese and Shanghai governments are both starting to promote more private investment in the healthcare industry. This could offer more opportunities for both local and foreign investors.
China's Health ministry has set the goal of private medical enterprises providing 20 percent of healthcare services in China by 2015, from just 5 percent in 2012.
In December 2013, the Boai medical group begun construction of an even larger private hospital at the new Yuanda Health town in Shanghai's Qingpu district, which is expected to open in 2017. The investment is close to US$500 million, and includes a not-for-profit section, as well as an international hospital.
Shanghai already has many small private clinics, but these mainly serve migrant workers. The first large-scale private general hospital, Ren-ai, a member of the Bo Ai medical group, China's largest privately-owned healthcare group, was established in 2001. This hospital opened an international medical center for Shanghai expats in 2008.
The main obstacle to the growth of private healthcare facilities is their difficulty in entering the Chinese state health insurance scheme. This scheme already covers 95 percent of Chinese people to some degree, and has the goal of covering 100 percent by 2020.
The national government also issued a law requiring expats working in China to take part in this scheme, although it has so far only been implemented partially.
A few private clinics can already help their patients get partially reimbursed through the state health insurance scheme, but once this is more prevalent, private investment in China's healthcare system is likely to increase quickly.
There are lots of hospitals and clinics that serve Shanghai expats in English