San Jia: Why a Chinese Cold Queues Behind Cancer — Epoche B1
Chinese hospitals carry an official grade, and the top mark is san jia — grade three, class A. It is printed at the gate, quoted in taxis and typed into search engines by anyone with a worrying symptom. Grade one is the small local facility, grade two the district hospital, grade three the large teaching hospital, and within each grade a class from A downwards. The grading was meant to describe capacity. It became a queue. Because a patient in China may register at almost any hospital without a referral, and because the grade is public, the sensible individual choice is always the same: go to the best. So a young woman with a cough travels an hour across the city, takes a number and waits half a day at a san jia hospital, behind people who have come from three provinces away with cancer. Meanwhile the community clinic near her flat has an empty corridor and a doctor with time. The shortage, then, is not of doctors. It is of doctors where the patient is standing. The response has been to build a path rather than more buildings. Tiered diagnosis and treatment, set out in national guidance around 2015, asks that the first visit happen locally and that hospitals refer upwards and back down again. Family-doctor contracts sign a household to a named community doctor. Reimbursement rates lean the same way: the insurer pays a larger share if you start near home. The classics saw the point long before the queue formed. The superior physician, says the ancient Inner Canon of the Yellow Emperor , treats what is not yet illness. That work belongs in the clinic on the corner. The teaching hospital is where it is already too late for it. References Ministry of Health of the People's Republic of China (1989). Measures for the Grading and Administration of Hospitals. Beijing: Ministry of Health. General Office of the State Council of the People's Republic of China (2015). Guiding Opinions on Promoting the Construction of a Hierarchical Diagnosis and Treatment System (Guo Ban Fa [2015] No. 70). Beijing: State Council. Unschuld, P. U. & Tessenow, H. (2011). Huang Di Nei Jing Su Wen: An Annotated Translation of Huang Di's Inner Classic — Basic Questions. Berkeley: University of California Press.