Hijacking Health

　

While in the West, patients see doctors when they schedule appointments, in China patients see doctors only if their number comes up. Whether they have an ear infection or a brain tumor, they need to register at the right department, receive a ticket that says how many people are ahead of them, and wait their turn.　

　

This system may work in China’s banks, but in hospitals it has created a serious problem.　

　

Intense demand for access to the country’s best medical facilities has generated a market for enterprising vendors who hoard these tickets and then sell them to sick people at a steep markup.　

　

Guang’anmen Hospital, like many others, had once been plagued by these ticket scalpers, but they all disappeared earlier this year thanks to one young woman. On January 19, the woman from northeast China spent the entire night in line for a ticket, only to find them sold out. Frustrated and furious, she alleged that hospital security guards were colluding with scalpers. She yelled that the security guards don’t control the line, the scalpers do.　

　

The young woman claimed that scalpers arrived after her, but still obtained tickets and offered to sell her a 300-yuan (US$46) ticket for 4,500 yuan (US$694). Someone caught it all on tape and the video clip instantly went viral, garnering over 10 million views.　

　

On January 29, Beijing Municipal Commission of Health and Family Planning, the local health authority, united with police to launch a campaign cracking down on scalpers, detaining more than 20 of them at several major hospitals in the city’s Haidian and Xicheng districts.　

　

Although ticket scalping is illegal in China, scalpers are a common sight at the country’s top medical institutions. A police officer stationed in a local hospital told NewsChina: “It’s not like we don’t try to catch them, it’s just that we can’t.” Family Business Wang Hong and his wife first came to Beijing seeking treatment for their son, who has cerebral palsy. When the couple made it to the front of the line on their first visit and began to register for an appointment, scalpers approached them and offered them 50 yuan (US$8) to register for an additional appointment.　

　

They saw this solicitation as a business opportunity, and eventually they joined the scalpers’ ranks.　

　

“Many ticket scalpers have a family member who is suffering from chronic problems like mental health issues or paralysis,” said the police officer, who declined to give his name.　

　

“They rely on scalping to foot their medical bills. Because of the huge profits, they transform from patients to scalpers.” Wang told our reporter that if his son were not suffering from cerebral palsy, he would push him to join the business, too. It is common for a family of three to do so, he added.　

　

Zhang Meng (pseudonym), a police officer charged with monitoring two hospitals ranked at the top of China’s three-tier public hospital system, told our reporter that it is easy for family members to divide up the work – the amiable wife drums up customers; the son, familiar with online apps, makes the online reservations; and the husband distributes the tickets and collects the money.　

　

This basic model has proliferated nonstop, resulting in a standard hierarchy of boss, middlemen and runners. “Those we catch are usually the lowest on the totem pole,” Zhang said. “It is very difficult to ferret out the mastermind behind the scenes.” She added that scalping at hospitals was most rampant back in 2012. At that time, police in plain clothes patrolled hospitals every day and recorded any illegal activity before making arrests. However, she complained that even after they nabbed a scalper and asked the patient to hand over the evidence, the patient would usually refuse to cooperate and flee the scene.　

　

“We have to run after both scalpers and patients,” said another police officer. “Hospital security guards just watch us, they don’t help us out.” To make an appointment for a family member at Beijing Tongren Hospital’s famous ophthalmology department, Zhang Lin arrived an entire day in advance. Shortly after 5 PM, when the registration office employees had all gone home, she stood on a small stool she had brought and climbed through a waiting room window. She was quickly followed by a scalper. Zhang managed to nab the coveted first-in-line position, but soon groups of scalpers came and tried to physically push her away.　

　

Many of them yelled at her, but one scalper resorted to threats: “Believe it or not, I can place you in the front of the line or the back.” Zhang dared not reply and focused all of her energy on clinging to the handrail below the ticket window, trembling all over.　

　

“I never thought that the same people who ask you quietly whether you want a ticket would be so fierce when fighting for them,” she told NewsChina.　

　

Police officer Zhang Meng told our reporter the youngest scalper she has ever caught was only 19 years old. Scalpers are not afraid of being caught over and over again. One 21-year-old was caught scalping the day after he’d been released. When he was freed the second time, Zhang asked him whether or not he will continue in the same line of work.　

　

With his new iPhone in hand, he responded: “I can’t not do it; if you could earn 70,000 to 80,000 yuan [US$10,812-12,356] a month, wouldn’t you?” (The average Beijing monthly salary in 2014 was 6,463 yuan [US$998].) Zhang knows that the sky-high potential profits make it impossible to root out scalping completely, especially while the offense’s punishment remains so light. Under China’s Law of Punishment for Public Security and Administration, apprehended scalpers face five to 15 days’ detention, with an accompanying fine of 1,000 yuan (US$154) at most.　

　

“To some scalpers, getting detained is like taking a vacation,” Zhang said. “They can easily earn over 1,000 yuan [US$154] in a single transaction, enough to cover the fine and then some... They have too small a price to pay.” In contrast, the crime of scalping train and ship tickets has already been written into China’s Criminal Law. People who scalp tickets priced at over 5,000 yuan (US$772) or who reap a profit of over 2,000 yuan (US$308) can be sentenced to up to three years in prison, with a fine five times that of the scalped ticket price.　

　

According to Zheng Xueqian, an expert from China Health Law Society, the lack of regulations in the national criminal code that targets hospital ticket scalpers is a gaping legal hole. She said tougher punitive measures are necessary to maintain a sound healthcare market.　

　

Plight According to the Beijing Health Bureau, doctors at Beijing hospitals met with patients for treatment and consultation about 220 million times in 2014. Half of those appointments occurred at the city’s major hospitals, and 90 percent of patients preferred to see specialists. The bureau also found that only 1.8 million specialist appointments are available in the capital every year, meaning more than 99 percent of patients who wanted to see a specialist were out of luck.　

　

Data from China’s Ministry of Health show that 80 percent of the country’s medical resources are concentrated in big cities, and 30 percent of those resources are directed to top-tier hospitals. Beijing Health Bureau found an average of 94 percent of beds in these hospitals were occupied, but that number dropped to 46 percent at smaller facilities.　

　

“Major hospitals ought to focus on complex and rare diseases,” Zheng Xueqian said.　

　

“Minor ailments could be treated easily at lower-tier hospitals.” In the face of overwhelming demand, many doctors hope to increase registration fees to ease major hospitals’ load. One doctor told NewsChina that “the price provided by scalpers reflects the real market price; patients buy these tickets because they think they’re worth it.” At this doctor’s hospital, appointment ticket fees for two famous specialists once yielded 2,000 yuan (US$308) and 5,000 yuan (US$772) on the black market, much higher than the original price of 300 yuan (US$46).　

　

“The price astonished a foreign doctor visiting our hospital, who only charges 300 euros

　

Huang Yuguang, head of the anesthesiology department at Peking Union Medical College Hospital, however, said ticket scalping is the result of a severe shortage of highquality medical resources, leaving top-tier hospitals unable to cope with the deluge of demand.　

　

“The distribution of quality medical resources varies greatly in different regions, and between urban and rural areas,” he told China Daily. “The hospitals that people are really dissatisfied with fall far short of requirements.” This imbalance has become a focus of the country’s medical reforms. In 2015, the State Council, China’s cabinet, announced that China will set up a new system to improve services at county- and township-level health centers. The National Health and Family Planning Commission stated that training general medical practitioners would be a main aspect of the new reforms.　

　

Nevertheless, it remains hard to change patients’ traditional way of thinking. One dermatology patient told our reporter that she came to Beijing specifically for the best doctors. She bought a ticket from a scalper at more than 300 yuan (US$46), only to find that the medicines prescribed by physicians at the reputable Peking Union Medical College Hospital were the same as those recommended by doctors in her own town.　

　

Both hospitals and public security organs have been making an effort to make it more convenient for patients to make their own appointments, attempting to pull people away from the scalper route. Starting in 2001, hospitals began to implement an appointment system that required giving the patient’s name when registering. In 2009, making an appointment online and by phone became possible at major Beijing hospitals. But hospitals remain heaving with scalpers.　

　

A police officer told NewsChina that scalpers make appointments with patients’ medical cards in hand and also register appointments with false information online because those platforms are not connected to the public security bureau’s ID database. A doctor revealed that new patients are required to show their ID cards when they apply for a medical card, but if patients forget to bring their IDs, hospitals usually still let them obtain a card. As a result, a scalper could potentially have several medical cards and make many bookings under different names.　

　

And even when the eventual ticketholder’s name doesn’t match what’s on the paper, the scheme usually still works, as hospital staff find it hard to turn away patients who are often desperate and in need of medical care. “If a patient was holding a ticket under someone else’s name but kneels before you begging for treatment, would you refuse him?” asked one doctor at a top-tier hospital.　

　

According to Wang Yue, a medical law professor at Peking University, these problems could be solved by closing systemic loopholes, and there are plenty of ways to do so. “There are always more solutions than there are problems,” he said. For example, doctors could be required to see patients’ ID cards once more before giving prescriptions, rather than just their medical cards. He said the health ministry should learn from the railways ministry, as some high-speed train routes have forgone paper tickets altogether and rely on ID cards alone when checking passengers at the station.　

　

“It is a matter of administration. Each department in the system has their own regulations; they rely on each other, but rarely communicate with each another,” he told NewsChina. “Hospitals, social security departments and public security organs need to figure out how to better exchange information.” Changes are in the works. After the Chinese New Year break in February, several reputable departments at major hospitals, including Beijing Tongren Hospital’s ophthalmology department where Zhang Lin was threatened by scalpers, removed the limit on the number of appointments to eliminate scalping. Industry insiders, however, are pessimistic about the move, saying it will “motivate more patients to see a doctor at the major hospitals and place those doctors under even more pressure.” At the same time, 22 major Beijing hospitals have started requiring all patients to make appointments either online or by phone as of this year. According to the Beijing Municipal Administration of Hospitals, canceling onsite appointments and requiring patients to register with their own names will effectively suppress scalping in the future.