Managing a China Hospital? Be Careful of New Laws!

So you can’t add a new outpatient block to your hospital in 3 days? Sorry, you won’t be able to accept any new patients.

Although this may seem strange to you, I actually encountered this situation when working in China. I have previously talked about the differences in how laws in China can be interpreted and implemented, and if you’ve read those posts then you can understand that variations exist between provinces and cities. This same phenomenon exists with the introduction of new laws.

Typically new laws come down from the Ministry of Health and lower levels such as the Provincial Health Bureau, City Health Bureau etc., and are not infrequent. Once these new laws and regulations come into effect then they succumb to the issues I have already outlined in the interpretation and implementation sections. One of the largest differences I’ve found in the introduction of a new law in China vs. the West, is the speed in which the new law must be implemented.

A hospital may be notified of a new law or regulation and only have a day or two before they must begin compliance. In some cases there is no grace period and a new law must be followed immediately. This requirement can in some cases cause havoc on your bottom line.

For example, you may recall the period around 2002/2003 when there was a SARS outbreak in many countries. Once China became aware of the danger of this infection (i.e. high death rate), it immediately created a set of new regulations including checking the temperature of every person entering your facility to see if it was elevated (fever being indicative of some kind of infection), and the requirement to have an isolated “fever clinic” in which to hold in isolation any person who did have an elevated temperature, until tests confirmed if they may have SARS or not.

Naturally, as already explained in the interpretation section, there were multiple different ways that this new requirement was interpreted across districts. In the area I was working the local authority indicated that the fever clinic must be a building physically separated from other buildings, with a minimum separation distance and number of rooms etc. We were given 3 days to prepare such a building (from recollection the law appeared on a Friday and was to be implemented by the following Monday) otherwise we were legally not permitted to accept any outpatients. Some areas interpreted that the fever clinic could be in the same building as other outpatient services as long as there was a separate dedicated entrance which was clearly signed as “fever clinic”.

Now, not being able to see outpatients is a big deal. In China and Thailand the public believe that hospitals provide the best care – both inpatient and outpatient. For this reason hospitals have very large outpatient clinics. Other “outpatient only” clinics that do not have inpatient facilities and therefore cannot be called hospitals, have a very low level of trust by the public. The great majority of a hospital’s inpatients are admitted via their outpatient section. So, to be unable to see outpatients will dramatically affect the hospital’s revenue.

The hospital I was working at did not have a physically separate building that could be commandeered to become a fever clinic, and so it was decided that a new building would be constructed close by, and – get this – be finished and ready by Monday! To cut a long story short, it was done. The ground was prepared, foundations set, and the building constructed in time to open by Monday. Of course the quality was pretty bad with many cracks appearing in the next days and weeks since the concrete etc. had not had sufficient time to set.

How are new laws promulgated? Nowadays they come via email, however for the longest time they came by fax. If you didn’t check the email address or fax at least daily, then you were putting yourself at great risk of not being compliant with some new law that had “immediate effect”. Receiving an email or fax declaring a new law “with immediate effect” was not an infrequent thing either. So you must have a system to ensure that the email/fax is checked every day (including weekends). Typically this person is the government relations person as with their contact network they could call-up the relevant government official to try and get further information on the new law coming down.

Once a new law comes into effect it then goes down the same pathway as I wrote in the implementation and interpretation section; that is, the law may be strictly monitored for a while and then not monitored at all. Or the interpretation can change. You can still see this in many places regarding the fever clinic. Although the law is no longer implemented (but still on the books) many hospitals decided to keep the fever clinic in case another outbreak of some disease occurs and the government brings back strict implementation of this law. Some places still have a strict interpretation and will expect to see a fever clinic when performing inspections.

Finally, when new laws and rules are promulgated the reason is typically simply stated as “for safety …..”, or “for work efficiency….”, or “according to requirements…” and then the new law is stated. Even if one does not understand why such a new law should be in place, particularly if that law will negatively affect revenue, it is of no consequence. The law must be followed. Complaining will in most instances have no effect, and may even attract more unannounced inspections if the complaining is taken negatively by the relevant official.

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