Are There Health Inequalities Among Beijing Expats?

I’m done. I just finished my sixth and final written exam, thus ending year one of my Masters of Science in Public Health. I’m officially an expert — on eye strain and multitasking. But I discovered a wonderful thing along the way — I really like the subject matter. I’ve immersed myself in a new way of thinking about health, and of the root cause of  illness. This whole concept of inequalities of health, and of a social gradient that underlines health issues with just as much statistical risk as “lifestyle” risks (such as exercise and smoking), is a very interesting and new concept to me.

Along the way, I’ve started to wonder: what about Beijing expats? Is there a social gradient among us that underlines health differences? Is there an invisible population living along the edges and just scraping by, at a higher risk of diseases? For example, do poorer expats living in lower income, older hutong complexes have more exposure to indoor air pollutants and building hazards and local street foods, causing more illness than someone living large in Palm Springs apartments? Does a commuter taking a bike or the subway have more lung and heart disease than someone chauffeured to work in a company car?

To find out answers to such questions, we would need to first find out if the underlying assumption is true: are there health differences among expats? In other words, are there different levels of acute and chronic disease among different socioeconomic levels among Beijing expats? Also, is there less access to health care at different levels? I think there is, and I think we don’t know a lot about this inequality, nor about these groups — and perhaps it’s time we did.

For example, I know that my expat clinic, as much as the others, provides solid service but can be extremely expensive for those who don’t have the luxury of insurance. So, what about all those expats without insurance, where do they go? I’m sure that many traveling students may not have insurance, but there are also plenty of English teachers here, or “local hires” at Chinese companies or NGOs, who don’t get insurance in their benefits. A trip to an expat clinic may be out of the question for them, so they may be navigating through local Chinese clinics — and their health outcomes may be very different. Not automatically worse, or better: in either case, I’d like to see some data.

I would love to find out everyone’s stories, and to find out just how big — if any — this difference really is.

How To Find Out?

The first step may be to simply start a discussion on websites like this, to see how all my readers feel about this. Then, we could maybe do focus groups, perhaps mediated by the Beijing Healthcare Forum.

I think a big step would be a questionnaire survey. Run via the internet and open to all Beijing expats, a survey can be a terrific snapshot of the health of our community — and may reveal some neglected inequalities that could be addressed.

Fortunately, I need to find a project for my MsPH thesis, and I may take on such a project. I would love to have some help on this, from colleagues, students and others, so let me know if you’re interested (leave a comment below, or email me at [email protected]).

Down The Line…

So let’s say that we did discover that 15% of the expats had no insurance and were skipping doctor visits or unable to cover their Western meds — what could we do about it? That could be a good debate among us. For example, maybe we expat clinics could be more creative with special insurance, or discounts, to such groups. Or, we could help local clinics and hospitals set up more satellite clinics for foreigners, especially on the west side of Beijing. But that still wouldn’t address the more fundamental factors, such as not having universal health insurance, or improved indoor and outdoor pollution, among many others.

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7 thoughts on “Are There Health Inequalities Among Beijing Expats?”

  1. Very good subject indeed.
    It's been 2.5 years I am living in Beijing, and it's been 2 years without any health insurance.
    I am a free-lance photographer, when I cam to China, I thought I could keep my home insurance, I did not dream very long. Much too expensive for me.
    Thanx to a friend, I managed to get rid of a nerve trauma on my leg by paying 170RMB for ten session of acupuncture. Then I realized I could maybe afford Chinese medicine.
    So that is how I have been doing for two years, I am trying to get a healthy life, food and enough sleep, I am careful for any flue or fever which I cure with sleep, lots of water and fresh vitamins. I don't speak Chinese so going to any Chinese hospital is not easy for me, when I get the chance to have a friend with, it's ok.
    And when I feel it's smth important, I go to the expat's place, I just came back from there with because of an Angina with bacterias….cost me 2000RMB (500 just for the antibiotics), which is a little fortune for me.
    I wish I could have the Chinese prices with someone speaking English 🙂 I guess I'll just have to learn Chinese then.

    1. Thanks for the comments! A good middle ground for people should be the “VIP departments” at top hospitals like Peking Union or Sino-Japanese. You pay 100-300RMB usually for a doc, with much less lines and waiting, and often the docs speak english, or a nurse can help translate.

  2. This is fascinating topic. I’m definitely interested in helping you out on this question. I’ve been very interested in public health since becoming a nurse and studying medical librarianship (and also reading Laurie Garrett’s books – I’m an infectious disease junkie.) And I think I might have mentioned to you in an email that I’m looking for a way to get involved in health care issues here in Beijing.

  3. I think there are definite inequalities and they are growing as many companies replace expat hires with local hires and more young people come to China to start jobs "at the bottom" so to speak and gain experience. In addition, you have students, NGOs, artists, etc. as you mentioned in your article. As a Consultant, I was only able to afford catastrophic health insurance for my family, so each time that any medical issue comes up we have to evaluate seriously whether it merits a doctor visit and which system to use. What that means is that my family has had a patchwork of care over the past 10 years with no consistent physician (which you don't get in the Chinese system, anyway) and we do not have any type of maintenance care, just focus on lifestyle factors ourselves for prevention. I think there is definitely room for a middle ground service in this market. Friends have had varying experiences with different foreigner wings of international hospitals and healthcare is ALWAYS a hot topic on Beijing Cafe.

    1. Thanks for that. Many studies have shown that access does indeed effect outcomes; many countries which studied copays found a sharp drop in healthcare use just by asking for a copay. So it does seem intuitive that less access may mean worse health — but not necessarily, not if that person is young and healthy and motivated and lucky. Still, it’d be nice to get some real-world data in our community.

  4. I live in Qingdao, Shandong not Beijing so this post may not have much use on your site but here goes anyway.

    My family and I have not had health insurance since we left America for China 7 years ago. We started as a couple teaching at University and now include a toddler, grandma and another baby on the way. Qingdao has several hospitals and a few international clinics to choose from. We have pretty much made a patchwork quilt of our healthcare going to a different clinic based on who and what is the issue.

    We are comprised of one major breadwinner working for a foreign company with a combined Chinese/US salary that does not afford International insurance, one University English teacher with Chinese medical insurance that has doubtful coverage, and one homebound pregnant mother not working at all.

    In general, for basic care we have had few complaints and feel content. We feel the care we can get here we would describe as 'mid level'. Big issues though scare us. Like a potential tumor in Grandma that needs surgery, and the surprise pregnancy with possible complications. In both cases the Chinese Dr recommended going back to America, but we had to explain that was not a viable option for us an that we would have to take care of it here.

    One challenging issue has been that for us finding a Dr we are satisfied with can take a while and several visits. And those who speak English as a second or third language can be very difficult to communicate with. There are a couple of American Doctors but they are general practitioners so we must go to a Chinese or Korean Dr for any specialist care.

    Hope this is of some use to you. The subject is a very important one.

    1. Thanks for the posting, and your Qingdao comments are definitely welcome here. In fact, it’s a great example of the health inequalities simply from access — once you’re out of China’s Tier 1 and 2 cities, there are almost no expat-style clinics, and likely less VIP-type local hospitals. The care may be excellent but language barriers are always a complication.

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