A doctor diagnoses a baby. Photo: IC

Deng Qihai will never forget his experience at a Beijing hospital in November. He and his wife waited more than four hours around midnight at an emergency department of the Capital Institute of Pediatrics for their 15-month-old daughter to be treated for a high fever.

"There were huge crowds of patients. The doctor spent less than five minutes on diagnosis and prescribed a few anti-fever drugs," Deng said. "The medical fee was less than 100 yuan ($16.3), but waiting for our turn was torture."

He is now searching for a family doctor and health adviser for the family, as are many people across China, who have grown fed up with the public health system.

Xie Jingyu, the mother of a 2-year-old daughter in Beijing, is among those who have made the change. She has enjoyed private services for more than three years. "Although Beijing has the country's best medical resources, patients from around the country all come here, so the access to services is quite limited," Xie told the Global Times.

"When I was pregnant, it would take me several hours to see a doctor for a regular check," she said. "Besides, infections easily jump from one person to another on crowded occasions. A friend of mine said her child got infected with pneumonia while being treated for a cold in a hospital."

The private clinic where Xie has purchased membership also offers a packaged price of 480 yuan for one consultation, including diagnosis and treatment of common ailments.

Personal physicians have in the past been a luxury most people cannot afford. Previously, the service mainly targeted foreign officials or rich businessmen. Now, driven by country's growth and increasing awareness of health issues, private physicians have expanded their customer base to serve middle-income families.

Alternative to hospitals

Finding adequate yet affordable medical care has long been a challenge in China. Despite reforms in 2009, the system remains stressed and overcrowded.

Some people have begun to turn to personal physicians.

"After years dealing with patients, I know clearly how important one-to-one communication between the doctor and patient is," Shao Wenhong, an associate chief physician of Beijing United Family Hospital and Clinics (BJU), told the Global Times.

She has been acting as a personal physician for several years. "By tracking the patients' general situation at times, I offer the patients appropriate health management and preservation advice in terms of drugs and diet, and they recover well," she said.

Personal doctors can help build trust through long term communication with patients, said Huang Siqing, general manager of the Shanghai Qianjia Doctor Network, a private HMO which offers specified medical services to prepaid subscribers, established in 2004.

According to Huang, the demand for private medical services is growing. The network has now grown to about 400 members from only several in the beginning.

For 4,800 yuan each year, a member of Huang's network can enjoy tailor-made services including free medical checks, phone consultations on health, outpatient services and being accompanied by medical specialists to hospitals.

Doctors and nurses can also pay home visits to members based on appointments one day in advance, with a surcharge ranging from 200 yuan to 1,000 yuan.

He says that his service is growing because many patients have become disillusioned with the public health system. "The medical disputes between patients and medical staff nowadays are mainly the result of lack of mutual trust and respect. Private doctors can help build trust and reduce disputes," Huang told the Global Times.

Qiu Bingyu, a deputy to the National People's Congress and deputy head of the Shandong provincial bureau of health said that inadequate communications are partly to blame for medical disputes.

The average time a doctor spends with a patient is five minutes in China, much shorter than 17.6 minutes in the US and Canada, and 10.2 minutes in the Netherlands, Qiu told the Qilu Evening News.

To facilitate private medical conductions, Beijing municipal health department head Fang Laiying recently said the city plans to issue policy to allow incumbent doctors open private clinics. This has also been regarded as a move to have more doctors available for family medicine.

Cash on the side?

There is also the question of whether these private physicians are moonlighting to make extra money in addition to their regular jobs. Currently, doctors in public hospitals must first obtain consent from their employer before they can engage in any private medical services. But they don't always do this.

"The hospital officials, especially those in high-class public hospitals, will not be happy to see employees take on part-time jobs," said Shao. "BJU has some doctors from public hospitals who do part-time work, and they always dread being exposed."

Some hospitals have issued strict rules on staff members engaging in part-time jobs, such as deducting wages during days they are out of the hospital.

Liao Zhilin, publicity department director of the West China Hospital in Sichuan, said it's reasonable for hospitals to set limits on doctors moonlighting as private physicians.

"A doctor's reputation is somewhat established based on the hospital, which has a reason to ask for repayment from the doctor," he told cn-healthcare.com, an online news portal on health, in late October.

He said the public-welfare oriented multisite practice, instead of profit-oriented, should be supported and promoted.

Other reasons stopping doctors from becoming private physicians are the heavy workloads and a lack of insurance in cases of medical disputes.

Two community doctors make a house call to an elderly woman in Harbin, Heilongjiang Province, on December 13, 2012. Photo: CFP

Falling short of goals

Private medical care wasn't widely practiced until China allowed medical practices with multiple outlets in 2009. Since then, the Ministry of Health has strived to cultivate more GPs and promote family-style medicine in communities.

"Before that, the doctors offered private medical services reluctantly or secretly," Huang said.

Gradually, a number of cities have rolled out these services. By signing contracts with community health centers and a medical team made up of a GP, a nurse and a public health physician, the residents can enjoy services like routine checkups, health-risk assessments, and personalized counseling on maintaining a healthy lifestyle.

The official statistics show that in Beijing, a total of 4.13 million households or two fifths of its population had used the service by November 2013.

As the service grows, cities around the country have made bold pledges to roll out private medical care services. Wuhan, the capital city of Hubei Province, has set even loftier goals, vowing to have one GP for every 2,000 permanent residents by 2020. The city also pledged to only charge each resident 95 yuan a year, people.com.cn reported.

Similarly, Shanghai authorities have announced that they will strive to ensure all families can enjoy family practices by 2020.

But at present the reality falls far short of these ideals. Each community-based medical team in the country is allowed to contract 600-800 households.

"Generally speaking, it's best for a private physician to serve 30 permanent patients. But physicians participating in those community family-style services  can each serve up to several thousand patients," said Gou Xinyu, the founder and manger of vipyiyi.com, a website based in Beijing which caters to the private physician market.

"Such kinds of services have strayed from their true goals. Most of the community service centers each cover several communities and have become little more than house calls to prescribe medicines to senior citizens," Gou told the Global Times.

A staff member from a health center in Beijing's Tongzhou district said the service is still in the publicity stage and has not been properly implemented. The barriers vary from funding problems to personnel shortages.

In addition, the residents lack of confidence in community physicians. "Many community centers have no emergency department and do not work at night. Furthermore, I still believe that the resources and doctors' skills in large hospitals are better," Deng said.

Dr Gilbert Shiva, who serves in the Shuanyushu Community Health Service Center in Haidian district, Beijing, said that the remuneration for community doctors in China is too low to retain skilled talent.

"In the UK, a GP earns much more than a specialist in hospitals, and they also enjoy a higher social status. But the situation here is the opposite," Shiva, who came back to China in 2006 after 15-years' experience in family practices in the UK, Phoenix TV reported.

"Many of my coworkers have a sense of inferiority. On many occasions, the community physicians are regarded as inferiors who were kicked out of major hospitals," he told the Beijing Evening News in a report in December.

Meanwhile, many third-party networks between patients and doctors have emerged. Several leading health checkup companies have expanded their private healthcare services. The Ciming Health Checkup Group started to provide family medicine to prepaid subscribers in Beijing in 2012, targeting movie stars, celebrities, and entrepreneurs.

Early this year, Ciming revealed that its business model had been successful and said the company would extend its services to Shanghai. Ciming's success however, has not been universal. "The major barrier is that the rigid demand for GPs won't be high. Unlike some foreign countries where the patients must obtain family physician's signature when going to hospital, here people can go hospital at any time," Gou said. "Furthermore, currently medical insurance does not cover private healthcare."