Wealthy Chinese patients going abroad for latest drugs, better service

By Zhang Yu Source:Global Times Published: 2016/8/30 18:28:39

As China becomes wealthier, more and more well-to-do patients are going abroad to seek the finest medication and treatment money can buy. Some even participate in clinical trials to gain access to the latest potentially-lifesaving medicines. Experts say China's poor hospital service and inefficient drugs approval system are contributing to this trend.

A patient buys anti-cancer drugs at a pharmacy in Zhengzhou, capital of Central China's Henan Province. Photo: CFP

Three years ago, Li Minglei, a Beijing bone doctor, was diagnosed with lung cancer.

His physician told him he had entered stage 4, the terminal stage, during which surgery is no longer effective.

Li was told he could only use chemotherapy to control his disease, and soon he was so weak that he wasn't able to turn over in bed. His doctor told him he had only six months to live.

In despair, Li pursued a different option. He and his wife flew to the US to get treatment at Massachusetts General Hospital in Boston, a prestigious cancer research hospital. Doctors there prescribed him targeted drugs which were unavailable in China back then and recommended he have surgery after the drugs take effect.

Today, Li has almost recovered, and he often jogs along the banks of Charles River in Boston. He will soon be able to return to China and resume work, although he will need to return to the hospital every three months for regular checks.

Li is among a growing number of Chinese who have gone abroad for treatment after receiving a terminal diagnosis.

Cash for cures

In the past few years, many US hospitals have seen an exponential increase in the number of Chinese patients paying for treatment. Massachusetts General Hospital, which has won the top spot on US News & World Report's annual list of the US's best hospitals, for example, treated only 10 Chinese patients annually just a few years ago. By 2014, the number it was treating had grown to 100, Boston Globe reported.

The Mayo Clinic, a hospital in Rochester, Minnesota, has also seen a flood of Chinese medical tourists arriving in its wards.

"China is the country where we see the greatest growth… Mayo Clinic attracted 400 Chinese in 2014 compared to 200 in 2013, 100 in 2010 and 30 in 2012," the organization's international office medical director Mikel Prieto told the International Medical Travel Journal.

Chinese people are traveling to the other side of the world for the best treatment their money can buy. A 2014 study by the China Cancer Center shows that the 5-year survival rate for Chinese cancer patients was 30.9 percent. This is significantly lower than the rate in the US, which is 65.9 percent.

While some hospitals in major Chinese cities boast first-rate medical care, patients, even wealthier ones, often need to pull strings to get access to these resources.

A better overall experience is another reason wealthy Chinese patients favor foreign hospitals. "Wealthier Chinese people go abroad because Chinese hospitals generally provide a poorer experience," Eric Chong, president of the Hong Kong Institute of Asclepius Hospital Management, told the Global Times on Sunday.

In China, patients often have to wait hours to see a doctor. But at the end of their wait the doctors usually only have a few minutes to spend on a patient, and often with other patients waiting in the same room.

Chinese hospitals are categorized into three tiers, but most patients cram into the top tier hospitals, leaving doctors in these hospitals busy and overworked. In some hospitals, each doctor needs to see up to 100 patients each day.

To tap into this trend, in 2010 Cai Qiang founded Saint Lucia, a Beijing-based consultancy on overseas care which introduces patients to foreign healthcare.

"Lots of Chinese can afford imported BMWs and Hermes bags. They send their children to study abroad. I thought overseas medical care had to be in great demand in the future," Cai told the Global Times.

Cai moved to Australia in 2001. Before that, he had a son who was born in Zhengzhou, capital of Central China's Henan Province. His wife gave birth to their daughter in Sydney. The two countries' different methods of child delivery and treatment of newborn babies left a mark on Cai.

"When my daughter was born in Sydney, the hospital even lent me a camera to take photographs of my newborn baby. It suddenly occurred to me that hospitals could provide such detailed, human-oriented services," he said.

Cai said that in 2010, Saint Lucia had only two patients. In 2012, there were about 100. Now, the company has around 1,000 patients each year, over 70 percent of whom suffer from critical illness such as cancer. The remaining 30 percent want to go abroad to receive technically difficult surgical procedures such as brain and bypass surgeries.

The costs for medical care overseas ranges from $20,000 to $2 million, depending on the treatment plan.

A cancer patient should expect to pay around 1 million yuan ($150,000) for diagnosis and treatment abroad.

The company charges a fee from 28,000 yuan to 138,000 yuan for its services including medical translation, reservation and referral and visa applications.

An online medical care platform was established on September 23, 2015 that advises Chinese patients seeking medical treatment in foreign countrires. Photo: IC

Fresh start

Li's cancer was caused by the EGFR19 gene mutation. "In China, this was basically incurable. But the US had already approved drugs for this specific type of lung cancer," Li told China Newsweek. He decided to try his luck in the US.

In November 2014, Li took his first dose of afatinib, a targeted treatment for EGFR-mutation-positive lung cancer which had already been introduced to the US market but hadn't been cleared for sale in China.

Five weeks after he started taking the pills, tests showed that the number of cancer cells on his spinal and collar bones had reduced significantly. The area that the cancer first began, in his lung, had seen a 60 percent reduction in cancer cells.

But his quest in the West for a cure didn't stop here. In less than a year, doctors found that Li had developed a resistance to the drug.

Li then took on a path that very few Chinese have taken: He signed up for a clinical trial for a new type of targeted therapy called AZD9291, a third-generation medication for mutations that are resistant to second-generation drugs like afatinib. His resistance to second-generation drugs means he fit the requirements for joining the trial.

Li joined the trial group and signed relevant agreements.

0Two weeks later, Li found breathing had become much easier for him, and his bones no longer ached. The drug had proved effective.

Although more Chinese are going abroad for treatment, very few choose to sign up for clinical trials.

Chong said only those who have life-threatening illness resort to drug trials, as this is their last hope.

"I won't encourage it because there is no way to guarantee that the new drugs undergoing clinical tests are effective," he said.

Li was lucky. Three months into the trial, AZD9291 was approved by the FDA. This meant the drug is officially considered trustworthy, and his life span could be prolonged further.

But this also means Li could no longer  get free medication - he now had to pay for it. Previously, all testers could take the drug for free. The medication costs about $10,000 a month.

Sick system

Experts say China's drug industry is lagging far behind that in the developed countries. While the US Food and Drug Administration has over 9,300 employees, the China Food and Drug Administration (CFDA) has only 345 registered employees.

The lack of personnel and China's painfully bureaucratic review procedures means it can take a much longer time for drugs to be approved.

Although Chinese regulations say the review period for new drugs' clinical trials should not exceed 90 days, CFDA data shows that the review period for new medicines often actually takes 14 to 28 months.

According to the 2015 annual CFDA report, China reviewed 9,691 new drugs in 2015, leaving over 17,000 drugs still unreviewed on their books.

This has prevented many potentially-lifesaving medicines and vaccines from entering the Chinese market. For example, the Chinese mainland approved the country's first human papillomavirus (HPV) vaccine  this July, almost a decade after the first HPV inoculation was developed.

Over the past decade, many Chinese have had to travel to Hong Kong to take the vaccine.

Chong said due to China's ongoing medical reform, the procedures through which the country introduces new drugs have slowed down in the past years and the reviews have become even tougher.

Cai said this is also why two-thirds of Chinese patients' treatment plans are changed after they are diagnosed by doctors in the US.

"Take lung cancer for example. China is still using drugs developed in 2011. In the US, there are many more choices," he said.

Talking about market prospects, Cai said overseas medical care remains a niche market in China, the growth of which is stable. He estimates that less than 3,000 Chinese patients went abroad for treatment for their critical illness in 2015.

Newspaper headline: Hospital holiday

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