Violence against doctors in China
2014; Elsevier BV; Volume: 384; Issue: 9945 Linguagem: Inglês
10.1016/s0140-6736(14)61438-0
ISSN1474-547X
Autores Tópico(s)Workplace Violence and Bullying
ResumoWe are thankful to The Lancet for covering hospital violence in China.1The LancetViolence against doctors: Why China? Why now? What next?.Lancet. 2014; 383: 1013Summary Full Text Full Text PDF PubMed Scopus (125) Google Scholar According to a survey by the Chinese Hospital Association between December, 2012, and July, 2013,2Jia X Zhou H Zhao Y et al.Investigation on hospital violence 2003–2012 in China.Chinese Hospitals. 2014; 18 (in Chinese).: 1-3Google Scholar violence against medical staff has increased from 20·6 assaults per hospital in 2008, to 27·3 in 2012, based on data from 316 hospitals in more than 30 provinces. 96% of medical staff have been abused or injured in 2012, and 39·8% of staff planned to give up the medical profession or switch to another profession.2Jia X Zhou H Zhao Y et al.Investigation on hospital violence 2003–2012 in China.Chinese Hospitals. 2014; 18 (in Chinese).: 1-3Google ScholarWhat is the reason for this surge in hospital violence in China? First, there is a serious shortage of investment in health. China's population accounts for 22% of the world's total population, whereas China's total health expenditure accounted for only about 2% of the world's total expenditure. In 2008, the total health expenditure was only 4·3% of GDP, health expenditure was 10·3% of government expenditure, and health expenditure was US$146 per head in China, whereas in the USA these were respectively 15·2%, 18·7%, and $7164. The number of physicians per 1000 citizens is 1·4 in China, whereas it is 2·7 in the USA.3Ministry of Health of the People's Republic of China. China Health Statistics Yearbook 2012. Beijing: Peking Union Medical College Press.Google Scholar Second, medical costs increased rapidly. The total health expenditure rose from ¥361·9 to ¥1490·1 per head and out-of-pocket health expenditure nearly tripled from 2000 to 2010.3Ministry of Health of the People's Republic of China. China Health Statistics Yearbook 2012. Beijing: Peking Union Medical College Press.Google Scholar Third, there is an imbalance between high workload and low income for doctors. About 80% of doctors describe themselves as overworked and underpaid. For example, in my hospital, from 2001 to 2012, the number of admissions increased from 1·423 million to 3·504 million, an annual average rate increase of 7·8%. The number of inpatients increased from 22 406 in 2001 to 70 424 in 2012. The number of surgeries tripled during the same period of time. However, the number of doctors increased from 438 to 720 during the 12 years, an annual average increase of only 4·23%; therefore, the workload greatly increased from 12·94 to 19·39 patients per doctor per day, a 49·79% increase. Even in cities, many doctors earn as little as ¥5000 ($780) a month or less. The imbalance can lead to medical errors, corruption, and poor communication between health professionals and patients.I hope that hospitals in China will become safe by increasing governmental investment, vigorously promoting primary prevention of chronic diseases, spreading public health literacy, and improving the status of doctors.I declare no competing interests. We are thankful to The Lancet for covering hospital violence in China.1The LancetViolence against doctors: Why China? Why now? What next?.Lancet. 2014; 383: 1013Summary Full Text Full Text PDF PubMed Scopus (125) Google Scholar According to a survey by the Chinese Hospital Association between December, 2012, and July, 2013,2Jia X Zhou H Zhao Y et al.Investigation on hospital violence 2003–2012 in China.Chinese Hospitals. 2014; 18 (in Chinese).: 1-3Google Scholar violence against medical staff has increased from 20·6 assaults per hospital in 2008, to 27·3 in 2012, based on data from 316 hospitals in more than 30 provinces. 96% of medical staff have been abused or injured in 2012, and 39·8% of staff planned to give up the medical profession or switch to another profession.2Jia X Zhou H Zhao Y et al.Investigation on hospital violence 2003–2012 in China.Chinese Hospitals. 2014; 18 (in Chinese).: 1-3Google Scholar What is the reason for this surge in hospital violence in China? First, there is a serious shortage of investment in health. China's population accounts for 22% of the world's total population, whereas China's total health expenditure accounted for only about 2% of the world's total expenditure. In 2008, the total health expenditure was only 4·3% of GDP, health expenditure was 10·3% of government expenditure, and health expenditure was US$146 per head in China, whereas in the USA these were respectively 15·2%, 18·7%, and $7164. The number of physicians per 1000 citizens is 1·4 in China, whereas it is 2·7 in the USA.3Ministry of Health of the People's Republic of China. China Health Statistics Yearbook 2012. Beijing: Peking Union Medical College Press.Google Scholar Second, medical costs increased rapidly. The total health expenditure rose from ¥361·9 to ¥1490·1 per head and out-of-pocket health expenditure nearly tripled from 2000 to 2010.3Ministry of Health of the People's Republic of China. China Health Statistics Yearbook 2012. Beijing: Peking Union Medical College Press.Google Scholar Third, there is an imbalance between high workload and low income for doctors. About 80% of doctors describe themselves as overworked and underpaid. For example, in my hospital, from 2001 to 2012, the number of admissions increased from 1·423 million to 3·504 million, an annual average rate increase of 7·8%. The number of inpatients increased from 22 406 in 2001 to 70 424 in 2012. The number of surgeries tripled during the same period of time. However, the number of doctors increased from 438 to 720 during the 12 years, an annual average increase of only 4·23%; therefore, the workload greatly increased from 12·94 to 19·39 patients per doctor per day, a 49·79% increase. Even in cities, many doctors earn as little as ¥5000 ($780) a month or less. The imbalance can lead to medical errors, corruption, and poor communication between health professionals and patients. I hope that hospitals in China will become safe by increasing governmental investment, vigorously promoting primary prevention of chronic diseases, spreading public health literacy, and improving the status of doctors. I declare no competing interests. Violence against doctors: Why China? Why now? What next?China's National People's Congress ended on March 13. The event is important not only as the sole annual country-wide gathering of political representatives, but also because it marks the first full year in office for President Xi Jinping and Premier Li Keqiang, so gives a sense of the new government's priorities. The theme of deepening reform was repeated frequently. Nowhere is this required more urgently than for health care. Deterioration of doctor–patient relationships has emerged as a highly visible risk to China's ambitious health-care reform. Full-Text PDF
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