A Tough Market to Crack – China Business Review. Foreign investors in China’s healthcare sector must work hard to reach their target clientele—China’s increasingly affluent middle class. ![]() James Glucksman and Roberta Lipson. The healthcare reforms that the PRC government announced in early 2. China’s large and growing healthcare services market. The reforms will boost healthcare spending by . Though most of the public funds will be used to build capacity and extend basic healthcare services, the reforms also hint at greater private participation in the sector. The rising wealth and discernment of China’s middle and upper classes make the country a potentially lucrative market for domestic and foreign private healthcare companies. Expectations of more personal and higher- quality service will likely draw patients to private clinics, where the staff- to- patient ratio permits a level of attention and excellence that is difficult to achieve in a public setting. These segments of the population will desire private clinics that focus on treatments of chronic conditions that require regular patient visits, such as dialysis and chemotherapy, or treatment of insulin- dependent diabetes, and centers that provide conception and pregnancy services, such as in- vitro fertilization. It is uncertain, however, whether foreign participants will be able to realize opportunities on a grand scale, because prospective entrants into China’s market face considerable regulatory hurdles. Moreover, Chinese consumers generally have entrenched, negative attitudes toward private healthcare—though these attitudes are slowly changing. Even with the potential obstacles to setting up private healthcare facilities in China, the government’s focus on developing grassroots and rural healthcare centers and county- level hospitals may provide foreign and domestic private investors new opportunities to enter the market at the urban premium- care and specialist levels. Signs the market is warming. As the quality of customer service in other sectors reaches new heights previously unknown in the People’s Republic, some Chinese consumers have begun to question why the country’s healthcare sector does not offer a similar level of customer service. For instance, the prevailing service model at Chinese hospitals and clinics does not allow patients to make appointments. Instead, patients queue to register to see a doctor, with some patients arriving at the hospital in the middle of the night to increase the chance of seeing their preferred doctor. Recently, several government directives have asked public facilities in big cities to institute appointment systems, but implementation has been difficult because of technical difficulties and high demand. To address the growing demand for patient- focused care, some state- owned hospitals have established VIP wings, sometimes in conjunction with private (including foreign) healthcare companies, where the surroundings and amenities are more pleasant. In most of these wings, however, only the patient’s room is special—offering more privacy, better furnishings, and extra attention from nurses. Once a patient leaves his or her room, the VIP aspect of the experience disappears. In addition, a small number of private hospitals and clinics have emerged in some of China’s major cities in the past 1. Hello my name is Sabrina Warren and I just wanted to send you a quick note here instead of calling you. I came to your Photo gallery InformationWeek.com: News, analysis and research for business technology professionals, plus peer-to-peer knowledge sharing. Engage with our community. ![]() Box). These facilities range from private dental clinics to multi- city hospital networks. They often operate on a much smaller scale than the average public hospital, allowing them to devote more time to each patient because of a better staff- to- patient ratio and lower patient numbers. The facilities also provide a more pleasant environment because they can devote more resources to their patients and facility maintenance. With all the talk about cutting Individual Unemployability benefits, the new VA secretary may be pushing for an even more radical step to VA disability compensation. Even more » Account Options. Sign in; Search settings. A few of these facilities have been established with foreign investment, though most are wholly Chinese owned. Obstacles to investment. Red tape. Healthcare services is a restricted sector in China’s 2. Catalogue Guiding Foreign Investment in Industry, which limits the speed at which new projects may be approved and increases the red tape associated with launching such projects. According to long- standing PRC requirements on the administration of joint- venture (JV) and joint- partnership medical institutions, foreign entities in healthcare services must have Chinese partners that hold at least 3. These JVs must have registered capital of at least . Foreign participants that want to have a presence in multiple cities, or at more than one site within a city, must establish separate JVs for each outlet. The approval process is onerous, requiring dual- track approval from China’s healthcare bureaucracy (the PRC Ministry of Health . Though provincial- level governments—instead of the central government—have provided commercial approvals for healthcare JVs since early 2. MOH in Beijing still oversees all JV applications for medical licenses. Thus, the central government retains significant control over the process. Even after a foreign investor establishes a private healthcare institution, the institution must overcome significant obstacles to hire clinicians. For instance, Chinese physicians’ licenses are held by the hospital where the physicians work rather than by the doctor as an individual. Until physicians are legally permitted to work in more than one facility, a development that is expected to occur in some jurisdictions in the next two to three years, physicians who want to work in a private facility must transfer their medical licenses to the private clinic, thus divorcing themselves from the perceived prestige, security, and social services associated with employment at the top academic hospitals. Moonlighting at a second clinic or hospital is technically permissible, but only with the express permission of the doctor’s primary hospital each time the doctor consults at another facility. Some doctors are reluctant to take a second job out of concern that their loyalty will be questioned, out of fear that their extra income will be garnished, or because it is too troublesome. Foreign clinicians may practice in China, but each jurisdiction has its own regulations regarding the licensing of foreign practitioners. Other jurisdictions, such as Beijing, require each doctor to take a board- level examination before issuing a license. Though Beijing’s exam is currently offered in English and Chinese, many facilities that employ foreign doctors are concerned that the English- language exam will be eliminated so that only fluent Chinese speakers would be able to practice medicine in Beijing. Foreign nurses who come to any jurisdiction in China and who have a foreign nursing degree must take a licensing exam that is administered only in Chinese. Individuals cannot submit license applications; only fully licensed medical facilities as future employers of the applicants may submit the applications. Though foreign physicians need to take the licensing exam only once while working in their jurisdiction, they must apply to renew their license each year. Once a foreign physician reaches the age of 6. To qualify, the doctor must prove that he or she has rare skills that are difficult to replace and will benefit China. This application process is difficult, and the approval rate is low. Finally, until recently, private and foreign- invested hospitals were ineligible for the permanent preferential value- added tax and business tax treatments that the PRC Ministry of Finance announced for many types of JVs over the last year. In November 2. 00. State Council issued a circular that includes private healthcare institutions in the exemption. Difficulty attracting patients. Once a private clinic is established, it must attract patients—a challenging task for many reasons. Restrictions on advertising In response to a wave of misleading or even false advertisements placed by some private clinics, most jurisdictions have clamped down on content and type of healthcare facilities’ advertising. Though the restrictions help deter false advertising, they also hamper facilities’ ability to communicate with potential patients. To reach potential clients without violating advertising restrictions, some facilities conduct extensive outreach activities, such as blood drives and on- site health checks, to acquaint potential patients with their services. Distrust of private clinics Many Chinese patients are reluctant to seek medical treatment at private facilities. This reluctance may be a legacy of China’s centrally planned economy, or it could derive from the unethical behavior of some early private healthcare providers. Whatever the reason, many Chinese citizens believe that medical treatment, along with certain other social services, are the natural preserve of the government and come to them as a right. As private facilities proliferate and begin to earn the trust of a broader spectrum of Chinese society, this traditional reticence is likely to fade, especially as busy Chinese families begin to value the convenience and personal nature of private facilities more. A segment of the population, consisting largely of Chinese citizens who have returned to China after years of working or studying abroad and other relatively affluent people, already gravitates toward private facilities. These patients value the convenience of being able to make appointments instead of queuing to see a doctor. If private healthcare facilities are allowed to accept China’s social health insurance (yibao) as partial payment of their fees, such facilities will likely grow faster at the high end of the market. To break even or earn a return on their investment, these hospitals must operate on a fairly large scale. In many cases, however, these facilities have found it difficult to attract sufficient clinical talent to serve patients on this scale, mostly because clinicians are reluctant to leave academic institutions for untried, new providers. State Bank of India Probationary Officers Exam Online Practice Test . State Bank of India Probationary Officers Exam ( SBI PO ) 2. Online Practice Test. Applications are invited from eligible Indian Citizens for appointment as Probationary Officers ( POs ) in Associate Banks of State Bank of India. Candidates selected are liable to be posted anywhere in India. Important dates for SBI Probationary Officers Recruitment Exam SBI PO 2. SBI PO’s Online Application Registration Starts from : 7 February 2. March 2. 01. 7SBI Probationary Officers PO 2. PRELIMINARY examination : 2. April 6th & 7th May 2. Tentatively )SBI Probationary Officers PO Prelims Exam Dates 2. SBI Probationary Officers SBI PO No. Phase – I : Preliminary Examination ( 1. 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