On the night of January 23, 2020, over 18 million people tuned in to a live broadcast on the Chinese state TV network CCTV: the construction of a hospital on the outskirts of Wuhan had begun. Authorities had just closed this city in central China due to a strange virus that had not yet been named but had overwhelmed the emergency rooms of major medical centers. Many viewers did not want to miss the promised mammoth construction in record time: building a 25,000 square meter hospital with 1,000 beds in 10 days.
They met the deadline. Just like with another new hospital with 1,600 beds built in Wuhan in just one week. The rest of the world, still unaware of the upcoming pandemic, was amazed by the speed at which the workers in the Asian giant could build what the Chinese press dubbed "Noah's Arks". A name actually coined in 2003 when, amidst the SARS epidemic, Beijing built the Xiaotangshan Hospital in just seven days, with over 2,300 beds, twice as many as Madrid's La Paz University Hospital.
China, home to more than 1.41 billion people, has huge hospitals everywhere. It is estimated that there are approximately 35,000 public and 21,000 private hospitals, with the latter mainly concentrated in the most modern cities. Some, in times of health emergency, are erected in days and then, as in the case of those in Wuhan, are torn down just as quickly because they are no longer needed.
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There are also several giant centers that have expanded over the years. Such is the case of what many consider the world's largest: the First Affiliated Hospital of Zhengzhou University, located in the capital of Henan province in northern China. It covers a total area of 500,000 square meters and has over 7,000 beds. Its history includes a record of over 250,000 surgical operations and 350,000 hospitalizations in a year, with over 20,000 patients treated in a single day in outpatient areas.
Aerial view of the International Hospital of Xi'an, globally known for being the place where the Terracotta Warriors were discovered underground.
The Zhengzhou hospital spans several buildings, some up to 28 floors, and treats a wide range of conditions. It even has its own fire department and police station. This is the largest of the locally dubbed "superhospitals," centers with over 4,000 beds. China has over a dozen of them.
Also in the north of the country is the International Hospital of Xi'an, a city globally known for being the place where the Terracotta Warriors were discovered. In size, including the surrounding research campus, it is even larger than Zhengzhou. It covers an area of 530,000 square meters, with 5,000 beds. However, it has an internal transport system: a kind of golf cart that takes patients through different clinical areas.
The Asian powerhouse also boasts hospitals that float on water. Such is the case of the Silk Road Ark, a Chinese military hospital ship that made its debut last July, circling the disputed islands and reefs in the South China Sea. This 10,000-ton vessel, which will carry out international humanitarian missions and disaster response, can accommodate over 500 hospitalized patients and perform up to eight simultaneous surgical operations.
The International Hospital of Xi'an has an internal transport system: a kind of golf cart that takes patients through different clinical areas.
The effort in Chinese cities to build increasingly larger hospitals began mainly 10 years ago when census demographers started warning that the population was aging at an unprecedented rate. Currently, almost a quarter of the population is 65 years or older. Over the next 10 years, around 300 million people, currently aged between 50 and 60 years, will exit the Chinese workforce.
An aging population translates to increased pressure on the healthcare system. That's why many local governments embarked on building more hospitals and distributing them even in the most rural corners. However, the healthcare system remains overloaded in many major cities.
As explained in a report published in the Shanghai-based newspaper Sixth Tone, "Large hospitals act as magnets for a large number of people unwilling to entrust their lives to the medical staff of smaller clinics, which have poor local services and less qualified doctors. Superhospitals like Zhengzhou's represent a dilemma for policymakers: they meet a clear demand today, but in the long run, their presence may hinder achieving a more sustainable healthcare system in China."
The history of hospitals in the Asian giant
In the decades following the establishment of the People's Republic of China in 1949, many city residents were linked to the so-called danwei, a work unit supervised by the ruling Communist Party that covered medical expenses. Those living in rural areas were covered by agricultural communes that provided basic healthcare. Much of rural healthcare was provided by "barefoot doctors", as the peasants with very basic medical training who administered medicines were known.
After decades of economic openness that drove the country's development, public insurance programs arrived, which now, according to official figures, cover 95% of the population. There is basic medical insurance for urban employees, mainly funded by payroll taxes of city workers. Then there is basic medical insurance for urban and rural residents, which covers not only those living in rural areas but also self-employed city workers, minors, students, and retirees. The latter is mainly funded through government subsidies.
One of the most common complaints among Chinese is that much of this benefits package is ultimately decided by local governments, so it varies greatly from one province to another, leading to significant inequalities in terms of the quality and service of public healthcare. Publicly funded basic medical insurance covers hospital care and prescribed medications, although these are subject to different (albeit small) copayments. For example, outpatient visits in major cities like Shanghai usually cost between 10 and 50 yuan (between 1.30 and 6.30 euros).
A unique feature of hospitals is the integration of traditional Chinese medicine (TCM) with Western medicine. Patients visiting medical centers can choose between TCM-based treatments or conventional ones. In the Xi'an super-hospital, patients can take the golf cart to move through the corridors from the acupuncture area to the traumatology area.