Just over two weeks since Beijing launched major medical reforms, the city’s health bureau has been forced to respond to local residents’ complaints about the rising cost of care.

Before April 8, a visit to a doctor at a top-tier hospital in the capital cost patients just 2 yuan ($0.30). Now, however, patients pay at least 10 yuan, provided they are entitled to treatment under the city’s public health insurance system. Formerly a small administrative fee, the charge has been recategorized as a “medical service charge,” a move that residents suggest is a poorly disguised levy on patients.

“I visited three doctors to confirm my problem, which cost me 24 yuan more for a clear diagnosis than I’ve paid in the past,” complained a Beijing woman surnamed Li to Party mouthpiece People’s Daily two days after the reforms went into effect.

On Monday, the capital’s health and family planning commission explained that the newly imposed charge includes the original registration fee plus additional management fees, and added that the extra revenue will go directly toward subsidizing hospitals’ daily operations. It also noted that patients should save money when buying medicine, as hospitals are no longer permitted to profit from drug sales.

The majority of China’s hospitals are heavily under-resourced, and hospital administrators routinely use money made from the sale of drugs to help close the funding gap. The Beijing government wants to change this model, which leads to high prescription prices and dubiously moral relationships between doctors and drug companies.

Since 2012, the city’s government has been testing this new approach in five hospitals. However, most residents only learned of the policy change when the reforms were rolled out citywide earlier this month.

Li Sufang, vice director of the city’s development and reform office, said the pricing standards of medical services at the city’s public hospitals were set in 1999, before this latest round of reforms — and as a consequence, public hospitals had been long relying on revenue from drugs to sustain their normal operations.

“The disadvantages of such a mechanism have become increasingly obvious in recent years — like over-prescription and doctors’ preferences for prescribing expensive drugs,” Li said in an interview with People’s Daily. “This increases the burden both on the country’s health insurance funds and on patients.”

A dermatologist at a top-tier hospital in Beijing, who insisted on anonymity for fear of negative professional consequences, told Sixth Tone she has heard rumors that suggest 60 percent of the new revenue stream could be used to increase medical workers’ salaries. But she’s not convinced the change will make a significant difference with respect to patient care. “Under the new scheme, it seems the quantity of patients a doctor sees will determine their level of income,” she said. “Until this changes, I don’t think quality of service will improve.”

Since the start of the reforms, Beijing’s public hospitals have also abolished the policy of marking up drug prices by a standard 15 percent. Official statistics from the city’s health commission indicate that 150 million yuan has already been saved during the reforms’ first 10 days, which translates to an 8.5-percent reduction in spending by patients.

But for residents who are only looking for a diagnosis, this number makes little difference in how they feel. “My observation is that the registration fee, though replaced by a new name, has been hiked by five times,” Zhang Shuangfeng, an office worker in Beijing, told Sixth Tone. “It’s a bit hard to accept. It’s not that the absolute price of 10 yuan is too high; there’s just no buffer zone for such an increase. Besides, the cost of living in Beijing has soared in the past few years — that’s why residents here can’t help complaining about this new change.”

Editor: Sarah O’Meara.

(Header image: Patients stand in line to register at a hospital in Beijing, April 8, 2017. Zhuo Ensen/IC)