Harriet Clompus went to Beijing and saw the effects the drastically changing society is having on health

Showing such eagerness to get inside a hospital while on my hard earned summer break may seem to border on the pathological. But I had the chance, I had the language, and so I donned a beautifully starched and pressed white coat and went on the rounds of the 700 bed general hospital, the Railway Hospital, in Beijing, in the People's Republic of China.

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The way the healthcare system is run in China is completely different to what I'm used to in the United Kingdom, and it takes a little while to get your head round it. Surprisingly, in the largest socialist country in the world, healthcare is anything but free.

Until the late 1980s most Chinese people belonged to "work units," which provided not just a job but welfare from the cradle to the grave, including housing, education, and health care.

Now the unit system is breaking down as the economy becomes more market based. This is good in many ways as work units were a method of social control, interfering in all areas of life, even deciding when couples could have a child. People can find jobs on the free market, are paid a market salary, and are free to live where they like and leave when they want. At the same time, they pay their own way in the health and education markets.

In the countryside, the breakup of the unit system has devastated the rural healthcare system. In many areas not even rudimentary facilities exist, and no money is available to pay for them even if they did. There is simply nothing available for many peasants.

In the cities there are still "unit" hospitals, such as the Railway Hospital. These are open to unit workers and their dependants and, if there are beds left over, to anyone else who comes in. Everyone pays for treatment, although fees are subsidised and cover only about 30% of the hospital's running costs. Additionally, there are hospitals that are not affiliated to any unit, where the only requirement for entry is ability to pay.

The doctors who showed me round the hospital expressed incredulity when I explained that we really did (more or less) have socialised medicine in the United Kingdom, with funding through the tax system, with no one paying at the point of need. "But surely you pay for the best drugs; surely only the rich get them," they kept saying. I proudly said that no, medicine was based on need. However, I also had to admit that we had massive waiting lists and it could take months to see a hospital consultant, let alone have elective surgery.

In the Railway Hospital you just need to turn up to get treatment. Instant access reflects the fact that there is no primary care system, so hospital is the only port of call. After being assessed by nurses, patients are sent to the relevant specialist. These include all those you would expect in a British general hospital, plus practitioners of Chinese traditional medicine, who have five years of university training and are integrated into the system.

Patients can elect to see a named senior consultant in any specialty for £1, or an unnamed junior doctor for 60p. Investigations and medicines are extra--magnetic resonance imaging, for example, costs £50. If hospital admission is indicated the consultant will find a bed straight away. Operations take a few days to organise, and patients stay in hospital while they are waiting for surgery. Daily hospital charges are £3, food is £1, and medicines as per cost, and patients have to pay a deposit on admission. These charges may seem low, but some people in Beijing earn as little as £50 a month.

Dr Gao, a senior doctor on the infectious diseases ward, was my main guide in the hospital. Her ward was bright and spacious with four side rooms with two beds and two single sex rooms with eight beds. Twenty beds were occupied when I was there, looked after by 10 nurses and six doctors. Three patients had hepatitis B, the remainder diarrhoea and vomiting. AIDS patients are treated on dedicated wards in two Beijing hospitals. Tuberculosis is treated in an isolation annexe at the Railway Hospital, which was empty while I was visiting.

Hepatitis B has a 10% carrier rate in China and leads to liver cancer in 10% of cases, so it is a massive health problem. There is no immunisation programme, and treatment is basically supportive. ß interferon has some efficacy but is beyond the financial reach of most. Liver transplantation is rare because of a lack of available organs (nearly all come from executed prisoners) and a dearth of skilled surgeons.

The diarrhoea patients were all on penicillin drips.

Stool samples are taken, but usually no organism is found as patients often attempt to treat themselves with antibiotics (which can be bought over the counter) before going to hospital. Doctors are aware of the massive abuse of antibiotics and the danger of resistance, but are possibly guilty of contributing to it by administering antibiotic by drip on demand, even for known viral illnesses such as flu.

The doctors stressed how important it was to treat patients with respect. However, some of their comments, "Gosh, you're really fat" and "Have you got a death wish, eating that dirty food?" went against this. Such frankness is typical of Chinese discourse, and patients were not in the least put out.

Overall, I was left with the impression of extremely friendly, curious staff, conscientious in their work but a bit put out by low salaries and a perceived decline in respect from patients. They seem to be slightly less frantic than UK doctors. A ratio of doctor to patient of 1:2.5 and the fact that they don't have to write any letters to general practitioners give them slightly more time.

The overwhelming difference was the financial arrangements. The Chinese doctors could not conceive the United Kingdom's medical system and, although they said they would treat a penniless patient who turned up as a life and death emergency, anyone else who couldn't pay would be turned away. Dr Gao says: "If we had socialist medicine it would bankrupt the country."

As I left, I thought about the young woman in hospital basically because she needed a rest, and contrasted her with an emaciated, ill looking elderly man with a hacking cough who I had seen selling melons in the countryside the week before.