Appointment ticket touts are prevalent in the medical system in China, especially in big hospitals. They monopolize appointments for well-known doctors and increase prices to very high levels. The practice of ticket touting is causing many disputes and is harming the doctor-patient relationship. There have been reports in the media of doctors who have been injured by ticket touts.  Patients have also openly criticised ticket touts for hiking up the prices of appointments to unaffordable levels.
More than half the population of China live in rural areas, but the number of village doctors is very small. What’s more, village doctors cannot meet the growing healthcare needs in rural areas because of their lack of resources and the lack of opportunities for educational training to continue professional development. Meanwhile, high-quality medical services are concentrated in Beijing, Shanghai, Guangzhou, and other developed cities. There is also no established family practice or dual referral system in China. As a result, patients flock to large hospitals in big cities to access better medical services, leading to high demand and overcrowding in these large hospitals. Because of the mismatch between supply and demand for high-quality medical services, ticket touts have managed to gain control of appointment tickets. They operate in many big hospitals around China, buying up appointment tickets in bulk and selling them on to would-be patients for much higher prices to make a profit. They use other people’s ID cards or forged ID cards to buy the appointment tickets. When ticket touts find the would-be patients, they cancel the appointment and use the patient’s ID card to make an appointment. Additionally, some ticket touts can get some temporary tickets from doctors without ID information and sell these to patients. The touts make it more difficult for poorer patients to see doctors, and worsen the relationship between patients and doctors.
Ticket touts are taking away the freedom for patients to see a doctor and this has led to widespread discussions on Chinese media. Recently, some big cities like Beijing, Shanghai, and Guangzhou have encouraged patients to use electronic platforms for medical appointments. However, some ticket touts still use fake IDs or other people’s IDs to buy multiple tickets for profit. Therefore, more work is needed to prevent this. The ticket registry system could be linked to a police security system to validate the personal ID information and flag up fake IDs.
Additionally, the proportion of general practitioners is too low. The healthcare system in rural areas needs to be improved.  It needs to be made more attractive to medical students, so authorities should offer good training programmes as well as higher wages and allowances. Robust primary care backed up by qualified family doctors is the only solution to the problem.
Last but not the least, China should set up a hierarchical medical system to improve services at county and township-level health centers, especially in less-developed areas. Many community-level public clinics are empty, but large hospitals are crowded—this needs to change. Only with effective and prompt actions will we be able to make ticket touts disappear from big hospitals.
Yiran Wang, Ning Wang, Yajie Wang, Department of oncology, Changhai Hospital, Second Military Medical University, Shanghai, 200433, China
Competing interests: none declared.
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