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Fake it till you make it: Rent-a-Date and Chinese New Year

During Chinese New Year, parents press their kids to get married. To avoid the hassle, Chinese bachelors and ‘spinsters’ rent a fake boyfriend or girlfriend.

Manya Koetse

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Chinese New Year (also known as ‘Spring Festival’) is just around the corner, and Sina Weibo has started a countdown to the 31st of January. The anticipation of Spring Festival is evident in Weibo’s trending topic list, where ‘Going home for Chinese New Year’ or ‘Meeting the parents-in-law’ are subjects of the day. One important subject within the Chinese New Year excitement involves the pressure from parents for China’s singles to get married, and to bring home a potential partner for the holidays. To avoid the hassle, many Chinese bachelors and ‘spinsters’ decide to rent a fake boyfriend or girlfriend. This article sheds some light on China’s rent-a-date phenomenon – how does it work, what do netizens say about it and the most important question: why is ‘rent-a-date’ such a booming business during Chinese New Year?

It is the 27th of January, only four days before Chinese New Year. A girl who calls herself ‘White Tea’ uses her Weibo account to find a suitable escort for Spring Festival: “Renting a boyfriend for New Year,” she writes: “Time: the third day to the fifth. Location: Chengde. Requirements: 28-32 years old, 170 to 180 cm tall, living around the north of Yangtze River, minimum undergraduate education level, someone refined and not too ugly. Will take care of all costs and expenses for travel, food and stay. If you’re interested, send me a private message.” ‘White Tea’ is not the only one looking to rent a boyfriend for the holidays. The ‘rent-a-date business’ has been booming for a couple of years now. The demand for these kinds of services is on the rise due to two main issues: the large number of Chinese singles at marriage age, and the traditional societal expectations for them to get married.

whiteteaThe Weibo post of ‘White Tea’, asking to rent a boyfriend for Chinese New Year.
 

Since 1950, marriage officially became a ‘freedom of choice’ in Mainland China, abolishing the feudal marriage system of arranged marriages. Even though marriage became a free choice, it was still considered a “necessary and ‘natural’ step for each individual” (Croll 1981, 1-2). According to Confucian values, which are deeply embedded in Chinese culture, marriage is a family’s collaborative project. Traditionally, parents would arrange a marriage in accordance with social hierarchy. Confucian philosophy advocates the suppression of romantic feelings; marriage is an undertaking, a family business (Higgins et al 2002, 75). During the Mao years, romantic love was also discouraged. Expressing love, passion or sexuality was perceived as being bourgeois and highly individualistic; it did not contribute to the collective communist goal (Koetse 2008, 17). The end of the Mao era and Deng Xiaoping’s ‘Open Door’ policy in the late 1970s changed Chinese society in terms of economy, but also led to more freedom in love, sexuality and marriage (Higgins et al 2002, 75).

Due to the transformations in Chinese society in the late 1970s, there is a huge generation gap between the Chinese people that were born in the 1980s/1990s and their parents. Their differences in values and attitudes in terms of love and marriage do not only relate to the Open Door policy, but also to the implementation of the one-child policy since 1979. Because of preferences for sons and the practice of sex-selective abortions, the policy has affected the gender ratio within China, leading to a ratio of 118 males to 100 females (Burger 2012).

The problems caused by existing pressure on China’s young men and women to get married (which especially surfaces during the annual family New Year festivities) are a combination of 1) the difference in attitudes and expectations about love and marriage between parents and their post-1979 children, and 2) the (statistical) difficulty to find a suitable partner for China’s twenty and thirty-somethings.

With China’s surplus in men, it would be expected that females easily find a spouse. However, this is not the case for all women. In recent years, the issue of ‘leftover women‘ has been the focus of attention in many media reports both in and outside of China. The ‘leftover women’ are career-focused women with a good educational background, who are not ready to get married yet or are unable to find the right man. This also has to do with traditional views on marriage, where men look for a relatively young spouse (around the age of 25) who is a bit below him on the social ladder in terms of education or wealth, whereas women traditionally want a partner that is a bit above them in these aspects. This leads to a large number of smart, independent and good-looking women being ‘leftover’, as well as a large number of lower-educated and low-income men remaining unmarried.

Renting a date for New Year is especially convenient for ‘leftover women’. They often reside in China’s bigger cities and annually travel a long way to see their family. Because of their jobs and the distance between them and their hometown, it is only natural that parents have not met their ‘boyfriend’ yet. Due to their higher income, they can afford to rent an escort. Renting a boyfriend temporarily takes away the parental pressure or nagging questions from curious neighbors on why the daughter of the family is ‘still single’ at the age of 27 or above.

One can look for a date through Weibo, as ‘White Tea’ did, but most ‘fake boyfriends’ offer their services on Taobao Marketplace, China’s biggest online shopping platform. Searching for ‘rent a boyfriend’, many results come up with pictures of young men including their prices and description. A lady named Maoli complains on Weibo: “”I have just checked Taobao for renting a boyfriend for New Year, and there’s a bunch of selfies from ugly men selling themselves. Since when did this industry go downhill…?” The following are some examples of boyfriends-for-rent on Taobao:

 

2014pngThis man charges 300RMB per day. He describes himself as “not handsome, but pragmatic and stable”. In a short introduction about himself, he writes: “Man, 27 years old, 171cm, 65kg, Bachelor’s degree, working in Shanghai. Can work during holidays and weekends, or after office hours. Willing to travel outside the city. Will accompany you for shopping, car-rides, dinner parties, meeting your parents, social occasions, etc. I’m a happy talker and will cheer you up. Have had my driver’s license for three years. Can drive a car with shift stick. I’m a stable guy with a good sense of humor. We can negotiate my price. But if the feeling is right, I might do it for free.” 

 

rentabeauzwart

This young man is available for rent throughout the country. He asks 200RMB per day. For driving, he asks 30RMB per hour. For talking about love-related issues, he asks 30RMB per hour, for listening and appearing very interested he also asks 30 RMB. For meeting friends: 50 RMB per hour. Meeting family: 100 RMB per hour. For sleeping on a sofa, there’s an additional fee of 100RMB. In his accompanying text he writes: “Every single young woman is in distress before New Year’s. During family meals, there’s always nagging: ‘You’re all grown up now, why don’t you have a boyfriend yet?!’ The pace of today’s society is so fast. It’s not that you don’t want to search, but because of several reasons (..) your social circle is narrow, and there are no right men to choose from. Watching other couples in love at parties makes you feel akward and even more lonely (…) But now! Like every single lady wants, for a small prize, you can bring a handsome rented boyfriend to any occasion to save your dignity. I will save you from your parent’s pressure to get married. In any akward social situation, I will help you face your friends. (..). Height: 1.78. Weight: 70 KG. Appearance: Very good. Education: Bachelor’s degree. Occupation: Engineer in IT. Skills: Driver’s License, Singing, Cooking, Household, Drink Alcohol, Physically Fit, Can Also Function as Bodyguard. Qualities: Self-possession, Good Taste, Pragmatic, Strong Views, Appreciation of Life, Art and Spirituality. Weak Points: I smoke (I can stop smoking if client desires so) (…).

 rentboyfriendzwart

This young man from Fujian charges 500 RMB per day. He is prepared to join you for dinner, dates, and for meeting your parents. He can be booked anytime between January 28 until February 6th. He will not travel outside Fujian. Can be booked for one or multiple days. He is willing to bring gifts to please your parents, but you will have to buy them yourself. 

 

In the end, renting a partner to satisfy the family does not solve the deeper issues behind the phenomenon. On the long term, the gender ratio between Chinese men and women will have to become more balanced; the one-child policy is already being loosened. On a short term level, traditional ideas about the ideal marriage age and the requirements for potential spouses will have to undergo serious transformations. In the end, Confucius might have to make some room for Cupid in order to let love rule. And if Cupid’s arrow misses, there is always Taobao.

Happy New Year.

 
References
Burger, Richard. 2012. Behind the Red Door: Sex in China. Hong Kong: Earnshaw Books.
Croll, E. 1981. The Politics of Marriage in Contemporary China. Cambridge: Cambridge University Press.
Higgins, Louis, Mo Zheng, Yali Liu and Chun Hui Sun. 2002. “Attitudes to Marriage and Sexual Behaviors: A survey of Gender and Culture Differences in China and the United Kingdom”. Sex roles 46(3/4): 75-89. 
Koetse, Manya. 2008. “Shanghai Baby: China Voorbij. Een Chinese roman verbannen naar het westen”. Bachelor Thesis Literary Studies. Amsterdam: University of Amsterdam.
 

Manya Koetse is the editor-in-chief of www.whatsonweibo.com. She is a writer and consultant (Sinologist, MPhil) on social trends in China, with a focus on social media and digital developments, popular culture, and gender issues. Contact at manya@whatsonweibo.com, or follow on Twitter.

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Backgrounder

Coronavirus on Chinese Social Media: The 8 Major Trends in Times of the 2019-nCoV Crisis

The 8 main trends defining the online responses to the Wuhan coronavirus on Chinese social media.

Manya Koetse

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Since the outbreak of the new coronavirus becoming big news in China and around the world, there have been few other topics going trending on Chinese social media than those related to 2019-nCoV. What’s on Weibo gives an overview of the most noteworthy online media trends in China regarding the corona-crisis.

 
By Manya Koetse, further research and news-gathering by Miranda Barnes
 

From panic to patriotism, the outbreak of the coronavirus has led to a wide range of different responses from Chinese netizens and online media outlets over the past few weeks.

Although the first reports on the emergence of a pneumonia-like illness in the city of Wuhan came out in late December, it wasn’t until mid-January that the new virus, belonging to the coronavirus family, started dominating the top trending lists on social media in China and beyond.

The hashtag “Nationally Confirmed Cases of New Pneumonia” (#全国确诊新型肺炎病例#) became one of the biggest news-related topics we have ever seen on Weibo, receiving eight billion views by January 25, and reaching a staggering 13,5 billion views by February 2.

As of February 6th, approximately 28,200 cases of the new virus were confirmed, with over 170 cases reported in countries outside of China. The death toll also became much higher than days before, rising to 564. With these numbers, the coronavirus has exceeded the scale of the 2003 SARS outbreak in terms of infected patients.

Along with the quick spread of the new coronavirus across the country, the general mood and direction of the discussions and trends in the Chinese online media environment have also been in constant flux.

At What’s on Weibo, we have been glued to our social media screens, but because editor-in-chief Manya Koetse has been flooded with daily media requests we have not been able to update the site with regular updates (meanwhile, @manyapan did post regular updates on Twitter).

Here, we will highlight some of the main social media trends we spotted during the outbreak of the new Chinese coronavirus, now and over the past weeks.

 

TREND #1:

Online Backlash against the Eating of Wild Game

As an online media panic broke out around January 20, when a third person had died of the new Wuhan virus, one of the main trends to come up on Chinese social media was an online backlash against the eating of wild game (as reported here by Jessica Colwell).

The backlash flooded Weibo after the downtown Wuhan Huanan Seafood Wholesale Market (武汉华南海鲜批发市场), selling a wide range of dead and alive wild animals – anything from snakes and crocodiles to rats, hedgehogs or bats, – was identified as the suspected source of the deadly coronavirus outbreak.

Image posted by Sina Parenting on February 1st.

Since Chinese researchers linked the novel coronavirus (nCoV-2019) to bats, videos and images of bat dishes and people eating bat soon made their rounds on social media.

Many of these videos were actually unrelated to Wuhan, but were used in condemning the practice of eating (illegal/unsafe) wild game in general.

Around January 23, hashtags such as “Support the Banning of Wild Game Markets” (#支持禁绝野味市场#), “Refusing Eating of Wild Game Starts with You” (#拒吃野味从我做起#), “Control Your Mouth, Refuse Wild Game” (#管住嘴拒绝吃野味#) went viral on Weibo.

As images or videos of people eating bats or other exotic animals soon also spread to Twitter and other non-Chinese social media, some English-language media labeled them as “xenophobic” or “racist” – ignoring the fact that the anti-wild game storm actually started in the Chinese online media environment.

Online information leaflet spread by People’s Daily, “Resisting the Consumption of Wild Game Starts with Ourselves”

State media outlets such as People’s Daily, for example, played a role in the online dissemination of information against the eating of wild game and actually hosted some of these hashtag pages on Weibo.

The main argument behind the backlash is that those eating (unsafe, illegal) exotic and/or wild animals could risk their own health and that of their community and that what you eat is also your responsibility in keeping others safe.

A news story of a man hunting wild animals for consumption made its rounds on Weibo this week.

The backlash against the eating of wild game and online anger against people hunting or illegally buying wild animals for consumption is still ongoing, with some directing their anger against Wuhan people in specific.

This has also triggered discussions on Weibo about discrimination – not against Chinese people in general, but against Chinese netizens discriminating against Wuhan people or even against people from the Hubei province.

 

TREND #2:

Fake News and Censorship

Chinese social media platforms such as Weibo are tightly controlled online environments. When certain sensitive topics pop up, such as the anniversary of the Tiananmen protests, the Hong Kong demonstrations in their early phases, or big political events, virtually all related posts and news sharing will sometimes be removed by online censors.

In the wake of the coronavirus outbreak, this was not necessarily the case. From the start, there was a lot of reporting, sharing, and discussion of the virus online.

However, there certainly has been ongoing censorship of the topic. This was mainly done in the case of netizens reposting videos of chaotic situations in streets or at hospitals, but also in the case of ‘fake news’ posts (mostly called “starting rumors”).

Posts that could potentially trigger unrest or panic also were censored. One hashtag that made its rounds around January 22 was “Escaping Wuhan” (#逃离武汉#), with people trying to leave Wuhan before the city would go on lockdown. That hashtag page was soon completely removed from Weibo.

The comments sections of some posts reporting on controversial or sensitive news were also completely turned off (such as this report addressing local authorities in Wuhan allegedly taking donated face masks).

One Weibo user (@魔女小稀), an alleged nurse, posted a video of people in a hospital hallway on January 24th, claiming that “three [dead] bodies” had been lying in a Wuhan hospital for the entire afternoon covered in white sheets without being removed.

The post and the Weibo user were completely removed from the platform on January 25. By that time, however, the video and allegations were already picked up and reposted internationally.

According to Sina News, the post had been completely false; there were no bodies lying around this Wuhan hospital. If there were people covered in white sheets, it was merely people sleeping in the hallway after waiting for a long time.

This is but one of many examples of ‘fake news’ floating around Chinese social media over the past two weeks, with images and videos being placed in a misleading context, people claiming that patient or deceased numbers were much higher than those reported by the official media, and some even bringing up conspiracy theories about the source of the coronavirus (e.g. that the Americans started it, that it leaked from a biolab in Wuhan, etc).

The problem in this issue is, of course, when do we call it ‘fake news’ and when do we call it ‘censorship’? Amid the chaos and uncertainty of the coronavirus outbreak, it is not always easy to separate the two.

This is also a contributing factor in the general distrust in official media reports that clearly surfaced on Weibo over the past weeks. “I don’t believe it,” is a sentence popping up everywhere on social media.

Spreading online “rumors” is a crime under China’s Criminal Law and is punishable by up to seven years in prison. Although some foreign media outlets, such as this one, make it seem as though it is illegal to share fake news about the coronavirus in particular, it is actually illegal in China to share fake news in general.

 

TREND #3:

Virus Vigilantism

Another trend we noticed on social media during the wake of the coronavirus outbreak is not just a distrust in official media and authorities, but also distrust in fellow citizens.

One clear example that blew up on Weibo is that of a young woman from Wuhan who posted about her traveling to France – and enjoying nice food – despite suffering from a fever and cough. Because she took fever reducers, she claimed to have passed airport temperature monitors without issue.

The post sparked great anger among Chinese netizens and triggered the so-called ‘human flesh search engine,’ with people digging into her personal details.

The incident even led to the Chinese embassy in France investigating the matter. The woman turned out not to have been infected with the virus.

But there are many examples of people exposing and doxing those who allegedly are hindering the collective goal of minimizing the risk of a further spreading of the virus, for example by not self-isolating after visiting Wuhan.

There’s also been widespread online condemnation of people stealing tissue paper from public elevators. Many apartment buildings around China now provide a box of tissue paper for hygienic reasons so that people do not need to touch the elevator buttons.

Surveillance videos of people stealing these boxes have been making their rounds on Weibo and WeChat, such as this lady in an elevator in Chongqing, with thousands of netizens expressing their anger over their behavior – and sometimes naming and shaming them.

 

TREND #4:

Social Media as a Practical Communication Tool

Soon after the scale of the coronavirus outbreak started to become clear, social media platforms such as Weibo were started to be used as practical communication tools for authorities, (medical) organizations, and individuals to spread information or to ask for help.

Social media is now widely used as a practical communication tool for very general matters in the coronavirus crisis (e.g. providing information on how to avoid getting the virus), but also for more specific issues.

Various hospitals in Wuhan, for example, spread digital leaflets online summing up their specific shortages in supplies (face masks, surgical gloves, etc), and how people and organizations can contribute.

Another example is how authorities at various times use social media to search for people who were on board of certain trains or where passengers were later diagnosed with the virus.

But we have also seen individuals reaching out through social media. One woman, for example, reached out to netizens online after she and her husband fell ill and needed someone to look after their children.

Through the help of social media, there are now also local volunteers who help taking care of people’s pets while they are unable to return home to feed them.

One of the hashtags increasingly receiving attention online since early February is “Rescuing the Pets Left Behind in Wuhan Homes” (#武汉滞留家中宠物救援#).

Since January 26, Tencent’s WeChat has also opened a special “epidemic supervision” channel within its app where WeChat users can go to get the latest local information about the virus in their area or ask for medical help.

 

TREND #5:

Propaganda, Pride and Patriotism in Times of Crisis

The outbreak of the coronavirus coincided with the most important holiday of the year in China: the Spring Festival. On Friday, January 24, the CCTV broadcasted its annual Spring Festival Gala (Chunwan), a 4-hour long show that has been airing since 1983. The show is the biggest live TV event in the world, with a viewership of one billion.

The show is usually meticulously planned up to every second – with rehearsals starting months before -, but this year, for the first time ever, it included a segment on the Wuhan coronavirus outbreak. It showed scenes from inside a Wuhan hospital, and the show’s main presenters paid their respects to all the medical workers working day and night.

The event became trending on Weibo under the hashtag “For the First Time in History, ‘Chunwan’ Includes a Non-Rehearsed Segment” (#春晚历史上首次没有彩排的片段#)

It was during this time, with twenty million people under travel lockdown, that the sentence “Jiayou Wuhan, Jiayou Zhongguo” (“Come on Wuhan, Come on China”) was propagated by state media and became widely used on Chinese social media.

By now, the hashtag “Go Wuhan!” (#武汉加油#, hosted by Party newspaper People’s Daily) has over 12 billion views on Weibo.

“1.4 billion Chinese salute you”

Starting from the Spring Festival weekend, Chinese state media began to propagate more positive, patriotic, and nationalistic messages online during the corona crisis, focusing on the unity of China and the dedication and resilience of common Chinese people, with a specific emphasis on medical and army staff.

It is not uncommon, or actually rather common, for Chinese authorities and state media to propagate nationalism in times of hardship (also see our article on online propaganda during the Hong Kong protests).

 

TREND #6:

Quarantine Boredom: From Panic to Humor

From late January, the first humorous memes and videos starting flooding Chinese social media in light of the coronavirus.

Around January 25, there were over forty confirmed deaths due to the new coronavirus and over 1380 known infected patients. Along with the travel lockdown, most of the major tourist attractions across China had shut down, and driving bans were implemented in the city of Wuhan to restrict people’s movements in efforts to contain the outbreak.

What was supposed to be a time of joy and reunion and entertainment (the Chinese New Year) turned into a time of fear and self-isolation for many families in Wuhan and beyond.

Practically locked up in their homes, some people used humor as a ‘defense mechanism’ in times of coronacrisis.

The videos embedded in the thread below are some examples of people making the most of their times in lockdown.

But besides the creative solutions of people avoiding boredom inside the home, there were also many memes going around WeChat and Weibo making fun of the extreme measures taken by people and authorities, such as this photo below that was allegedly taken at a station in Yiwu, Zhejiang, saying: “Some people got off the train in Yiwu but thought they’d ended up in Saudi Arabia.”

There was also this viral image below of an office canteen where people were self-isolating for safety reasons, saying: “Eating at the cantine of my unit now feels more like taking an exam.”

Videos and images of people using sanitary pads, bras, plastic bags, or even fruit to protect their faces due to a scarcity of face masks also continue to make their rounds on social media, with people sometimes mocking neighbors, their friends or family, or even themselves in the extreme and sometimes silly measures they are taking to avoid getting the coronavirus.

 

TREND #7:

Anger against Local Authorities and Illegal Lock-Ins

As panic over the spreading coronavirus has become bigger over the past few weeks, the voices criticizing local authorities and organizations for mishandling the situation have also grown louder.

While loud criticism of the central government is usually censored before triggering bigger discussions, there has been ample criticism of provincial, city, and county authorities and organizations – and not without consequence.

In Hubei, local authorities have been criticized for, among others, initially censoring reports of an emerging new illness in December of 2019.

The mayor of Wuhan, Zhou Xianwang, became a major target of netizens’ anger. In late January, Zhou admitted that he had failed in disclosing information in a timely manner and also “did not use effective information” to improve the local government’s work.

The Hubei branch of the Red Cross Society of China (RCSC, 中国红十字会) also received massive criticism online in early February when it turned out that, while the public donated medical supplies and money, most of it remained in the Red Cross warehouse.

On February 4, Chinese state media reported that the Hubei Red Cross deputy director had been removed from office and dismissed from the leading Party members group of the RCSC branch.

On village and prefecture-level, there has also been public condemnation of how authorities are handling the corona crisis.

Some videos going around social media showed how people, seemingly against their will, were locked up inside their own homes by local authorities after returning from Wuhan (“武汉返乡人员”).

China Youth Daily, the official newspaper of the Communist Youth League of China, also condemned these practices as “illegal” and “inhumane” in an article that has since been deleted.

Through a new WeChat function mentioned earlier in this post, Chinese netizens can now also report any mishandlings of the coronavirus situation.

At the time of writing, there seems to have been some increased censorship, but nevertheless, criticism on local authorities keeps flooding Weibo.

“While people are busy helping themselves and each other, what are the leaders of Hubei and Wuhan doing?”, some people wonder: “Supplies in the hospitals are still scarce, there are still people who are unable to receive help!”

 

TREND #8:

Corona Panic Buying

It was around January 21st when the coronavirus panic reached a peak in China; a third infected patient had died of the virus the day before, the first cases were confirmed outside of China, and several big travel platforms had started to offer refunds or change flights via Wuhan.

Similar to the SARS outbreak in 2003, news of the coronavirus led to waves of “scare shopping” – a trend that also became very visible on social media.

Medical face masks soon sold out in Chinese pharmacies and on e-commerce platforms: around 80 million face masks were sold on Alibaba’s Taobao platform alone on January 20 and January 21st. Those (online) shops still offering face masks exploited the shortage of face masks, and would only sell them at exorbitant prices.

Twenty dollars for a face mask?

Although Alibaba soon announced it would remove sales of face masks from shops that were selling them at unstable prices, the sales and availability of (disposable) N95 masks is still an issue across China, with netizens complaining about it on Weibo every single day.

Another example of consumer panic followed the Jan 31st reports by two medical research institutions on the TCM oral medicine Shuanghuanglian, which would allegedly be effective in combating the new coronavirus.

Shortly after the reports came out, the herbal remedy sold out in stores across the country.

Chinese state media now warn people against “irrational purchases,” saying that the effectivity of herbal remedies such as Shuanghuanglian is still unsure.

Panic buying is a trend that is not just visible on Chinese social media, it is a trend that also seems to be triggered through social media, with rumors and reports of existing shortages of certain products leading to panic.

A clear example is the February 5 run on toilet paper in Hong Kong after rumors spread that the coronavirus outbreak would lead to insufficient supplies.

 

As there are still many new developments and news reports coming out concerning the coronavirus, we will keep on publishing more on What’s on Weibo about what’s trending on Chinese social media. (Also read: Distrust and despair on WeChat and Weibo after the death of Wuhan whistleblower Li Wenliang).

If it’s quiet here, please also follow us on Twitter here and here.

By Manya Koetse, additional research and news-gathering by Miranda Barnes
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Backgrounder

‘Good Doctor’, Digital Hospitals: How Mobile Apps Are Alleviating China’s Healthcare Problems

With the rapid digitalization of China’s healthcare, Chinese patients now have more ways than one to receive medical assistance.

Manya Koetse

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China’s healthcare industry is facing some serious challenges. As Chinese society is rapidly digitalizing, mobile apps now provide innovative solutions to alleviate pressing problems in the country’s health services sector.

 
This is the “WE…WEI…WHAT?” column by Manya Koetse, originally published in German by Goethe Institut China on Goethe.de: “Good-Doctor Apps und Digitale Krankenhäuser.” 
 

Social Credit System, artificial intelligence, surveillance cameras; these are some of the hottest topics making headlines in mainstream Western media when discussing China-related developments recently.

With the rapid digitalization of Chinese society, these topics certainly have come to play a more important role in social media discussions within the People’s Republic of China (PRC). But if there is one issue that seems to concern Chinese social media users the most, it is not facial recognition nor their ‘Sesame score’: it is the topic of healthcare.

In December of 2017, a photo showing a crying mother kneeling down beside a toddler on the sidewalk in front of a Shanghai hospital went viral overnight. The moment was captured on camera by a reporter who was visiting Shanghai’s Children’s Hospital.

The photo of Guo Yinzhen and her son that went viral in China (image via NetEase, source: https://3g.163.com).

The mother, Guo Yinzhen, is a single parent who had traveled from a remote village to seek medical help for her 3-old-son, who was suffering from congenital hydrocephalus or ‘water on the brain.’ Already having traveled to the city multiple times and spending all her money on medical bills, Guo could not afford the additional 100.000 yuan (€ 12.600) for medical procedures needed to save her son’s life.

Guo’s story struck a chord with Chinese netizens, who continue to share the heartbreaking photo on social media to this day. It has become emblematic of China’s healthcare problems.

 

Crowded Hospitals and ‘Healthcare Disturbance’

 

The key to an adequate healthcare system, no matter where in the world, is that there is a right balancing in the “iron triangle” of efficiency/cost containment, high quality care, and patient access.[1] China, however, struggles with all three sides of this triangle.

Guo’s case is an extreme example, but many people in China dealing with less serious health issues and needing basic medical services also struggle to afford and access the healthcare they need.

Over 95% of people in China have health insurance, but people from different regions do not enjoy the same benefits and their out-of-pocket expenses can vary greatly. Uncovered medical costs can sometimes be catastrophic and simply unaffordable for patients and their families.

As more money flows are going to healthcare facilities in China’s cities, there is also the issue of varying levels of providers’ medical education and the overall healthcare quality, with the substantial majority of modern hospitals still existing in urban areas.

Easy access to the right kind of healthcare can be especially problematic for China’s rural population, as people often need to travel long distances and have to go through the lengthy process of registering and waiting for their doctor’s appointment, which sometimes requires them to stay in the city overnight.

For all of these reasons, China’s bigger public hospitals can get super crowded, sometimes resembling shopping malls on an end-of-season sales day. On social media, both patients and medical workers often complain about the stress brought about by the huge crowds and the shortage of doctors in hospitals across the country.

Perhaps it is no wonder that China even has a word to describe outbursts of violence between patients and doctors: ‘Yī nào’ (医闹, literally: “healthcare disturbance”).

Weibo user ‘Sunscreen’ complains about the crowds at Huashan Hospital.

One major problem within China’s healthcare conundrum is the lack of local family or primary-care doctors, which often makes bigger hospitals the first stop to any kind of medical treatment for Chinese patients.

The reasons for this issue are manifold. There is a general lack of trust in private and smaller local healthcare clinics, for example, and patients often choose to go directly to a bigger hospital to avoid making extra costs.

This makes it extra difficult for many community health care centers – that are already struggling – to make enough money and to retain qualified staff. In a society that is rapidly aging, the challenges facing China’s healthcare industry are only becoming more pressing.

 

A Doctor Today, Just an App Away

 

As China’s online environment is thriving, new innovative online apps are popping up on a daily basis. Some of these apps, that have found their ways into China’s most popular app rankings, are offering solutions to some of the country’s most pressing healthcare problems.

One of these apps is Ping’an Good Doctor (平安好医生), which was developed by health insurance provider Ping’an in 2015 and calls itself China’s “one-stop healthcare ecosystem.”

“Ping’an Good Doctor” promotional image by Ping’an.

Employing some 1000 medical staff in its in-house team, contracting over 5,200 external doctors, and collaborating with 3000 hospitals and thousands of pharmacy outlets across the country, the app is somewhat of an “online hospital.”

Through the app, users can look through an online database of medical professionals, order medicine at nearby pharmacies, get 24/7 online medical consultancy, search for information about both Western and Chinese Traditional Medicine, etc., but they can also use Ping’an Good Doctor as a fitness app to track their own health.

Screenshot of Ping’an app screen, by author.

When looking for a specific doctor for a one-on-one consult, the app first lets users select an area of expertise (e.g. dermatology or gynecology), and then offers a list of different specialists in various price categories.

Doctors from well-known hospitals, for example, or those with excellent ratings, have a one-time consultation fee of 100 yuan (€ 12,60). Other doctors can be consulted starting from 30 yuan (€3,70). All costs can be paid efficiently via online payment apps.

Doctors to pick from within the app’s various price categories.

Ping’an Good Doctor uses an AI-driven system to ask patients various questions about their symptoms and to automatically create a user’s medical record to save time. Based on the AI-generated record and the conversation with the patients – files such as photos can also be uploaded to the app -, the doctors can prescribe medicine or refer the patient to a hospital for an offline appointment if needed.

Ping’an recently announced that its number of registered users exceeded 300 million users, with 62 million monthly active users. Because the app keeps building on its AI-driven system, Ping’an Good Doctor can be expected to only become a ‘smarter’ smart health app the more popular it gets.

Although Ping’an is now leading within China’s medical app category, there are many other apps providing similar services, such as Chunyu Yisheng (春雨医生), Haodafu Online (好大夫在线), or DingXiang Doctor (丁香医生).

The emergence of these apps is just one of the many ways in which China’s digital developments, online media, and tech giants are impacting the healthcare industry, profoundly changing how patients receive healthcare information and access medical services now and in the future.

List of recommended medical apps in the Tencent app store.

In a way, China’s medical consultation apps fill the void in offline primary care. Patients who would otherwise turn to hospital care as their first stop can now  access medical consultations any time, any day, at a relatively low cost. Those who suffer from relatively harmless conditions could be diagnosed by a medical specialist via the app and get the medicine they need within a matter of minutes. With the growing popularity of these kinds of apps, many patients no longer need to visit a hospital at all.

Are smart health apps such as Ping’an Good Doctor the solution to China’s healthcare problems? No, they’re not. Struggling mums like Guo Yinzhen will not find the help they need there. But they do contribute to a more efficient healthcare environment where crowd flows in hospitals can be reduced, and patients do not need to spend a lot of time and money to stand in hour-long queues to get five minutes of their doctor’s time.

Although smart health apps could not help Guo Yinzhen and her son, social media apps could. As soon as their story went viral in late 2017, Shanghai Children’s Welfare Foundation Xiaoxingxin offered to cover medical treatments for the little boy, with a notable pediatric neurosurgeon operating the child. According to the latest updates, the boy’s situation was “looking good.”

Hopefully, the same holds true for the challenging sides of China’s healthcare industry.

By Manya Koetse
Follow @whatsonweibo

[1] Burns & Liu, 2017: 3-4.

References/Linked Sources

Burns, Lawton Robert, and Gordon G. Liu. 2017. “Introduction.” In China’s Healthcare Industry: A System Perspective, Lawton Robert Burns and Gordon G. Liu (eds), pp-1-116. Cambridge: Cambridge University Press.

Economist, 2017. “China needs many more primary-care doctors.” The Economist, May 11 https://www.economist.com/china/2017/05/11/china-needs-many-more-primary-care-doctors [20.10.19].

Zhou, Viola. 2018. “Does China Have Universal Healthcare? A Long (And Better) Answer.” Inkstone, Oct 10 https://www.inkstonenews.com/health/china-translated-does-china-have-universal-health-care/article/2167579

This text was first published by Goethe-Institut China under a CC-BY-NC-ND-4.0-DE license (Creative Commons) as part of a monthly column in collaboration with What’s On Weibo.

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