A booming economy and seemingly unstoppable growth across different industries has made this country a popular destination for corporations and expatriates all over the world.
In the past, the vast majority of international business took place on the Eastern seaboard of China, home to the better known cities of Shanghai, Beijing, Shenzhen and Guangzhou.
However, through to 2015 approximately three quarters of wealth creation in China is expected to take place outside of Tier 1 cities and in to Tier 2, 3 and 4 as China’s new middle class continues to grow. This has resulted in new ground for international business, yet (depending entirely on their location) a potentially hazardous experience for their expatriates.
East to West
The majority of medical facilities in Shanghai and Beijing are of international standard due to the economic growth, stability and financial input both cities have acquired over the past few years.
However, closer to central China and the Tier 2, 3 and 4 cities, the standard of healthcare can fall dramatically as hospitals are in rural locations and many are underfunded. There is no requisite standardisation in China for hospital staff, including doctors, nurses and ambulance personnel, and language barriers remain a huge issue for many expatriates in China. This can mean that expatriates in Tier 2, 3 and 4 cities can potentially suffer a low standard of care or even receive the wrong treatment should they require medical attention.
Risk 1: Ambulance Protocol
The first risk is the unreliability of ambulances– and paying for an ambulance upfront is not uncommon. Again, there is no standardisation for ambulance vehicles, equipment or ambulance personnel, yet by law a Chinese ambulance must take an injured/ill person to the nearest medical facility. So, for example, if your expatriated worker broke their leg and called an ambulance, the nearest hospital may be a maternity unit, leaving your employee in an unfortunate situation.
Ambulances are also often delayed and can take longer to reach a casualty simply due to the huge amount of traffic in built up areas of China. Almost all Chinese families own a car, and roads are often completely gridlocked – which means ambulances are not always the best option for those who require urgent medical attention.
As a result, many Chinese nationals and expats hire a taxi or drive to hospital. Although traffic is a problem to all vehicles, choosing a taxi over a potentially unreliable ambulance means expats can be sure they are taken to the nearest and best appropriate medical facility.
Risk 2: Poor Hygiene, Overcrowding and Substandard Care
Once your expatriated employee has reached a hospital, they may be faced with (if in more rural areas such as central and Western China) substandard care, poor hygiene and misdiagnosis. Doctor’s surgeries and walk in clinics are few and far between, and if suffering from ill health hospital is frequently the sole option for expats and Chinese nationals alike.
Due to severe overcrowding, lack of funding and varying levels of expertise and care, many hospitals in rural areas and lower tier cities suffer a level of poor hygiene. Within the lower standard hospitals, it is not uncommon for operations to be carried out in corridors, and there is also a strong risk of blood contamination and infection to residing patients. It is important to remember that, whilst this is an extreme example, an international standard of healthcare may not be close proximity or available in your chosen province/city in China.
China also has a different approach to privacy, pain relief and pain management than the majority of healthcare facilities in the Western world. In rural hospitals and where language barriers remain an issue, consultations are brief with little respect for personal space or privacy.
Pain killers such as paracetamol and ibuprofen (widely available in many Western countries) are uncommon as are pain managing drugs such as codeine and morphine. Antibiotics such as Penicillin and Amoxicillin are also not as freely available in hospitals within less developed provinces, and instead many Chinese hospitals routinely prescribe a course of anything from hours to days on an intravenous (IV) drip to stave off infection.
Western expatriates in particular are used to the speed and convenience of tablets and Western medicine, yet a course on an IV drip would require a hospital stay resulting in absence from work and a potentially prolonged recovery.
Natural Disasters and Evacuation
Close to the subject of healthcare, employers must look at potential risks and potential Crisis Management/Evacuation Plans if they planning to send employees on an assignment to a developing country. China frequently experiences some degree of natural disaster; it is not uncommon for severe weather to turn in to typhoons, and the country frequently suffers flooding, drought and earthquakes in different provinces throughout the year. Thankfully, these are usually on a small scale, but as with all natural disasters have the potential to grow in to a real risk to an individual’s wellbeing.
Since the civil uprising ‘Arab Spring’ and the Fukushima plant disaster in Japan, Crisis Management has been a hot button topic for expatriates and HR/Global Mobility professionals around the world. According to a recent Global Mobility survey, an astonishing 86% of expatriates felt that their employers had a legal obligation to support them in an emergency, and 50% would deem it necessary to take appropriate legal action against their employer if they felt an emergency was mishandled.
As a result, many HR/Global Mobility professionals feel that a defined relocation policy and Crisis Management Plan is key if employees are expatriated to countries that have potential for dangerous circumstances (due to natural disasters or civil unrest).
How Can Our Relocation & HR Departments Manage This?
As the forecast for an influx of GDP growth outside Tier 1 cities becomes more certain, more and more international businesses are moving (or expatriating their employees) to provinces in central and Western China.
This is owed to more than growth; a workforce away from the Eastern Seaboard is cheaper to maintain (those on the Eastern Seaboard are reported to expect a 10% salary rise year upon year). International Business tax is also rising in Tier 1 cities and in provinces on the Eastern Seaboard, making it very expensive to run operationally in these locations.
For international businesses moving their corporation or employees to central and Western China, many things need to be considered. There are many positive aspects to this move – undisputed growth, a previously untapped market, reduced business taxes and a lower cost work force.
However, traffic, car accidents and air pollution are regular occurrences and major concerns here, and as a result travelling by car is not often a safe option. Many corporations advise air travel for their expatriates as travelling by rail or car can be ineffective (due to traffic) or simply poses too many dangers to employee wellbeing.
As aforementioned, a proactive Crisis Management Plan and an up to date relocation policy (outlining employer/employee responsibilities) is absolutely imperative to provide support, avoid potential confusion and manage employee expectations.
A good standard of health insurance may also be a wise choice for many corporations and their expatriated employees. Whilst it does not mitigate risk, a good health insurance plan greatly lessens the risk of substandard care or misdiagnosis. It also means that employees feel supported, and will receive appropriate medical attention and cover should they become ill or injured.
How Can We Help?
Are you thinking of relocating to China, or expatriating your employees there? HCR (hcr.co.uk) has 30 years of relocation expertise and a global reach of 149 countries. We have a vast experience in providing relocation services all over the world, including relocation policy writing and benchmarking, cross cultural training and advice on crisis management.
HCR harbours an innovative reporting system which provides instant access to all relevant parties - service provider, employer and expatriated employee. This can be used to follow each process for the relocation, and can also be used to track and contact your employees should there be any issues whilst on assignment.