Healthcare Dilemma: Staunton’s Insights into Qianlong’s Doctors’ Compensation Model

In the late 18th century, a remarkable British scholar and physician named George Staunton embarked on an extraordinary journey to the Far East. As an integral part of the Macartney Embassy of 1793, the first British diplomatic mission to China, Staunton was entrusted with establishing a dialogue between two of the world’s great empires. The mission aimed at expanding trade relations and seeking the Chinese Emperor’s favor.

During his time in China, Staunton, being well-versed in various disciplines, including botany and linguistics, kept detailed notes of the unique plants and meticulously recorded his interactions with the local populace. Yet, one of the most memorable encounters of his expedition was with the illustrious Emperor Qianlong, the sixth emperor of the Qing Dynasty, who ruled China for over 60 years. A patron of arts, literature, and an astute military strategist, Qianlong was a key figure in consolidating the Qing Dynasty’s power and expanding its borders.

One day, amidst the grandeur of the Forbidden City, Emperor Qianlong inquired about the British healthcare system, showcasing his perpetual curiosity about foreign cultures. After some difficulty in bridging the cultural and linguistic gap, Staunton explained the fee-for-service system prevalent in England. Qianlong, always the contemplative ruler, responded with surprise, “Is there even one person in England who can afford to be sick?” He then shared his innovative approach to healthcare: “I have four doctors in charge of my health; they receive a certain weekly stipend, but as soon as I fall ill, the stipend stops until I recover.” With a hint of pride, he added, “I don’t need to tell you that my illnesses are usually short-lived.”

On the other hand, if doctors are paid while everything is fine, many might be tempted to simply earn money without doing much, adhering to the “if it’s working, don’t fix it” philosophy. And when their patient faces a health issue, they might simply resign themselves to the fact that they can’t heal the patient. How can such abuse of a patient’s trust be avoided? Perhaps there’s a need to hold doctors accountable if their patients fall ill? At the very least, there could be financial consequences.

However, introducing financial penalties for doctors when patients get sick could create its own set of problems. It might discourage doctors from taking on patients with pre-existing conditions or those at higher risk of illness, as they’d be considered a financial liability. This could lead to patients with genuine health needs being denied adequate care.