Hard habit to break: China's smokers must cough up to get cured

Only 24,500 patients turned up at China’s 300 smoking clinics last year. People are reluctant to attend comparatively inexpensive public hospitals while many are happy to pay much more for private treatment.

Photo from CFP

Photo from CFP

By YUAN Yiming


There are more than 300 million smokers aged over 15 in China and many of them want to quit. Unfortunately, very few even know that hospitals have a department to help them, let alone attend such a clinic. Fewer yet ask for help.

There are more than 300 such centers in China’s hospitals, and last year they received only 24,500 patients. That’s around 80 patients a year per clinic, or one patient every five days, or so. There is obviously something wrong with the system. The clinics appear to be performing practically no function at all.

Prevention and cure

Most people who try to quit smoking think willpower is enough. The statistics suggested otherwise. LIANG Lirong is in charge of the smoking clinic in Beijing Chaoyang Hospital. She told Jiemian that less than one in twenty smokers managed to give up on their own. With proper care, up to 60 percent of smokers can quit within three months.

The Chaoyang clinic opened in 1996, the first in China. Last year, 2,000 smokers came here for help, not many compared with other departments in the hospital, but still almost ten percent of all patients attending smoking cessation clinics in the whole country. The Chaoyang clinic receives roughly 170 patients each month. In total, all other clinics in China receive an average of around six new patients every four weeks; some may see none at all.

A news report in 2015 described how a clinic in Jiangsu Province received only 110 patients in five years – one every two weeks. Another clinic in Henan saw less than ten in a year. ZHANG Jianshu, the chairman of the Beijing Tobacco Control Association, blames a poorly conceived system.

“Hospitals were instructed to open clinics, but people don’t want to spend money to quit smoking, so the clinics generate no profit,” said Zhang. None of the costs – neither consultant fee nor medication – are covered by social security.

Obviously, hospitals are reluctant to “waste” their money funding a clinic that no one attends and makes no money, but, legally, can’t shut them down. Some open only on certain days and doctors from other departments take turns to idle away their very valuable time sitting in an empty consulting room.

“The official attitude is that no one forced anyone to smoke. It’s a bad habit, and everyone knows it, so smokers ‘had it coming.’ The social security budget is tight and the State is reluctant to pay for people’s bad habits,” Zhang said. The problem with this simple accounting is that a good number of people do indeed suffer severe diseases because of their smoking, many of which are covered by the state. “Comparing to the huge cost of treating a cancer sufferer, the price of an anti-smoking clinic is nothing.”

Before the therapy, the patient will go through an assessment and the doctor will prescribe accordingly, costing 500 yuan (US$78) to 1,700 yuan. Most patients who make it to the clinic are desperate. Liang said she was never the first option. “They have all been through several painful failures before they come to me,” she said. “Some of them have much bigger troubles because of their smoking.”

Profits up in smoke

Liang followed up patients who received therapy for more than a month and found that almost two out of every three of them quit smoking after three months. In a recent survey of 400 smokers, 280 had never heard of hospital smoking clinics. Only three (3) had been to see a doctor: two refused treatment and the other’s therapy failed. The chances of success are generally reckoned to be 30 - 50 percent, therefore the chances of failure are 50 – 70 percent. Why spend money on a therapy that is likely to fail? Hospitals often require patients to make follow-up visits after the therapy, and many are found to have restarted smoking within a year.

In 2018, a survey suggested that 16.1 percent of smokers were planning to quit and 19.8 percent had already tried. Though people are reluctant to attend public hospitals to give up, many are happy to pay much higher fees for private treatment, but this is no more successful than attending a public clinic.

ZHONG Qiyuan runs a private clinic in Shandong Province. He was brimming with confidence when he opened his doors in 2018. A year later, and less than ten smokers had even walked in. He charges 1,280 yuan for a four-hour session and nicotine patches. If the client relapses within a year, he gives a full refund plus a carton of cigarettes. He’s not making any money at all.

While the hospitals follow health commission rules, private facilities have quite vague standards, especially in their criteria for success. If someone doesn’t “feel like smoking anymore,” they consider it a win.

There’s an app for it

Zhang Jianshu sees more hope in apps such as 3keyan. WANG Hua came up with the app. He studied more than 250 apps before creating 3keyan. After a year, the app had been downloaded over 500,000 times, but it had barely 5,000 DAU, not to mention the paywall. In the first week, only one user paid 1 yuan for the cheapest session.

“I’m not going to invest any more time or money in the app,” Wang said.