Can ‘Patient Companions’ Fill a Gap in China’s Safety Net?
Last year, Zheng, a doctor at a Shanghai hospital, began noticing a curious phenomenon: The same people repeatedly appeared in her consultation room, but each time they were in the company of a different patient. At first glance, these people seemed to be relatives or friends of the sick — they helped the patients carry their things, sat in on consultations, carefully noted down any treatment plans, and sometimes even spoke with the doctors on the patients’ behalf. But it seemed unlikely that they could have so many sick relatives at the same time.
Finally, unable to contain her curiosity, Zheng asked one of them what they were doing. The answer surprised her: They were there because they were paid to be there.
“Patient companions,” or peizhen, are part of a booming profession in China. According to the Intelligence Research Group, Chinese used patient companion services over 4.3 million times in 2023, and the total industry is valued at 747 million yuan ($102 million). Concentrated in large cities with better medical resources, such as Beijing and Shanghai, patient companions exist to help people navigate big-city medical systems. Most work with elderly patients, but some young people have also begun using the services.
Beginning in late 2023, my research team and I undertook a year-long study into this emerging industry. Focusing our investigations on Shanghai, we interviewed more than 20 patients, patient companions, and medical professionals, conducted field research in several key hospitals, and collected related posts from social media platforms such as Xiaohongshu, better known as RedNote in the West. We found that companions are filling an important gap in China’s medical system, though not always smoothly.
One of the patient companions we interviewed, Li, was a 31-year-old former graphic designer. After being laid off, Li began working as a patient companion in March 2024. One of her clients was a woman in her 60s from Anhui province, near Shanghai, who had been diagnosed with Alzheimer’s disease. The woman’s daughter works in Beijing and wasn’t able to accompany her mother on trips to the clinic where she was being treated in Shanghai, so she hired Li to take her. Li was responsible for picking the woman up from the train station and taking her to the hospital. Once there, Li had to listen to the doctor’s instructions and make sure the woman understood them. Then, just in case, she would write them out and send a copy to the woman’s daughter.
Li’s experience is typical. Patient companions are generally referred to clients through social media, though some are hired through insurance companies, patient companion platforms, or references from former clients. After the two sides sign an agreement, the patient companion must research the patient’s condition and the hospital where the patient is being treated. They’ll arrive early to check in for appointments, helping their clients skip the long lines found in many large hospitals. If the patients have difficulty walking or are unfamiliar with the treatment process, companions may also help with errands including making payments and picking up prescriptions.
An important part of the job is keeping patients calm. While waiting, companions will chat with their clients, try and ease their concerns, and provide simple medical information. When permitted, they will play the role of relative or friend, entering the consultation room with the patient, taking notes and helping with doctor-patient communication.
As China’s population ages, demand for patient companions has risen rapidly in recent years. Wu, a 46-year-old patient companion, told us that more than half of her clients were middle-aged or elderly, and that in most cases she was hired by their children rather than the patients themselves. Elderly Chinese often struggle to navigate the country’s medical system, as their old age and lack of technological know-how make it hard for them to book appointments at China’s crowded top hospitals. “There was an old man who had been waiting outside the hospital gate since 5 a.m. to book an appointment,” Wu recalled. “By the time he got in, there were no places left. He said that young people had booked up all the slots online.”
Wu believes the demand for professional patient companions will only continue to increase as more middle-aged people who are either single or don’t have children get older. Perhaps more surprising is the number of young people hiring patient companions. One of our interviewees, 36-year-old Zhang, used the service for the first time when she needed a gastroscopy. She felt awkward asking a family member or friend to take time off work, so she hired a graduate student in medicine who does part-time patient companion work to go with her instead.
Many young people who work away from home or who otherwise cannot be accompanied by relatives or friends have started using patient companion services. This reflects broader trends in Chinese society, as individuals become more detached from traditional family networks and cultural norms such as reciprocal favors and relationships gradually weaken. Rather than going into “emotional debt,” young people are more inclined to solve their problems with money.
“Because most (family and friends) our age work, and the check-up is on a workday, if I ask someone to go with me then they’ll also have to ask for leave and miss time,” Zhang said. “I’d be too embarrassed to ask.”
The emergence of patient companions has helped to fill some gaps in China’s medical system. Medical resources are limited, even in the country’s biggest and best hospitals. The average consultation time is among the lowest in the world, with doctors often not having enough time to give detailed explanations or provide emotional reassurance to patients. The emergence of patient companions has mitigated these issues to some extent. Zhang recalled that during her hospital visit, the patient companion comforted her and helped explain what was going on. “I’m a pretty anxious patient — I have a lot of questions,” Zhang said. “If the person takes the time to answer all my questions, is really patient and gentle, I’ll feel much more at ease.”
However, the industry currently lacks rigorous standards. Our interviewees frequently mentioned the difficulty of finding the right patient companion, the need to filter large amounts of information to screen candidates for professionalism, and the precarious nature of patient-companion trust.
Such relationships can also lead to complicated medical and contractual disputes. For example, some patients will ask their patient companion to sign surgery consent forms on their behalf. However, Chinese regulations state that signatures by anyone other than a close relative or legal representative are void, which could leave companions or doctors in legal jeopardy if the operation does not go as planned.
The rise of patient companions stems from shortcomings in China’s current medical system. In the future, as the country’s population continues to age, the demand for such services seems likely to grow, and patient companions may well become an important component of the country’s safety net. Just last week, Shanghai announced it would include patient companions in its eldercare welfare system on a trial basis. But sustainable growth will only happen if companions and patients alike feel confident that their actions are legal and safe.
With contribution from Jin Xiaopeng, Liu Yunchang, Zhang Jing, and Chen Shiyu.
Translator: David Ball; editor: Cai Yiwen; portrait artist: Zhou Zhen.
(Header image: Shijue/VCG, reedited by Sixth Tone)
