A green military truck stands near the entrance to Shanghai Changzheng Hospital. This is one of the city’s best known hospitals, and it happens to be owned by China’s People’s Liberation Army. A row of large photos shows the hospital’s finest doctors dressed not in white overcoats but in military uniform. Overhead, a big billboard reminds staff to “Obey the party’s command, triumph in every battle, uphold the highest virtue.”

Yet despite the hospital’s military facade, less than one in 10 of patients here are soldiers — the rest are civilians.

Army-backed hospitals in China like Changzheng have been in the news recently for a number of reasons.

The death of 21-year-old student Wei Zexi from cancer in April has sent shockwaves through Chinese society. It is also having repercussions for China’s military hospitals. Wei had sought treatment at the Second Hospital of Beijing Armed Police Corps, part of a nationwide network of hospitals and other medical institutions affiliated to the PLA. The treatment, the medical soundness of which has been called into question, failed.

But military hospitals are also under scrutiny as part of an overhaul of the nation’s military, including efforts to rid the army of its commercial interests. Over the years, some military hospitals have earned large amounts of money, thanks in part to cozy relations between some of them and private health care companies.

In Wei’s case, the 21-year-old student signed up for a type of contested treatment, which, according to his online posts prior to his death, cost him and his family 200,000 yuan (around $31,000). While the case is still under investigation, Wei’s treatment was provided by a company that up until recently was owned by a group of health care related business people based in Putian City, in China’s eastern Fujian province.

More than 80 percent of China’s private health care institutions are run by people from Putian and their associates. The quality of service provided by some of these units has been questioned in the past by extensive media coverage, including undercover exposes.

Putian-run medical organizations provide a wide variety of health care services at some PLA-affiliated hospitals, giving rise to the question: What is the nature of the relationship between the army and private medical providers, whose capacity to provide quality medical care has been called into question numerous times?    

Some clues may lie in measures to reform the PLA, spearheaded by President Xi Jinping.

Since he became president, China has taken large steps in military reform. In September 2015, Xi announced a reduction by 300,000 PLA personnel to 2 million, as well as a major overhaul in the structure of the army organization.

In March this year, China’s Central Military Commission (CMC) issued a circular announcing plans to terminate the commercial pursuits by the military over the next three years, according to a report by state news agency Xinhua.

This means that the military, including its hospitals, would no longer be able to sign new commercial contracts with outside companies, and that existing contracts would not be renewed. The move was driven by the need to rid the armed forces of corruption, Xinhua’s report added.

Further indications that PLA-run hospitals are coming under closer scrutiny came with an announcement from the CMC disclosed in the media on May 3 that proposed that military hospitals in the future should purchase pharmaceuticals through a centralized purchasing office. The move is seen by some analysts as an effort to curb corruption.

Army hospitals are mainly overseen by military authorities. How the proposed reform could change that is still unclear as precise details remain largely unknown. 

Yang Yujun, the spokesman for the Ministry of National Defense, interpreted the new policy at a recent news conference, suggesting that military hospitals and other medical institutions would continue to provide medical services to civilians, but that “a new model” would be explored that could see military hospitals integrated more into the national health care system, under the auspices of China’s National Health and Family Planning Commission (NHFPC).

Since the 1980s, it has been common practice for China’s military hospitals to seek out civilian patients, largely as a means of supplementing inadequate military budgets.

These days more and more medical employees at military hospitals are recruited from outside the military system. At Changzheng Hospital, for example, about half of the attending physicians are graduates from regular medical universities, as opposed to military-backed institutions.

Yet regardless of their background, staff at PLA hospitals around the country face an unclear future, with many left wondering what recent reforms may mean for their medical careers. Such reforms also raise questions as to what might happen to civilian patients who wish to turn to PLA hospitals for treatment.

“We are all waiting to see what is going to happen,” said one army doctor at Changzheng Hospital. “Everyone is concerned about their future,” he told Sixth Tone.

Since April this year, at least one military hospital in Shanghai is thought to have cut bonuses for military doctors. This has aroused concerns that more medical staff at army-affiliated hospitals might leave to take up employment elsewhere, people in the medical profession say.

The doctor said that if PLA hospitals split from the military and become regular hospitals under the auspices of the NHFPC, then former military doctors — as well the hospitals themselves — could benefit from increased freedoms. 

In his personal life, for example, the PLA doctor said he needed permission from his superior to travel outside Shanghai. Doctors at PLA hospitals are generally not allowed to go abroad for non-professional reasons. Even professional trips, like attending a medical conference, require at least six months’ notice. Changzheng makes sure that the doctor won’t take any unauthorized journeys out of the country. His passport is held by hospital management.

“We are not common people. We represent the PLA,” he said. “If anything happened on a trip, it could harm the army’s image.”

Since he entered a military medical university in early 1990s, the doctor has been a member of the PLA for more than 20 years, 18 of which he has spent at Changzheng. Despite the limits his employer places on him, he still feels pride in his military identity. “If one day you asked me to leave the army, I would be torn,” he said.

His pride does not mean he sees past the shortcomings of the military system, though. Compared to regular hospitals, the management of military hospitals is much more rigid, he said. For example, military hospitals have strict rules in terms of hiring new recruits and purchasing medical equipment. According to the PLA doctor, while civilian hospitals are rapidly developing new information technology systems that allow doctors to access information with other hospitals, military hospitals only allow doctors limited access to information on computers at the same hospital.

This is the militant culture that some critics believe is making it difficult for military hospitals to compete with regular hospitals.

Yet many patients are finding that stringent regulation is not necessarily extending to all areas of hospital management, according to a medical professional who declined to be named for fear of repercussions from their employer. Many people visit such military hospitals anticipating medical treatment provided under strict regulation, they claimed, yet many do not know that they are probably under risk of receiving unnecessary examinations, or unregulated or unproven health care. In the recent case of Wei Zexi center around this very claim — that the hospital was providing a course of treatment of questionable medical validity.

This perception gathered momentum last year, when a doctor working at a leased department at the Beijing No. 466 Hospital — affiliated to the Air Force — was revealed to be an impersonator. She was practicing medicine under the name of a doctor she knew from her hometown.

But the health bureau in the district where that hospital is located was helpless when it came to taking action because, as a military-affiliated hospital, the institution did not fall under the bureau’s area of supervision. “The military medical system was a world onto itself with minimum oversight for many years,” said Ellon Xu, CEO of the China arm of Artemed, a Germany-based health care group.

For now, the public’s focus is very much on how the PLA will handle the latest scandal involving Wei’s death from cancer, and the possible involvement of private operators that stand accused of placing profit over patients’ well-being.

A commentary on the case published by the PLA’s official news outlet 81.cn on Tuesday said that any person responsible will be held accountable by the relevant authorities. The military would not tolerate any behavior that went against its aim to serve the people, the commentary said.

A spokesman for the NHFPC said in a statement on Tuesday that the commission, the Health Bureau of the Supply Security Department of the CMC, and the Health Bureau of the Supply Department of the Armed Police would jointly investigate the Second Hospital of Beijing Armed Police Corps.

With contributions from Li Xueqing and Yan Jie.

(Header image: The entrance to the Second Hospital of Beijing Armed Police Corps can be seen behind an armed police vehicle, May  3, 2016. IC)