My colleague’s wife had a baby last Christmas in a Chinese hospital in Zhuhai. It was a typical scenario. Meet your doctor in advance and decide whether to have a natural birth or a c-section. In this case, the choice was to go c-style at a planned date (that was not on an unlucky date, mind you. No number 4s.) Of course, there is a relationship that develops naturally with an expecting couple and their doctors, but in China there is an additional consideration to be made: how painful do you want this birth to be? That’s when red envelopes start to appear.

A red envelope (also called Lucky Money during Chinese New Year) is a common “gesture of appreciation” in Chinese traditional culture. At the hospital it is used to ask for better care, smaller incisions, or a better anesthesia program. Depending on whether it’s a city or the countryside, any number of possibilities could occur if a red envelope isn’t paid.

In Bruce Ramsey’s “The red envelope: capitalistic health care in Red China“, he reports surgeons talking about the health care industry in China. In Beijing, as all of China, patients should give a red envelope in order to be sure the senior surgeon will operate on them. Those who want the best care are willing to pay, and those that don’t could be discharged, “sometimes with their damaged joints allowed to fuse.”

As for having a baby in China, it is unlikely a mother will not receive care if she wants it. If a mother doesn’t have the money (or opts out of paying the “additional fee”, let’s call it) she should expect a more painful birth that takes more time and is likely done by a less experienced doctor. From discussions with locals, I’ve heard that this can mean the difference between a short and long scar on the tummy and varying degrees of an anesthesia program.

Now recently I visited a clinic to get a popped blood vessel cleared up after some years of avoiding it. (It was taken care of well by the way.) When I walked up the stairs to visit the doctor’s office I was pleasantly greeted with a few “warm” reminders: Keep Silent, No smoking, Slippery floor, and No red envelopes. 

At first I smiled at the sight of a red envelope getting crossed out, but then I realized that it was an administrative attempt at beating down this age-old Chinese tradition of getting the best medical attention.

But it still exists and is unlikely to go away any time soon. It’s true that Chinese healthcare is 1/5 the price of American care, but just beneath the surface there is a lot more red money flowing around.

“Having a Baby in China” is a great resource for expecting couples and provided some info for this post.