Freedom Initiative

Huadu District People’s Hospital in Guangzhou, China, where Juliana Brandy Logbo, a Liberian, gave birth to twins this month but wasn’t allowed to see them, she said, until she had raised hundreds of dollars to pay medical fees.CreditGilles Sabrié for The New York Times

By Sui-Lee Wee

GUANGZHOU, China — A day after Juliana Brandy Logbo gave birth to twins this month through an emergency cesarean section in a Chinese hospital, she thought the worst was over. Then the demands for money began.

First, Ms. Logbo said, the hospital told her that she had to pay $630 in hospitalization fees if she wanted to see her girls. Three days later, she said, the amount rose to nearly $800.

She didn’t have the money. The demands left her weeping outside the newborn department in the hospital.

“I want to get my kids discharged because I need to breast-feed them,” said Ms. Logbo, a 28-year-old Liberian living in Guangzhou. “I gave birth to my babies, and I can’t even see my babies. Which type of country am I in?”

In most developed countries, patients who need urgent care are given it first, regardless of whether they can pay. That isn’t always the case in China.

Ms. Logbo is living in China on an expired visa and can’t speak Chinese. But her experience is an extreme example of what millions of Chinese people deal with in an inflexible health care system that sometimes requires patients to pay upfront for treatment.

China has rolled out an ambitious $130 billion package designed to make medical care more affordable. It now has almost universal health insurance for its nearly 1.4 billion people.

But the system is still plagued with gaps in coverage. Depending on the disease, whether the person lives in a city or the country and other factors, many Chinese can face huge out-of-pocket costs.

Then there are the remnants of the country’s “pay as you go” system. People who can’t cough up the money are often denied care — even in life-or-death situations. Some hospitals require patients with particular diseases to pay a hefty deposit first.

While medical reform was supposed to make health care more accessible, industry analysts say the problem persists. In 2015, for example, national health officials recommended that for critically ill patients, hospitals had to “first save them and then demand payment later.”

New parents are vulnerable, according to Chinese state media reports.

In 2012, a couple in Shenzhen were denied access to their newborn twins for two months because they could not pay nearly $19,000 in fees. In 2011, a 57-year-old grandmother in Nanjing, whose son owed a hospital $2,800 in medical fees for his newborn, knelt and begged doctors and nurses to allow him to see his child. That same year, a hospital in Dongguan told the parents who owed it more than $1,600 that it had sent their newborn child to an orphanage in order to “frighten” them into paying. While the families inevitably get their babies back, hospital officials can use their demands for faster or fuller payment.

Rebecca Taylor, an Australian breast-feeding counselor in Beijing, called Ms. Logbo’s case “a ginormous violation of human rights.” She added that separating Ms. Logbo from her babies could be “almost catastrophic” in terms of breast-milk production.

“I’m saddened, disappointed and horrified, but I’m not surprised,” Ms. Taylor said. “If anybody goes to a local hospital for anything, everybody knows you have to go to the A.T.M. first to carry a fistful of cash. You will literally not get things without paying.”

Ms. Logbo acknowledged that her situation complicated matters. Her boyfriend, also a Liberian and the father of her twins, has been detained in China since September, she said, accused of lending his Chinese bank account to a friend for a money transfer.

At the Huadu District People’s Hospital in Guangzhou, the demands for money came early. On May 5, as Ms. Logbo was going into labor, she had to pay $130 for an “ambulance fee.” After her C-section the next day, she had to pay a $790 deposit.

Ms. Logbo gave birth at 3 a.m., and the nurses whisked the twins away without letting her hold them. When she asked to see her girls the next day, administrators demanded a $630 discharge fee, she said.

Her friend Salome Sweetgaye helped her raise the money, but they were too late. On May 10, they were told that they had to pay $800, according to Ms. Logbo. Ms. Logbo told the hospital that she had no money. It reduced the price to $707. Copies of these bills were viewed by The New York Times.

That afternoon, Ms. Logbo held her babies for the first time.

A woman surnamed Tang, who works in the hospital’s medical disputes department, challenged Ms. Logbo’s account. “There definitely isn’t this situation of demanding that she first pay up before letting her see her children,” said Ms. Tang, who declined to give her full name. She said hospital workers had merely been “reminding” Ms. Logbo to pay up.

Ms. Tang said Ms. Logbo’s babies were premature and could not be taken out of the newborn department. Many Chinese hospitals have a policy of denying parents access to premature babies because of a lack of nurses to monitor the visit and a fear of infections.

One of Ms. Logbo’s twins, days after birth. Mother and daughters were discharged on May 13 after Ms. Logbo paid nearly $3,500 that had been raised through donations.CreditGilles Sabrié for The New York Times

Ms. Logbo rejected Ms. Tang’s assertions, saying her babies were born healthy at 37 weeks.

Ms. Sweetgaye, 28, verified her friend’s account and said the hospital was “lying.”

“They refused to give the babies to Juliana,” Ms. Sweetgaye said. “She had to cry a lot.”

Hospital officials didn’t respond to additional requests for comment.

Ms. Logbo, who has a degree in business management from the University of Liberia, gets some income from giving tours to African tourists in Guangzhou. She and her boyfriend, who was also in China on an expired visa, lived in a one-bedroom apartment bordering Beijing. Before he was detained, they were planning to return to Liberia.

Ms. Logbo took a trip to Guangzhou, where she discovered she was expecting. Then her boyfriend was detained. Ms. Logbo, who has not seen him since, is now living with Ms. Sweetgaye in Guangzhou.

Hospital employees didn’t speak English, so it isn’t clear how much was lost in translation. Employees used smartphone translation apps, Ms. Logbo said.

But the hospital’s demands were clear, she said. One employee, she said, typed on his phone that she needed to pay 5,000 renminbi — nearly $800 — to get her babies discharged.

Ms. Logbo and her twins were discharged on May 13 after she paid nearly $3,500 in total, money raised through donations. She named her girls Grace Annabelle and Gracious Anna. (“Because I’m grateful to God for everything.”)

The pay-as-you-go system persists in part because, some doctors say, they get stuck with unpaid bills themselves. Hospitals stress that they are not charities.

Felicity Miller, a British woman who was working at a factory in China, said a Shanghai hospital refused to give her premature daughter, born in 2011, an injection to prevent her lungs from collapsing because it had not received a deposit of about $1,600. Then, it threatened to withdraw treatment because her insurance company had not given the hospital a deposit of nearly $7,900.

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