Following the killing of a senior doctor and the subsequent mass protest by hundreds of hospital workers in the Zhejiang city of Wenling last Monday, the issue of hospital security and the dangers faced by China’s doctors has once again hit the headlines [2].

At the same time, the detention without trial of 12 hospital security guards in Guangzhou [3] who staged a much smaller protest against the hospital’s refusal to discuss long-standing work-related grievances has largely been ignored.

The absurdity of the situation was made even starker by the issuance of fanciful central government guidelines on 12 October, which stated that at least three percent of all hospital staff should be security personnel and that there should be one guard for every 20 beds.

I suspect the officials at the National Health and Family Planning Commission [4] who came up with these regulations did not realize that most security guards at hospitals these days, like cleaners, porters and other auxiliary staff, are not actually employed by the hospital they work at. They work for agencies or outside contractors: They are poorly paid, work long hours and have little job security. And this was precisely the reason why the hospital security guards in Guangzhou went out on strike.

The explanation for why some many hospitals refuse to give security personnel a full-time employment contract or pay them a living wage is not hard to find: They simply don’t have the money.

In 2011, the Chinese government spent just 477 yuan per person on healthcare. And a staggering 99 percent of that came from local government budgets. The vast majority of hospital income comes from the sale of drugs, diagnostic tests and treatments. And, as a result, doctors will often prescribe unnecessary drugs, treatments and tests in order to bolster hospital coffers. The doctors themselves are grossly underpaid and all often demand bribes to perform vital operations and ensure the right treatment is provided.

Medicine is now seen by many as a dead-end profession [5] and some medical schools are finding it hard to recruit students to train as doctors. A survey of Chinese doctors in 2011 showed that 78 per cent preferred that their own children not join the profession.

It is this highly commercialized, dispiriting and increasingly corrupt system that is the root cause of the highly combustible relationship between doctors and patients.

The deeply entrenched problems of China’s healthcare system will require time, resources and substantial political will to untangle. They will certainly not be resolved by locking up discontented security guards for more than two months without trial.

The Guangzhou guards’ protest, like the doctors’ protest in Wenling, which even the Global Times covered in a sympathetic manner, [6] are just symptoms of a broken system. And the first step towards fixing the system has to come from the central government. We can only hope that the much vaunted third plenum of Party Central Committee [7], scheduled for 9 November, actually provides some substance and not just rhetoric.