ZHENGZHOU — Even at its current size, the First Affiliated University Hospital of Zhengzhou in the capital of China's central Henan province is the largest hospital in the world. And it's still expanding.

The "super hospital," as some have dubbed it, already boasts 7,000 beds. Ongoing tendering for construction of a new branch should soon push that total to 10,000 beds. This far surpasses the capacity of Sichuan's 4,000-bed West China Hospital, ranked as China's second largest.

As recently as 2008, the Zhengzhou Hospital, as it is also known, had just 2,000 beds. Things began to change quickly, however, when a man named Kan Quncheng took over as president of the facility. Annual revenue has also soared under Kan's leadership, from 680 million yuan ($11 million) to 6 billion ($980 million) last year. "Over the past five years our workload has grown more than five times while our staff has grown only by 70%,” he says. Kan estimates that this year the hospital will receive more than 4.6 million outpatients and more than 320,000 inpatients.

To a large extent, the story of Kan and of the Zhengzhou Hospital is a microcosm of China’s health care reform process in recent years. “The hospital has no alternative but to expand," says Kan. "Henan province has a lot of poor farmers. Hotels around this hospital are packed. The ones who can’t afford to stay in hotels lie around under bridges. Life is sacred. I am obliged to find a solution.”

Unrelenting demand

The hospital president says he felt tremendous pressure upon seeing the long queues of patients. To satisfy demand, he is continuously buying nearby buildings to integrate them as part of the hospital. In 2012, a new 28-story ward building was built. The 120,000-square meter facility has nearly 3,000 beds, boasts 66 operating theaters and was outfitted with state of the art technology.

“Chinese hospitals just aren’t coping with the growing number of patients. While the government has yet to find a solution it’s up to hospitals themselves to deal with the headache”, says the hospital's vice-president, Wen Jianguo.

Many other provincial capitals of China have adopted the same development model as the Zhengzhou Hospital, though none to quite the same degree. The difference is that Zhengzhou is the capital city of Henan, which is China’s second most populated province after Guangdong and has a stable population of over 100 million people, more than 80% or whom are relatively poor farmers.

As Kan points out, one of the reasons his hospital has received an overwhelming number of patients in the last few years is because Chinese authorities have introduced a new health insurance system, called the New Rural Cooperative Medical Care, that covers much more of the rural population"s medical expenses and thus spurs patient attendance. Before 2009, a lot of farmers were reluctant to go to hospital simply because they couldn’t afford it.

As the affiliated hospital of Zhengzhou University, the Zhengzhou Hospital enjoys a unique level of authority in both academic and clinical fields and thus has a large number of well-known specialists and professors. Nevertheless, its rapid expansion is increasing demand for medical staff, which the university alone cannot supply. The hospital has therefore had to attract doctors from all over China — and even from abroad. To do so, it offers relatively high pay, research funding and equipment, and housing.

The recruiting strategy has been effective. Currently the hospital employs more than 6,000 medical staff. That number does not take into account the approximately 4,000 medical school students and interns also present. Of the estimated 1,500 doctors practicing in Henan province, 1,000 work at this hospital. "We are definitely the best hospital of Henan. But our goal is to be the best in the whole of China," says Kan.

The president of the hospital begins his workdays just after 6 a.m. First he pays a random visit to the vast compound of hospital wards to have a general idea of how the facility operated the day before. By 7:15 a.m. he is back in his office to deal with staff issues before he starts working with other doctors for the day.

"The hospital is so big and the patients so many I can't afford to waste any time!" says Kan.

Too big for its own good?

And it's only going to get bigger. Zhengzhou city is expanding eastward. The hospital is following suit, building a new branch in the new urban zone. Expected to be open in 2016, the branch promises to be a high-end comprehensive hospital with 3,000 beds.

Alarmed by the rapid and often blind expansion of public hospitals everywhere, Chinese health authorities have recently issued an urgent notice to strictly regulate size, construction and funding for the facilities.

At the Sino-U.S. Hospital Management Forum held two months ago, Liu Xiaocheng, director of Tianjin International Cardiovascular hospital, shared his concerns about China's current public hospital expansion spree. "A big public hospital is like a super aircraft carrier. Its volume and its efficiency could go in opposite directions if it's not properly managed," he said. "The sad thing is that Chinese hospitals are still taking on a responsibility that should have been shouldered by the government."

Kan also made his voice heard during the forum. He agreed with other participants that there are certain drawbacks associated with large public hospitals, but said he is hopeful that such facilities can reform by improving their internal management or by partnering with other hospitals to share the workload and thus provide better health services to patients.

Not everyone agrees. As one anonymous member of the Chinese Hospital Association opined, a resource-rich provincial hospital like Zhengzhou should focus on treating patients with severe diseases instead of expanding without limit. Observers also warn that the Zhengzhou Hospital could have problems in the coming years due to government efforts to control the reimbursement rates of patients depending on which county or prefecture level hospital they visit. Kan's "super hospital," as a result, may prove to be too big, with just too many beds to fill.