This article is written by Guan Lin
In 2019, the National Development and Reform Commission issued the "Pilot Work Plan for the Construction of Regional Medical Centers", which announced that by the end of 2022, it is necessary to basically complete the nationwide planning and layout, and strive to build a national regional medical center to cover all provinces in the country.
Subsequently, 89 hospitals with the strongest domestic specialty strength have entered the ranks of outward export, carrying personnel and materials to various places.
This is the way for hospitals to "go up the mountain and go to the countryside".
Eternal propositions
First of all, we need to introduce a familiar old saying: "It is difficult to see a doctor, it is expensive to see a doctor".
In 1995, "it was difficult to see a doctor" and "expensive to see a doctor" began to appear in the news reports of the People's Daily at the same time, and then the attention continued to grow, and in 2006, the eve of the new medical reform reached its peak.
Image source: "It is difficult to see a doctor, it is expensive to see a doctor" (1978-2012)
Dismantling the problem of "difficult and expensive medical treatment" will get two core indicators.
The first indicator is the accessibility of medical and health resources, which assesses whether the total amount of medical resources is sufficient, whether the distribution is fair and just, and whether it can cover enough people, and these complex conditions are later abstracted into a short-answerable goal - "serious illness does not leave the province".
The imbalance and redistribution of medical resources is the eternal proposition of medical reform, of which the imbalance between cities determined by political status, economic conditions and geographical conditions is particularly significant.
Beijing and Shanghai are the first echelon of medical resources, defined as the "radiation of the whole country" national medical center; while the second echelon of Wuhan, Changsha, Guangzhou, Chengdu, Xi'an and other places, also belong to the "high-quality medical resources concentration" of the city, covering East China, North China and other regions; provincial capitals need to become the first choice for patients in the province for serious diseases; local cities and grass-roots health institutions should do a good job in the basic medical service needs of local patients.
From the perspective of the whole country, the construction of the echelon has not been completed, from the third echelon below, the "graded diagnosis and treatment" of urban medical treatment needs to be improved, and patients across the country are still accustomed to "seeing a doctor in Beijing".
The General Office of the National Health Commission once said in the "2018 National Tertiary Public Hospital Performance Appraisal National Monitoring and Analysis Of the Relevant Situation" that the problem of inpatients seeking medical treatment across provinces still exists, and the top 5 provinces with the largest inflow of patients are Shanghai, Beijing, Jiangsu, Guangdong and Zhejiang Provinces, accounting for 53.6% of the country's off-site medical treatment; the provinces with the largest number of outflow patients are Anhui Province, Hebei Province, Jiangsu Province, Zhejiang Province and Henan Province. It shows that the problem of unbalanced and insufficient development of tertiary public hospitals in the country is more obvious.
On the other hand, personal hygiene expenditure and indirect health costs can be measured, of which indirect costs can be understood as travel expenses, accommodation, lost work and other costs incurred in the process of medical behavior.
Image source: 2018 Statistical Bulletin on the Development of Mainland Health And Health Undertakings
The algorithm of personal hygiene expenditure + indirect health cost can partially reflect the patient's economic burden of disease, and it is worth noting that there are several variables in this set of calculations that can be lowered x:
In terms of personal health expenditure, the 2021 "14th Five-Year Plan" National Medical Security Plan was issued, and the proportion of personal health expenditure in total health expenditure was included in the main indicator system of development as a binding indicator, and the expected target of reducing from 27.7% in 2020 to 27% in 2025 was proposed; from the perspective of indirect costs, the distance of good hospitals, the level of doctors' medical skills, and the popularity of information - that is, the efficiency and quality of patients' medical treatment can directly affect the "expensive medical treatment".
It took a big turn and things came back to square one.
For most people in most cities, there are too few good doctors, too many good hospitals, too difficult and too expensive to see a doctor, while resources continue to flow to the head, and from a national perspective, they still fail to reduce the economic burden of disease on patients.
And in 2017, a document cracked the endless cycle.
A hospital's mission
In 2017, the then National Health and Family Planning Commission issued the "13th Five-Year Plan for the Establishment of National Medical Centers and National Regional Medical Centers", which pointed out that general hospitals with leading levels in medicine, teaching, research, prevention and management should be selected according to each province, and 1 comprehensive category of national regional medical centers should be set up. In principle, hospitals are selected in 6 districts of North China, Northeast China, East China, Central South, Southwest China and Northwest China, and are set up according to specialties such as children, oncology, cardiovascular, obstetrics and gynecology, infection, stomatology, and psychiatry.
According to the 2018 National Medical Service and Quality and Safety Report, the top 5 departments with the largest number of patients outside the province are surgery (24.24%), internal medicine (22.61%), oncology (11.01%), obstetrics and gynecology (9.91%) and pediatrics (7.23%).
In October 2019, the Pilot Work Plan for the Construction of Regional Medical Centers was issued, officially launching the pilot work of the construction of national regional medical centers.
Compared with the lower grassroots level of counterpart assistance in the past, this round of national regional medical centers has essential differences in location.
The first is the difference in the input region. The national regional medical center in the first batch of pilots selected Fujian, Henan, Yunnan and other 8 provinces, and these 8 provinces are not traditionally need to receive medical resources assistance or import areas, henan although the number of people is large, but there is ZhengDa First Affiliated Hospital sitting, and fujian as an example, as a coastal province economy is relatively developed, convenient transportation, medical resources are not weak, 2021 Fudan top 100 list there are two hospitals in the list, and even long-term commitment to the task of counterpart support.
But the National Regional Medical Centre is clearly not content with this. The "Pilot Work Plan" shows that the selection of pilot areas mainly has the characteristics of a large population base, a large number of medical treatment abroad, and a shortage of high-quality medical resources, and the hospital that is imported must also be a first-class hospital of the "national team" level (mainly located in Beijing, Shanghai, and a small part is Wuhan, Changsha, etc.), with the purpose of narrowing the gap between the treatment level of local key diseases and the national advanced level through the construction of the center.
In other words, it is to let the national team "go to the mountains and go to the countryside" and incubate its own national-level medical institutions.
But if it is only to this step, in addition to the foundation of the help object is more solid, the essence of the center has not changed much. In order to solve the problem of a large number of patients seeking medical treatment in different places and improve the radiation range and capacity of the hospital, it is also necessary to change an idea, that is, the "patch board".
The "13th Five-Year Plan" National Medical Center and National Regional Medical Center Establishment Plan points out that it is necessary to select hospitals with high management level, good infrastructure, advanced medical technology and strong service capabilities, and select the best for setting.
Taking the Anhui Hospital of the Children's Hospital affiliated to Fudan University in the first batch of pilots as an example, the Anhui Provincial Government and the Children's Hospital Affiliated to Fudan University cooperated to build it by relying on the Anhui Provincial Children's Hospital. The output hospital ranked first and second in the 2020 Fudan list, and the corresponding support of pediatrics-pediatrics is obviously to continue to increase the "longboard" of the original specialized hospital and build a hospital in Anhui with pediatric strength enough to radiate the whole province and even affect the surrounding cities.
At the same time, from the perspective of construction and structure, the National Regional Medical Center is more like an independent and flexible third-party "new institution" than a "listed hospital". Because the planning requires priority integration of existing resources, making full use of existing facilities and equipment and talent teams, often relying on well-known hospitals with deep roots in the local area for co-construction, the internal structure also needs to be reorganized.
However, from the perspective of the composition of the leadership team of the national medical centers, the two hospitals tend to maintain a relative balance, in terms of construction, the output hospitals often send more high-level experts to stay, and the import hospitals will even separately dismantle the departments for joint construction. A staff member of a national regional medical center told Lilac Garden: "Our priority is: first as a national regional medical center to play the function of radiation peripherals, and then to build a hospital."
Can serious illness really not go out of the province?
Can serious illness really not go out of the province?
This problem is now given the abstract meaning of many "indicators", but fundamentally, it depends on the level of medical care in the province on the long board of "treatment of serious diseases", and for the comprehensive discipline of medical treatment, the "long" of the long board often means the balanced development of other strengths.
From the national regional hospital center plan in 2017 to the 89 strongest hospitals in 2019 "going to the mountains and going to the countryside", it may take some time for the country's top medical level to be on par.
According to the National Development and Reform Commission, after the opening of Zhengzhou Hospital of Beijing Children's Hospital, the outpatient and inpatient children in Henan Province who went to Beijing Children's Hospital in 2020 decreased by 82,600 and 2,542 respectively compared with 2016, a decrease of 63.1% and 51.3%.
When beijing experts can be seen at the doorstep of their homes, patients will naturally vote with their feet. (Planner: Leu.)