On February 18, a company in Shenzhen issued an announcement saying that it had recently received a civil ruling from the Henan Provincial Intermediate People's Court, showing that the merger and bankruptcy determination of Xuchang Second People's Hospital, Xuchang Municipal Hospital and Xuchang Municipal Hospital Management Co., Ltd. "failed" on the grounds that "the basic facts were unclear and the evidence was insufficient". The company has signed a medical expansion project contract of 250 million yuan with the Second People's Hospital of Xuchang City
A progress announcement issued by the company
The Second People's Hospital of Xuchang City and Xuchang Municipal Hospital are public hospitals at first glance, but they are actually private. After 2006, several large public hospitals in Xuchang changed their identities from public to private in a government-led reform. In order to improve the enthusiasm of doctors, the hospital allows all employees to hold shares, so that everyone can become the real "master" of the hospital.
Similarly, Luoyang. Luoyang also completed the reform of "whole-hospital shareholding and public reform" a few years later than Xu Chang, and the difference between the two is that Luoyang's reform came to an end in 2017, and all the restructured hospitals were changed back to public; Xu Chang's reform is still ongoing.
The impact of this reform continues to this day. A Zheng University graduate from Xuchang said that Xuchang's "restructuring" has now prevented him from returning home for employment and has forced him to leave his hometown. "Everyone said that we would rather go to other prefecture-level cities or go to the second class, and we would not return to Xuchang."
The whole hospital holds shares, and doctors become shareholders
Many say 2009 was the first year of the national medical reform, and for Xuchang, the reform pushed forward for at least 4 years.
In 2005, the Leading Group for the Reform of the Property Rights System of Enterprises and Institutions in Xuchang City issued the "Opinions on the Reform of the Property Rights System of Municipal Public Medical and Health Units (Trial)", requiring public hospitals in Xuchang City to carry out property rights reform. Subsequently, 3 units such as Xuchang Central Hospital were listed in the municipal public institution restructuring account, and the municipal people's hospital was included in the Weidu District public institution restructuring account.
In June 2006, all four hospitals were restructured into joint-stock non-profit hospitals with employee shareholding, technical backbone and management control, and all state-owned assets were withdrawn.
Xuchang Municipal People's Government introduced the reform of the property rights system of a hospital
In order to implement the hospital-wide shareholding system in the hospital, the consent of the hospital staff is first required. Jiang Rong, who has worked in Xuchang Central Hospital for more than 30 years, remembers the scene during the restructuring: "At the beginning, many people were against it, and everyone didn't know what 'joint-stock system' meant. The hospital will have a weekly meeting every Friday to talk and repeatedly tell everyone the benefits of restructuring."
The hospital also gave a compensation plan, saying that although there is no establishment after the restructuring, it will give compensation for identity replacement according to the title and number of years, and will not treat everyone badly.
In Jiang Rong's eyes, young people at the beginning of the new century are easy to accept new things, and they are not so cautious, and after listening to it, they feel "then try it". At that time, he had been working in the hospital for a while, and his status replacement fee was 10,000 yuan. Not long after, the hospital notified everyone to subscribe for shares: 5,000 yuan for resident doctors, 10,000 yuan for attending physicians, 30,000 yuan for deputy high doctors, 50,000 yuan for positive height, and 100,000 yuan for staff representatives (usually department heads, head nurses).
"You can give up, and if you have a quota, you can subscribe a little more." Fei Yunjiang, who had just come to another general hospital in Xuchang at that time, subscribed for an additional 10,000 yuan out of trust in the hospital, and paid a total of 20,000 yuan. "In a hospital of seven or eight hundred people, there are only dozens of people with the title of deputy senior or above, and the rest are young attending and resident doctors, and it is not difficult for them to subscribe with 10,000 yuan."
"There should be less than 10 people in the hospital who did not buy, many of them are department heads, mainly because it is difficult to subscribe for 100,000 yuan in one go." Jiang Rong said.
In the memory of doctors, in addition to the 51% share held by the government, only 10% of the remaining 49% of the shares belong to doctors, and the rest belong to the top of the hospital. "Now that I think about it, the shares we give our doctors are pitifully small and can almost be ignored." Jiang Rong said.
"There were about 10 people at the top, and they should have subscribed to three or five million each. Restructuring is the best for them." Fei Yunjiang said that although there is no explicit notice, the monthly dividends of 100 or 200 yuan make doctors believe that the top management may pay more dividends.
The wave of expansion after the restructuring
After the restructuring, several hospitals have ushered in a period of development, and the first manifestation is in the autonomy of employment.
Taking Xuchang Central Hospital as an example, within three years of restructuring, Xuchang Central Hospital introduced 45 graduate master's students, invited well-known experts and professors at home and abroad to hold 23 lectures, and selected business backbones to go out for further study; Xuchang People's Hospital introduced 12 graduate students; Another hospital, which used to have difficulty recruiting undergraduates, also recruited 75 undergraduates after the restructuring.
Source: Luoyang Daily
Jiang Rong said that after the restructuring, the hospital did not set off a "wave of departures" as rumored by the outside world, on the contrary, the hospital also poached many people, "occasionally a few doctors who left, but they just felt that there was no relative freedom in compiling, so they could go to a better platform." Fei Yunjiang also graduated during this period and "jumped" from the original hospital to another hospital.
Several doctors believe that the "vitality" of the hospital has become stronger after the restructuring. "Give young doctors a platform, work as much as they earn, and the hospital will develop more learning opportunities for everyone." Jiang Rong said that before the restructuring, his monthly salary was only about 2,000 yuan, and after the restructuring, it rose some, if you feel tired, it is relatively fair to do less and earn less.
In order to cope with the development, hospitals have also strengthened their hardware facilities. After the restructuring of Xuchang Central Hospital, nearly 30 million yuan was invested to purchase medical equipment such as magnetic resonance; Invested nearly 100 million yuan to start the construction of surgical ward building[1]; The Xuchang Second People's Hospital, which is now bankrupt, mentioned above, has also signed expansion projects totaling nearly 300 million yuan with a number of medical companies after restructuring for the hospital's operating department, interior and exterior decoration projects, HVAC and intelligent system construction. [2]
The scale of such an investment is not small. For example, as the largest third-class hospital in Xuchang City, the central hospital's business revenue in 2009 was 210 million yuan[1], which is equivalent to more than half of the annual income used to build ward buildings; Luoyang Central Hospital, which has also undergone restructuring, has an annual business income of about 400 million yuan, and the budget for the construction of ward buildings in 2010 is 170 million yuan, accounting for about 1/3 of the total annual income. [3]
Moreover, Xuchang is less than 100 kilometers away from the provincial capital Zhengzhou, and can be reached in 20 minutes by high-speed rail, which will also absorb some of Xuchang's patients. A resident of Xuchang said that the restructuring is very famous, and everyone knows that hospitals in the city have become private, or they prefer to go to more well-known public hospitals.
"I have rheumatism, and I have to go for a follow-up every two or three months, and I take the high-speed train to Zheng Dayi to see it." She said that she would leave home at six o'clock in the morning and be able to go to Zheng Dayi in about an hour, which was very convenient for seeing a doctor.
Although the receiving doctors are still those and the health insurance can be used as usual, patients still care about the nature of the hospital. Health Times once reported a related dispute: a patient went to the Fifth People's Hospital of Xuchang City to see a doctor, because of the word "people", she took it for granted that it was a public hospital, but she did not expect that when she asked the front desk "the nature of the hospital", the front desk was branched, and she found that the hospital was private. [4]
Later, the staff of the Fifth People's Hospital of Xuchang City responded that the hospital was non-public in nature, and the name of the unit was not changed after the restructuring, which was a historical problem.
On the other hand, the government is gradually "weaning" the restructured hospitals. From the fourth year, the government gives hospitals 50% of the original financial subsidy, 30% in the fifth year, and abolition in the sixth year. Although the hospitals have not disclosed follow-up revenue data later, they will face unprecedented economic pressure to a certain extent. "I forgot that from the first few years, dividends will not be paid." Fei Yunjiang said.
Young Doctor: It's hard to go back to Xuchang
In 2016, Xuchang Central Hospital, which had been restructured for nearly 10 years, returned to its public identity.
Jiang Rong said, "It took a long time to change it, and it was only a momentary matter to change it back, and it was over after a notice" The 10,000 yuan subscription shares he handed in that year were also returned. The hospital's original plan was to return 1:2, but it was actually 1:1. "It's still 10,000 pieces, intact." He said.
The successful transfer of Xuchang Central Hospital back to the public has made the people in this hospital sweat and the people in the outer courtyard envious. Fei Yunjiang said that it is still "more stable and more down-to-earth" to change back. He feels that "changing back to the public is the trend of the times, and everyone knows it."
In January 2019, Kan Quanquan, former director of the Henan Provincial Health Commission, said at the provincial health work conference, "Reform is not a reform, everything that is restructured must be taken back or newly built by the government." Kan Quanquan said that it is necessary to expand and deepen the comprehensive reform of public hospitals, so that public hospitals will become the main force in providing basic medical and health services for the people.
As for why only the central hospital was changed, but other hospitals were not, doctors have their own guesses. A doctor at a former people's hospital said that it was very difficult for other hospitals to change back, "because some hospitals' capital chains have been broken."
For example, in early 2021, the Weidu District People's Court of Xuchang City issued an announcement saying that it was ruling to accept the bankruptcy restructuring case administered by Xuchang Municipal Hospital. Public information shows that since 2019, Xuchang Municipal Hospital has experienced a debt crisis, and in 2020 alone, there have been more than 10 contract disputes caused by overdue payment of drugs and equipment, involving more than 200 million yuan, and 67.18 million yuan in enforcement cases.
Photo: Weidu District People's Court of Xuchang City
The Shenzhen company that cooperated with it conducted a single impairment test on the hospital and found that the proposed credit impairment provision in 2022 was about 129.1628 million yuan, indicating that it had a greater impact on the company's current performance. [5]
Outside the central hospital, doctors are confident that there will be such a day, even though the whistle has not yet been sounded. Feng Duoduo, who joined Xuchang People's Hospital in 2018, said that the hospital has never told herself about holding shares, nor have other doctors, and she guesses that only the older generation of doctors have. "We are usually no different from public hospitals, and we have also gone to fight the epidemic before."
In her eyes, the working status is no different from that of public hospitals, and there is a precedent of Luoyang's "change back to all", "it may only be a matter of time before people's hospitals change back to public".
From the perspective of senior doctor Xu Chang, there is no "good" and "bad" in restructuring, and what he should do is to judge the time and size up the situation. Jiang Rong, who retired from his position as chief physician this year, said, "Instead of judging the merits of the system, it is better to adjust the posture of moving forward." For young people who are just starting their careers, the salary and whether there is a staffing are almost 100% determined whether he joins or not.
"As a Xuchang person, my family has been preparing a new house for themselves for a few years." Chen Xiaohao, a fresh graduate, said, "I am still waiting for the recruitment announcement of the Central Hospital. If you can't meet it, you can only leave your hometown and go to other cities, which is very helpless, because the choice is very limited." When he was just enrolled in graduate school, a fellow senior brother told him that Xu Chang did not have many opportunities to plan ahead. Now, he is also admonishing his junior brothers and sisters in this way.
In the text, Jiang Rong, Fei Yunjiang, Feng Duoduo, and Chen Xiaohao are pseudonyms
Curator: yxtlavi|Executive Producer: Gyouza
Source: Visual China
Written by yxtlavi
Resources:
[1]http://lyrb.lyd.com.cn/html/2010-10/15/content_677057.htm
[2]http://stock.10jqka.com.cn/20220418/c638414962.shtml
[3] Wu Fengqing. President of China Hospital,2011(22):34-35+13.)
[4]https://m.gmw.cn/baijia/2020-11/29/1301849782.html
[5]https://pdf.dfcfw.com/pdf/H2_AN202302171583298334_1.pdf?1676666503000.pdf
[6] Eggenfa. The dilemma and countermeasures faced by the restructuring of hospitals[J].China Health Industry,2011,8(9Z):51-52.)