On July 19, the National Health Commission issued the "Letter on Reporting the Evaluation of the Medical Service Capacity of County Hospitals in 2023". It introduces the basic situation of the medical service capacity building of county hospitals across the country, the continuous improvement of the comprehensive capacity of county hospitals across the country, the positive results of the key work of county hospital capacity building, the main problems and the requirements for the next step.
The General Office of the National Health Commission on the circular
Letter on the assessment of the medical service capacity of county hospitals in 2023
In order to further improve the medical and health service system, implement the hierarchical diagnosis and treatment system, and continuously improve the medical service capacity of county hospitals, our committee continues to carry out third-party evaluation of the medical service capacity of county hospitals. In 2023, 2,062 hospitals will participate in the evaluation, with a county coverage rate of 98.6%. The 2023 annual assessment is hereby notified as follows:
1. The basic situation of the construction of medical service capacity in county hospitals across the country
According to the basic standards and recommended standards for the medical service capacity of county hospitals issued by our committee in 2016 (among them, the basic standard is equivalent to the capacity of secondary hospitals, and the recommended standard is equivalent to the capacity of tertiary hospitals), among the 2,062 county hospitals participating in the evaluation in 2023, 1,894 (accounting for 91.85%) meet the basic standards, of which 1,163 (accounting for 56.40%) meet the recommended standards, an increase of 38 and 199 respectively compared with 2022 (see Figure 1 and Figure 2).
Figure 1: The proportion of county hospitals in China that meet the basic standards
Figure 2: The proportion of county hospitals in China that meet the recommended standards
Second, the comprehensive capacity of county hospitals across the country has been continuously improved
(1) The capacity of medical services continues to increase.
First, the setting up and diagnosis and treatment capabilities of departments related to common and frequent diseases have been further improved. County hospitals across the country generally have internal medicine, surgery, obstetrics and gynecology, and pediatrics. The setting rates of intensive care medicine and rehabilitation medicine increased to 87.44% and 86.28%, and the psychiatric department increased by 7.38 percentage points compared with 2022. More than 98% of county hospitals can master the diagnosis and first aid of heart failure, kidney failure, respiratory failure, etc.; More than 95% of county hospitals can master obstetrics and pediatric emergency and critical treatment techniques; More than 88% of county hospitals are able to diagnose and manage multiple trauma. The proportion of hospitals with imaging, laboratory, pathology and other departments whose service capacity meets the basic standards has increased in an all-round way, and the proportion of hospitals with pathology service capacity meeting the basic standards has increased the fastest, increasing by 7.91 percentage points. On average, each county hospital was able to treat 1,690 types of diseases and 524 types of surgeries and operations, an increase of 13.50% and 7.38% respectively compared with 2022 (see Figure 3).
Fig.3 The suborder of disease types and the types of surgery and operation treated in county hospitals across the country
Second, the number and efficiency of diagnosis and treatment continue to improve. The average number of visits to each county hospital was 370,100, which was basically the same as in 2022. Among them, the number of discharged patients was 24,400, an increase of 14.55% over 2022; The number of surgeries and operations reached 16,500, an increase of 19.87% over 2022; The bed occupancy rate reached 87.66%, an increase of 7.07 percentage points from 2022, and the average length of stay was 7.59 days. (See Figure 4)
Figure 4: The efficiency of medical services in county hospitals across the country
Third, the quality and safety of medical care remain stable. The coincidence rate of admission and discharge diagnosis, pre- and postoperative diagnosis, and pathological clinical diagnosis was stable at more than 95%, and the infection rate of surgical site of class I incision was stable at a low level. (See Table 1)
(2) Management capacity continues to be enhanced.
First, the level of informatization has been steadily improved. The average level of the application level of electronic medical record system in county hospitals across the country has increased from 3.21 in 2022 to 3.31, and 1,814 (accounting for 87.97%) county hospitals have reached the level of electronic medical record level 3 and above, an increase of 92 compared with 2022 (see Figure 5), realizing data exchange and sharing among various departments in hospitals.
Figure 5: The classification of the functional application level of the electronic medical record system in county hospitals across the country
Second, the level of standardized clinical management has been continuously improved. The average number of diseases carried out by clinical pathways in each county hospital is 146, an increase of 13 compared with 2022; The patient management rate and clinical pathway completion rate of clinical pathway were 42.74% and 88.10%, respectively (Fig. 6).
Figure 6: Patient management rate and completion rate of clinical pathways
Third, the structure of revenue and expenditure continued to be optimized. The average annual income of each county hospital is about 350 million yuan, and the medical income accounts for 79.97%, an increase of 0.46 percentage points compared with 2022. Among them, the proportion of medical service revenue in medical revenue was 31.67%, an increase of 0.37 percentage points compared with 2022. The consumption of sanitary materials per 100 yuan of medical revenue was 24.52 yuan, a decrease of 3.08 yuan from 2022 (see Figure 7). Among the 36 single diseases monitored, the average hospitalization cost of 29 diseases decreased compared with 2022, and the average cost of 24 diseases such as acute ST-segment elevation myocardial infarction and inguinal hernia decreased by more than 10%.
Figure 7: The income structure of county hospitals is assessed nationwide
(3) The construction of talent team has been further strengthened.
The average number of health technicians in each county hospital in the country was 647, an increase of 3.52% over 2022, of which the number of licensed (assistant) physicians with master's degree or above and senior professional titles increased by more than 8% compared with 2022, and the number of nurses with college degree or above increased by 4.90% compared with 2022 (see Table 2).
(4) Synchronous improvement of facilities and equipment.
The average number of beds in each county hospital nationwide is 535, an increase of 3.24% over 2022. The building and construction area was 59,700 square meters, of which the average business space area was 51,000 square meters, an increase of 13.95% and 13.48% respectively over 2022. On average, each county hospital has about 993 pieces of equipment with more than 10,000 yuan, an increase of 16.82% over 2022. (See Figure 8)
Figure 8: The total value of equipment and the number of equipment above 10,000 yuan in the county hospital
(5) The role of county leaders and urban-rural links has been continuously highlighted.
1,928 (accounting for 93.50%) county hospitals took the lead in establishing county-level medical communities, and the number of two-way referrals reached 8.32 million, an increase of 14.90% over 2022. Among them, 4.24 million people were transferred to urban hospitals and received from township health centers, and 4.08 million were transferred to township health centers and received from urban hospitals, an increase of 2.54% and 31.40% respectively compared with 2022.
3. Positive results have been achieved in the key work of capacity building of county hospitals
(1) The "Thousand Counties Project" has been steadily implemented.
Among the 1,233 county hospitals of the "Thousand County Project", 1,005 meet the recommended standards. The key tasks of the "Thousand Counties Project" have been effectively implemented, and first, the clinical service capacity has been effectively enhanced. The setting rates of oncology, interventional radiology and intensive care medicine in county hospitals were 76.48%, 80.94% and 97.16%, respectively, which were higher than the national average.
Second, the emergency first aid capacity has been further improved. 99.51% of the county hospitals were able to diagnose and treat acute cerebrovascular disease and acute chest pain, and 98.05% were able to diagnose and treat multiple trauma. 96.76% of the county hospitals were able to master the emergency treatment of serious obstetric complications and complications such as amniotic fluid embolism, pregnancy complicated with heart failure, cerebrovascular accident, etc., and 99.35% were able to master the emergency treatment of pediatric acute and critical diseases.
Third, the level of medical resource sharing and high-quality management at the county level has been continuously improved. 1,198 county hospitals are the leading units of the county-level medical community, and the average proportion of medical service income of each county hospital to medical income is 31.25%, an increase of 0.75 percentage points compared with 2022. The average level of application of the electronic medical record system was 3.55, the average length of hospital stay was 7.35 days, and the infection rate of the surgical site of class I incision was 0.22%, all of which were better than the national average.
(2) Counterpart assistance in tertiary hospitals continues to advance.
Among the 791 county hospitals in the 785 counties that participated in the assessment, 671 met the basic standards and 350 met the recommended standards, an increase of 37 and 79 respectively from 2022. First, in terms of diagnosis and treatment capacity, hospitals providing standardized diagnosis and treatment services for common and frequently occurring diseases in hematology, thoracic surgery, and neurosurgery accounted for 72.57%, 90.01%, and 86.09%, respectively, an increase of 5.57, 5.75, and 2.97 percentage points compared with 2022.
Second, in terms of hospital management, the average level of application level of electronic medical record system in each county hospital has increased from 3.01 in 2022 to 3.17. The cost of sanitary materials per 100 yuan of medical income decreased from 25.90 yuan in 2022 to 24.02 yuan.
Third, in terms of talent construction, the average number of health technicians in each county hospital is 507, an increase of 14 compared with 2022, the number of licensed (assistant) physicians with a master's degree or above increased by 20% compared with 2022, and the number of nurses with college degree or above increased by 5.31% compared with 2022.
(3) Progress has been made in the "group" of medical talents to help hospitals in key counties of national rural revitalization.
Among the 158 people's hospitals in the key counties of the National Rural Revitalization Program, 148 meet the basic standards, of which 67 meet the recommended standards, an increase of 12 and 29 respectively from 2022. First, the setting rates of pediatrics, gynecology, and nephrology were 99.36%, 94.27%, and 78.34%, respectively, an increase of 3.79, 5.03, and 9.35 percentage points compared with 2022. More than 98% of the county people's hospitals can master the diagnosis and treatment of acute cerebrovascular disease, acute chest pain, and pediatric acute and critical diseases, and more than 92% of the county people's hospitals can carry out multiple trauma treatment and emergency treatment of serious obstetric complications and comorbidities. Second, the average number of health technicians in each county people's hospital is 484, an increase of 15 over 2022, of which the number of practicing (assistant) physicians with a master's degree or above increased by 28.70% compared with 2022, and the number of nurses with a college degree or above increased by 2.52% compared with 2022. Third, the average level of application level of the electronic medical record system in each county people's hospital has been increased from 3.01 in 2022 to 3.13. The cost of sanitary materials per 100 yuan of medical revenue decreased from 25.60 yuan in 2022 to 22.23 yuan.
Fourth, the main problems
(1) The progress of improving the medical service capacity of county hospitals is uneven, and there are still shortcomings in the construction of specialties.
The proportion of county hospitals meeting the basic standards in the eastern, central and western regions was 98.36%, 95.57% and 85.99%, respectively, and the development of the regions was unbalanced. The compliance rate of the basic standards of medical services in county hospitals in the bottom 10% of the counties is only 46.39% on average, which is 52.95 percentage points worse than that of the top 10% hospitals. The setting rate of otolaryngology, ophthalmology, and psychiatry is less than 80%, and the setting rate of oncology and other departments is less than 60%. Otolaryngology, ophthalmology, pathology and other departments still meet the basic standards of hospitals, accounting for less than 80%.
(2) The problem of talent shortage in county hospitals still exists.
In 2023, there will be an average of 211 licensed (assistant) physicians in each county hospital, 308 in the eastern, 225 in the central, and 152 in the western regions. There are 65 practicing (assistant) physicians with middle and senior professional titles, 107 in the eastern, 67 in the central and 41 in the western regions, and there is a significant gap between regions.
(3) The equipment configuration does not match the clinical needs.
According to the basic standard, the average allocation rate of specialized equipment in each county hospital was 69.70%; According to the recommended standard, the average allocation rate of specialized equipment in each county hospital was 54.65%. There are 29 devices in 17 specialties such as hematology, thoracic surgery, and anesthesiology, and the allocation rate of each equipment is less than 30%. 286 county hospitals are not equipped with hemodialysis machines.
Fifth, the next step of the work requirements
(1) Continue to implement the key tasks of improving the capacity of county hospitals, and improve the ability of county hospitals to diagnose and treat common and frequently occurring diseases.
All localities should implement the work requirements of "group-type" assistance for medical talents, counterpart assistance for tertiary hospitals, roving medical treatment of national medical teams, "10,000 doctors to support rural health projects", "1,000 county projects" and "Notice on Further Improving the Mechanism to Promote the Sinking of Urban Medical Resources to County-level Hospitals and Urban and Rural Grassroots", strengthen the comprehensive service capacity building of county hospitals, focus on common diseases, frequent diseases and diseases with a high transfer rate in the county, improve the setting of departments, and improve the ability of diagnosis and treatment. Increase the introduction and training of professional and technical personnel in shortage of specialties and key positions in county hospitals, actively carry out personnel training and training, and build a stable and reasonable echelon of professional talents.
(2) Fully implement the functional positioning of county hospitals.
Actively promote the high-quality development of county hospitals, give full play to the role of county hospitals as county leaders and urban-rural links, strengthen county-level overall planning and scientific management, improve the efficiency of county-level medical resource allocation and use, consolidate the relationship with urban hospitals for telemedicine services, smooth two-way referral channels, and improve the accessibility and continuity of medical services.
(3) Continue to improve relevant supporting policies.
All localities should strengthen the main responsibility, increase support for the comprehensive capacity improvement of county hospitals, and refine the implementation of work priorities and policy measures. Cooperate with the promotion of the reform of medical insurance payment methods, and improve the dynamic adjustment mechanism of medical service prices at the county level. Deepen the reform of the salary system, reasonably approve the total amount and level of performance-based wages, and establish a salary system that reflects job responsibilities and technical value. Implement the autonomy of county hospitals in personnel recruitment and other aspects.
Annex:
- The basic standards for the medical service capacity of the county hospital are met
- The county hospital's medical service capacity recommendation standards are met
- The "Thousand Counties Project" county hospital medical service capacity recommendation standards are in compliance
- The basic standards for the medical service capacity of the counterpart county hospital are met
- The service capacity of each department of the county hospital is in line with the situation
- The setting up of each department of the county hospital
- Grading and evaluation of the application level of the electronic medical record system in county hospitals
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