In the new era and new journey, the construction of rural medical and health service system is in an important strategic position. Although the primary medical and health system in mainland China is the focus of the construction of "Healthy China", there are still many shortcomings. This study focuses on the primary medical and health services in mainland China from 2017 to 2023, analyzes the development trends in the number of institutions, the number of personnel, and the supply of services, analyzes the existing problems and explores countermeasures, so as to provide a reference for the implementation of the policy of "strengthening the grassroots" and promoting the equalization of primary medical and health services.
Source: Thousand Towns and Thousand Hospitals Development Research Pro
Author: Tomiya
Editor: Lingxing
Cover source: pixabay
Placing the construction of rural medical and health service system in an important strategic position is an inevitable requirement of the new era and new journey. The status of the primary medical and health system determines that the construction of "Healthy China" in the new era should be "focused on the grassroots level", implemented and promoted the high-quality development of primary health care, which is an important policy for the mainland's health and health work under the new situation, and is a historical choice for the development of China's medical and health undertakings.
Primary medical and health institutions are most closely related to the daily life of residents in the tertiary medical service system, which directly determines whether residents' health service needs can be realized, but there are still many deficiencies in the current primary medical and health services in the mainland, such as the allocation of medical and health resources and the quality of health services can not fully meet the needs of the people.
This study compares and analyzes the development trends of primary medical and health service provision, human resources, and the number of institutions in mainland China since 2017-2023, analyzes their problems and seeks countermeasures, so as to provide a reference for the implementation of the policy of "strengthening the grassroots" and promoting the equalization of primary medical and health services.
2017-2023
The trend of the number of primary medical and health institutions in mainland China
From 2017 to 2023, the number of primary medical and health institutions in mainland China has increased year by year, with an overall increase of 36,500, and the annual growth rate is not much different, indicating that the national planning and approval control of primary medical and health institutions is in place.
Among them, the number of township health centers (including township health centers, neighborhood health centers, and central health centers) and village clinics has shown a decreasing trend year by year, with a decrease of 164 and 5,785 respectively in the past two years. The number of community health service centers (including community health service stations) is increasing year by year, and by the end of 2023, the number of community health service centers (including stations) has increased by 729; In addition, the number of clinics (infirmaries) has increased year by year and has increased significantly, with an increase of 36,600 by the end of 2023, becoming the main force for the increase in the number of primary medical and health institutions.
2017-2023
The trend of the number of personnel in primary medical and health institutions in mainland China
(1) Overall change trend: In the seven years from 2017 to 2023, the number of personnel in primary medical and health institutions in mainland China has increased year by year, with an overall increase of 402,000, and the growth rate has remained at about 15%, of which the number of personnel in township health centers has increased by more than 74,000 in the past two years, with an average increase of 8-9%; The number of personnel in community health service centers (stations) has increased by more than 60,000 in the past two years, with an average increase of more than 20% and an increase of 5 percentage points over the average; The number of staff in the village clinic is still decreasing overall, with an average decrease of more than 6%, and a total of more than 130,000 people in the seven years to the end of 2023.
(2) The trend of changes in the classification of personnel in township health centers: the number of personnel mainly includes licensed physicians, licensed assistant physicians, registered nurses, pharmacists (doctors), technicians (doctors) and other health professionals, and the number of the above personnel shows an increasing trend year by year, indicating that with the gradual improvement of the country's hard requirements for the medical service capacity of primary medical and health institutions, the talent team of township health centers is undergoing structural adjustment.
For example, the number of licensed (assistant) physicians increased by 12.71%, and the number of licensed physicians increased by 18.33%, of which the data of licensed physicians were included in the number of licensed (assistant) physicians. Among the health technicians, technicians and registered nurses increased significantly, ranking in the top two, while other health technicians showed a decreasing trend year by year. The largest decrease in management personnel was 43.45%; Other technical personnel mainly refer to non-health professionals engaged in medical device repair, health promotion, scientific research, teaching and other technical work, with a relatively prominent increase of 25.13%.
The change in the decline shows that the township health centers have obvious deficiencies in the allocation of pharmacists (doctors), management personnel, service skills and other personnel, which is related to the positioning and goal setting of the institution for its own development, and the significant reduction of management personnel is related to the unified requirements of the personnel of the construction of the medical community, and the reduction of work and service skills is related to the number of equipment in the hospital.
(3) The change trend of community health service center (station) personnel by category: among the personnel of community health service centers (stations), there is an overall upward trend, with an increase of 23.12%. Among them, except for other health technicians and management personnel, which are decreasing year by year, other personnel are increasing year by year.
As shown in the table below, the total number of licensed (assistant) physicians in community health service centers (including health service stations) increased from 198,000 to 278,000, with an average increase of nearly 24% in five years (2017-2021), of which the number of licensed physicians increased from 160,000 to 237,000, a net increase of nearly 80,000, or 26.31%. In addition, technicians (doctors), other technical personnel, and registered nurses increased the most, with 46.27%, 40.24%, and 34.92% respectively, ranking in the top three. The growth rates of pharmacists and workers were relatively average, with 17.33% and 18.36% respectively. Other health technicians and managers showed a decreasing trend year by year, with a decrease of 16.96% and 24.91% respectively.
(4) The trend of changes in the classification of village clinic personnel: the personnel of village clinics mainly include licensed physicians, licensed assistant physicians, registered nurses, rural doctors and hygienists, and the data in 2021 included pharmacists.
As shown in the table below, from 2017 to 2023, the number of staff in village clinics continued to decline, and by the end of 2023, it had decreased to 1.327 million, a decrease of 6%. At the same time, the number of registered nurses and licensed (assistant) physicians in the village clinic continued to increase year by year, and in seven years, the number of licensed (assistant) physicians increased from 352,000 to 508,000, an increase of 35%, and the number of registered nurses increased from 135,000 to 196,000, an increase of 43%, ranking among the top two. From 2017 to 2021, the number of rural doctors and hygienists decreased by 130,000 and 48,000, respectively, a decrease of 25.49% and 71.51%.
2017-2023
The supply of primary medical and health services in mainland China
(1) The annual diagnosis and treatment volume of primary medical and health institutions is generally on the rise. As shown in the table below, the number of diagnoses and treatments in 2023 will reach 4.94 billion, a significant increase from the previous year. Specifically, in terms of medical institutions, the number of diagnosis and treatment in township health centers has increased year by year, from 1.12 billion to 1.31 billion, with a net increase of 190 million, accounting for basically the same as in 2019, but still a decrease of 1-2 percentage points compared with 2020-2021; The total number of visits to community health service centers is 830 million, with an average annual diagnosis and treatment volume of 82,000 per community health service center, and the number of visits to community health service stations nationwide is 210 million, with an average annual diagnosis and treatment volume of 7,612 per station; in terms of village clinics, in 2023, the number of visits to village clinics will be 1.4 billion, an increase of 120 million over the previous year, with an average annual diagnosis and treatment volume of 2,407 people per village clinic, with the largest decrease of 25.01% in village clinics. Taking the data from 2017 to 2021 as an example, outpatient departments had the largest increase of 55.19%, followed by clinics (infirmaries) and community health service centers (stations), with an increase of 13.10% and 8.96%, respectively. Health centers saw the smallest increase of 4.56%.
(2) The annual number of admissions in primary medical and health institutions is generally declining, and it will usher in an inflection point in 2023. Among them, township health centers have the largest decrease, down 20.44%, with 39.921 million admissions in 2023, an increase of 7.53 million over the previous year, community health service centers (stations) with a decrease of 11.03%, with 4.804 million admissions, an average of 477 annual admissions per community health service center, and outpatient departments with a large increase of 125.44%.
(3) Beds and utilization of primary medical and health institutions: In the past seven years, the number of beds in primary medical and health institutions in mainland China has generally shown an upward trend, with a total of 1.82 million beds, an average increase of 10%. Among them, the total number of beds in township health centers was 1.5 million, an increase of more than 200,000 over 2017, and the average number of beds in each township health center was 44.6, an increase of nearly 10 beds per home compared with 2017 (35.15 beds per home); The total number of beds in community health service centers (stations) was 285,200, an increase of nearly 70,000 over 2017, and the average number of beds in each community health service center was 7.7, an increase of 1.4 beds per home over 2017 (6.3 beds/home).
Considering the epidemic factors from 2020 to 2022, in 2023, the bed utilization rate of township health centers will be 6 percentage points higher than that of community health service centers. Among them, the bed utilization rate of township health centers was 53.3%, which was still 4 percentage points lower than the three years before the epidemic, and was still in a state of recovery; The bed occupancy rate of 50.2% of community health service centers has exceeded that of 2019 (before the epidemic) by 0.5 percentage points, and is 1.8 percentage points lower than that in 2018, indicating that with the acceleration of urbanization, the establishment of community hospitals dominated by community health service centers has achieved remarkable results.
In terms of average length of stay, the average length of stay in community health centers is 9.7 days, which is more than 3 days higher than that of township health centers (6.5 days), and from the perspective of changes, since 2023, community health service centers and township health centers have requirements for patients' hospital days, showing a downward trend.
(4) The average daily burden of physicians in primary medical and health institutions: the average daily burden of physicians showed a downward trend, with the largest decrease of 21.99% in community health service stations, followed by 9.88% in community health service centers and 5.32% in health centers. Taking the relevant data in 2023 as an example, they are gradually returning to the pre-epidemic level (the gap is further narrowed); The average daily inpatient bed days of physicians showed an overall downward trend, and the decline was large, with a decrease of 29.41% in township health centers and 28.57% in community health service centers.
Conclusions
(1) The number of primary medical and health institutions has increased steadily, while the number of township health centers and village clinics has shown a downward trend. As for the future development of these two types of primary medical and health institutions, some scholars believe that due to the obvious acceleration of village merger in recent years, some places have chosen to change villages into communities in the tide of urbanization, which has accelerated the demise of village clinics, and also caused the merger and re-establishment of general township health centers. As for the medical institutions themselves, due to the limited level of medical service supply, it is difficult to meet the needs of residents, especially the fault line of grassroots personnel, and the reluctance of young personnel to work at the grassroots level, resulting in an increase in mergers.
(2) The number of pharmacists, rural doctors and hygienists is insufficient, and the number of registered nurses and technicians remains on the rise. The author believes that in the process of developing the nurse team, we should continue to maintain the tilt towards the grassroots to meet the nursing needs of the grassroots people. In particular, it is necessary to strengthen the professional training of nurses, especially the service ability and service awareness of nurses in health management, geriatric nursing, rehabilitation promotion, palliative care, etc., and strengthen training through such methods as "inviting in and sending out", so that they can play a full role in accelerating the construction of a hierarchical diagnosis and treatment system and promoting the contracted service system of family doctors. Encourage basic level medical and health institutions to develop family beds and home care, and provide nursing services for patients who are bedridden for a long time, patients with advanced palliative care, elderly patients, and other groups. Nursing services are extended to communities and families, and the content and methods of services are gradually improved to ensure the continuity of nursing services.
(3) The allocation of beds showed an upward trend, but the utilization of beds declined. In recent years, under the policy of "strengthening the grassroots", the government has attached great importance to the allocation of grassroots resources and continuously increased investment in the field of primary medical and health care. The configuration standard of the nursing station is relatively simple, and the basic service content mainly involves basic nursing and specialized nursing, which can better serve the elderly and other groups, with a large market space, strong replicability, and rapid development of the business format. The outpatient department has a wide range of services, flexible service methods, high treatment efficiency, simple and convenient service process, and low medical costs, which can meet the individual needs of most people. Studies have shown that the opening of nursing outpatient clinics shortens the length of hospital stay, reduces the cost of hospitalization, and can provide patients with more and better health services, and patients have a high level of satisfaction with them. This is probably the main reason for its rapid development.
In recent years, the number of migrant workers in urban areas has increased, which has directly led to an increase in the number of people served by urban community health service centers (stations), and an increase in the demand for health resource allocation. The utilization rate of hospital beds has been declining year by year, and the reduction in health centers has been the largest. This may be related to the relatively low level of medical care and management level of primary medical and health institutions, resulting in a lack of attractiveness, coupled with the loss of both talents and patients, resulting in a decline in bed utilization. It is suggested that the two-way referral system should be strengthened, and the primary medical and health resources should be fully utilized to improve the utilization rate of beds. The average daily burden of physicians in primary medical and health institutions has shown a downward trend, which is convenient for primary medical and health personnel to have more energy to improve the quality of medical care, improve medical services, and promote the harmonious relationship between doctors and patients.
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Source of this article: Development Research Pro
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