"Our large hospitals and teaching hospitals should do something tasteful," said Minister of Health Chen Hao at the 2012 annual academic meeting of the Chinese Medical Association held on January 7.
Chen Hao pointed out that the main difficulties and challenges in the reform of public hospitals are that they still lack the top-level design. The concrete manifestations include the unclear government responsibilities, the distorted incentive mechanism, weak regulatory oversight, and unbalanced resource allocation. In particular, the distortion of the incentive mechanism has become the institutional cause of the current tension between doctors and patients.
“The period of growth of extensive, extension-type public hospitals that rely on building houses and expanding beds has already passed. These will be incorporated into the government's regional health plan,†Chen said. Avoiding the blind expansion of public hospitals can also create space for the entry of private capital. .
The "expanding ground" period has passed
According to the statistical bulletin of the Ministry of Health, in 2005, the personal health expenditure of Chinese residents accounted for 52.2% of the total health expenditure, and it has dropped to 37.5% in 2009. In contrast, the total number of people attending medical institutions in China is 2.305 billion. By 2010, this number has reached 5.838 billion. It is expected that the total number of people in 2011 may exceed 6.2 billion.
Accompanied by this process is the rapid expansion of public hospitals, especially the top three hospitals. Including Concorde, Tongren and other famous top-three hospitals have opened branch offices; and such as the implementation of the multiplication plan in Henan Province, within five years, 10 provincial direct management hospital beds from 14,000 to 40,000.
There are too many expansion methods like this, and public hospitals are moving from the original "large" and "giant" to the "aircraft carrier" level by virtue of their dominant monopoly position. But this is not a healthy and sustainable development model.
"From the analysis of the amount of medical services in China in the past two years, the growth period of blowouts has passed," Chen said. "We are prepared to stop the public hospitals in an extensive, extension-style approach to building houses and increasing the number of beds."
Chen Hao said that in the future, investment in infrastructure and increase in equipment and equipment will be based on the government’s regional health plan. The government’s finances will be responsible for this, which will leave room for private capital to enter the medical market.
Liu Guoen, a professor at Peking University Guanghua School of Management, pointed out that regional health planning is a typical feature of the planned economy era. If we must adhere to the guidance of regional health planning, we need to reinterpret it and fundamentally adjust the allocation of public and private institutions.
Inverted Pyramid Talent Structure
The current key to the reform of public hospitals is the personnel system. This system has led to more and more talented people concentrating on high-ranking top-three hospitals, causing a shortage of primary medical personnel.
"We now have individual departments in some of the top three hospitals, which are five or six chief physicians and eight to ten deputy chief physicians." Chen Xiao pointed out that few hospitals in developed countries are such talent structures and they are all pyramids.
Chen Yu pointed out that the reform of public hospitals in China lacks top-level design. The concrete manifestations are four aspects: government responsibilities are unclear, incentive mechanisms are distorted, regulation is weak, and resource allocation is unbalanced.
The imbalance in resource allocation is mainly due to the concentration of human resources and other health resources to the urban areas. This not only causes shortage of health resources at the grass-roots level, but also results in low utilization efficiency at the macro level. Faced with the growth in medical demand brought about by the expansion of medical insurance coverage this year, the contradiction between the supply and demand in China's medical market has become increasingly prominent.
The problems caused by unclear government responsibilities and distorted incentive mechanisms all point to "remedy by medicine." "Remedy by medicine" is the tangled issue of many problems in public hospitals at present, including over-prescription, over-medical treatment, medical personnel withholding the deduction, and even a tense doctor-patient relationship.
The Ministry of Health has already strived to eliminate all public hospitals as the “Twelfth Five-Year†target for drug supplementation. However, directly related to this is the establishment of new distribution incentives for medical personnel.
At this year's health work conference, Zhang Mao, secretary of the Party Committee of the Ministry of Health, pointed out that “let medical staff are encouraged†the success of the relationship reform. "In the "12th Five-Year Plan" period, we must carefully study and actively explore the policy measures to mobilize the enthusiasm of the medical staff, and bring into play the dual role of material incentives and spiritual incentives," said Zhang Mao.
Chen Hao pointed out that the main difficulties and challenges in the reform of public hospitals are that they still lack the top-level design. The concrete manifestations include the unclear government responsibilities, the distorted incentive mechanism, weak regulatory oversight, and unbalanced resource allocation. In particular, the distortion of the incentive mechanism has become the institutional cause of the current tension between doctors and patients.
“The period of growth of extensive, extension-type public hospitals that rely on building houses and expanding beds has already passed. These will be incorporated into the government's regional health plan,†Chen said. Avoiding the blind expansion of public hospitals can also create space for the entry of private capital. .
The "expanding ground" period has passed
According to the statistical bulletin of the Ministry of Health, in 2005, the personal health expenditure of Chinese residents accounted for 52.2% of the total health expenditure, and it has dropped to 37.5% in 2009. In contrast, the total number of people attending medical institutions in China is 2.305 billion. By 2010, this number has reached 5.838 billion. It is expected that the total number of people in 2011 may exceed 6.2 billion.
Accompanied by this process is the rapid expansion of public hospitals, especially the top three hospitals. Including Concorde, Tongren and other famous top-three hospitals have opened branch offices; and such as the implementation of the multiplication plan in Henan Province, within five years, 10 provincial direct management hospital beds from 14,000 to 40,000.
There are too many expansion methods like this, and public hospitals are moving from the original "large" and "giant" to the "aircraft carrier" level by virtue of their dominant monopoly position. But this is not a healthy and sustainable development model.
"From the analysis of the amount of medical services in China in the past two years, the growth period of blowouts has passed," Chen said. "We are prepared to stop the public hospitals in an extensive, extension-style approach to building houses and increasing the number of beds."
Chen Hao said that in the future, investment in infrastructure and increase in equipment and equipment will be based on the government’s regional health plan. The government’s finances will be responsible for this, which will leave room for private capital to enter the medical market.
Liu Guoen, a professor at Peking University Guanghua School of Management, pointed out that regional health planning is a typical feature of the planned economy era. If we must adhere to the guidance of regional health planning, we need to reinterpret it and fundamentally adjust the allocation of public and private institutions.
Inverted Pyramid Talent Structure
The current key to the reform of public hospitals is the personnel system. This system has led to more and more talented people concentrating on high-ranking top-three hospitals, causing a shortage of primary medical personnel.
"We now have individual departments in some of the top three hospitals, which are five or six chief physicians and eight to ten deputy chief physicians." Chen Xiao pointed out that few hospitals in developed countries are such talent structures and they are all pyramids.
Chen Yu pointed out that the reform of public hospitals in China lacks top-level design. The concrete manifestations are four aspects: government responsibilities are unclear, incentive mechanisms are distorted, regulation is weak, and resource allocation is unbalanced.
The imbalance in resource allocation is mainly due to the concentration of human resources and other health resources to the urban areas. This not only causes shortage of health resources at the grass-roots level, but also results in low utilization efficiency at the macro level. Faced with the growth in medical demand brought about by the expansion of medical insurance coverage this year, the contradiction between the supply and demand in China's medical market has become increasingly prominent.
The problems caused by unclear government responsibilities and distorted incentive mechanisms all point to "remedy by medicine." "Remedy by medicine" is the tangled issue of many problems in public hospitals at present, including over-prescription, over-medical treatment, medical personnel withholding the deduction, and even a tense doctor-patient relationship.
The Ministry of Health has already strived to eliminate all public hospitals as the “Twelfth Five-Year†target for drug supplementation. However, directly related to this is the establishment of new distribution incentives for medical personnel.
At this year's health work conference, Zhang Mao, secretary of the Party Committee of the Ministry of Health, pointed out that “let medical staff are encouraged†the success of the relationship reform. "In the "12th Five-Year Plan" period, we must carefully study and actively explore the policy measures to mobilize the enthusiasm of the medical staff, and bring into play the dual role of material incentives and spiritual incentives," said Zhang Mao.
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