Interview with medical reform: cure the three major diseases to be surgery

The policy has continued to increase, so that China's health reform plan will re-emerge at an important moment in 2014. However, on the original issue of “difficulty in seeing a doctor and expensive to see a doctor”, medical reform encounters multiple resistances, and it is advancing slowly. Where are the stubborn diseases?

“Public hospitals have not established a reasonable compensation mechanism for a long time. It is precisely the problems that reform parties need to face, and it is also a problem that needs deep-level reforms to crack.” Hou Yan, director of the Planning and Information Department of the National Health and Family Planning Commission, reiterated recently. The lack of mechanisms has greatly contributed to the disorderly expansion of public hospitals, which has exacerbated misallocation of medical resources. On the one hand, it is the reform of public hospitals that has been slow for a long time, and the other is the sudden release of social services that are not yet clear. In October last year, the relevant documents issued by the State Council suggested that by 2020, the total size of China's health service industry will reach more than 8 trillion yuan. How to implement this goal requires further exploration.

What kind of hospital does China need? The reporter has carried out in-depth discussion on this topic from various angles and has also caused great concern from all walks of life. However, in the face of three ills, such as unreasonable allocation of medical resources, unclear social model of medical treatment, and small-scale private hospitals, it is necessary for industry experts to further explore.

The reform of public hospitals has entered the period of attack

If "medical reform is a world problem", public hospital reform is a difficult problem.

In recent years, the problem of “difficult to see a doctor and expensive to see a doctor” has always plagued the people. In 2012, the annual outpatient visits of our residents exceeded 5 times, and the annual hospitalization rate reached 13%, which was higher than the 4.2 times in the United States and 10.4% in the same period. Behind the imbalance in the distribution of medical resources and the use of medicine to support medical treatment, it is the urgent need for “a moving knife” for the “aortic” medical reform in public hospitals.

Rao Keqin, a member of the State Council's Medical Reform Expert Consultation Committee, wrote not long ago that in the past period, public hospitals in our country have weakened their “public benefit” and “non-profit” characteristics. There are obvious shortcomings as “public policies or institutional arrangements”, which are mainly reflected in: Problems such as unbalanced allocation of medical resources, low government financial investment, inadequate compensation, distorted prices of medical workers' technical services, high drug prices, and excessive medical treatment lead to tensions between doctors and patients, and lack of regulation and ineffective supervision have further aggravated these contradictions. .

With the continuous refinement of reform measures, the state has successively promulgated the "Opinions on Deepening the Reform of the Medical and Health Care System," and the "Notice on Issuing the Guiding Opinions on the Pilot Projects for the Public Hospitals Reform" and "Deepening the Medical and Health System during the 12th Five-Year Plan." “Reform Planning and Implementation Plan Notifications,” and “Opinions on Pilot Projects for Comprehensive Reform of County-level Public Hospitals” and other related documents. The public hospital reform path selection and pilot scope have also been continuously expanded: in 2010, the country selected 17 cities to carry out public hospital reform pilots, and in 2012 it also selected 311 counties (cities) in 18 provinces to carry out county-level public hospital reform pilot projects. The number of pilots increased to 1,000 and full coverage in 2015. The implementation of the reform of public hospitals has entered a period of toughness.

At present, it seems that with the promotion of policy documents and pilot projects, some achievements have been made in resolving the problems existing in public hospitals. For instance, Shanghai and Wuxi have promoted the separation of management and management. The health system is no longer both an “athlete” and a “referee”. ". However, the core issues of medical reform have never been reached, and contradictions between doctors and patients have become increasingly prominent.

A number of industry sources pointed out in an interview with reporters that it is the lack of a variety of institutional mechanisms that seriously hindered the medical improvement exhibition. Among them, the loudest voices include establishing a sustainable compensation mechanism, a scientific medical payment system, a standardized medical supervision system, and improving corporate governance mechanisms.

"The lack of funding in public hospital reform is not a mechanism," said former Health Minister Chen Hao.

Hou Jianmin, a member of the National Committee of the Chinese People's Political Consultative Conference and chief physician of the Fujian Provincial Hospital, told reporters earlier that “in the reform of public hospitals, we must first innovate in the institutional system, and we should establish appropriate compensation mechanisms to fully mobilize the enthusiasm of medical staff.”

Social-run medical model still needs to be explored

While the reform of public hospitals has entered a period of hard work, the wave of socially-run medical services is also looming. On January 9 this year, the National Health and Development Commission and the State Administration of Traditional Chinese Medicine issued the "Several Opinions on Accelerating the Development of Socially Operating Medical Care." It clearly requires priority support for social capital in the organization of non-profit medical institutions and the accelerated development of non-profit medical treatment. Institutions are the mainstay and for-profit medical institutions supplement the social medical system.

On May 28, the General Office of the State Council issued the “Key Tasks for Deepening the Reform of the Medical and Health System in 2014”, among which public hospital reform, social medical treatment, the construction of a universal medical insurance system, and the regulation of the order of drug circulation have attracted attention.

The policy warm winds are blowing and social capital is moving. Right now, pharmaceutical companies, medical device companies, industries, and the financial industry have all entered the medical field and placed corresponding industrial chains. Although the above-mentioned $8 trillion health service industry has an attractive prospect, the current development of the medical service industry, which accounts for 80% of the output value of the health service industry, remains unsatisfactory.

Xu Shanchang, former deputy director of the State Council’s Medical Reform Office, said earlier that the current scale, number, and speed of medical services provided by the society and the national "Twelfth Five-Year Plan" plan for health services will set the number of beds and services to 20% of the national total by 2015. There is still a big gap.

Behind the slow growth of the numbers is the unsuccessful implementation of a series of policies and unclear social model. In the opinion of many people in the industry, although a number of pharmaceutical listed companies are expected to make substantial moves this year in the private capital sector, private equity giants have already locked their eyes on more than 20 listed companies, but what should be the social capital? Mode of operation, there is no clear idea.

According to the reporter's understanding, private hospitals nowadays mostly rely on the "Putada model." As a pilot for comprehensive reform of the national private economy, Fujian Putian has a good foundation for the development of private hospitals. According to public information, there are more than 60,000 employees in private hospitals in Putian all year round. At present, more than 8,500 privately-run hospitals are established by Putian people, accounting for 80% of the total number of privately-owned hospitals in the country, with an annual turnover of more than 250 billion yuan. The annual purchase of medical equipment and consumables amounts to more than 150 billion yuan.

"Putian City will strive to reach 20 billion yuan by 2018. The total output value of the medical industry will reach 50 billion yuan." Liang Jianyong, Secretary of Fujian Putian Municipal Committee, recently demonstrated his ambition in an interview with the media. However, many people in the industry also told reporters that even in Putian, where “first try first”, fast-growing private hospitals cannot overcome such problems as “false advertising”, “exaggeration of illness”, and “talent bottleneck”. In addition, the equity cooperation model has also been tried in many places, but there is still uncertainty in policy and law. Self-built private high-end hospitals are also prepared for long-term investment.

“Private hospitals have played an active role in supplementing publicly-owned medical resources and promoting basic public health services,” Hou Jianmin told reporters. “But they are also faced with difficulties such as small scale, overall strength, illegal behavior, and crisis of confidence. ."

Heavyweight guest advocates medical reform

One side is the public hospital reform that has been proposed for a long time but has been slow, while the other is a social model that has not yet been clearly defined. How can we help medical reform when the policy is sunny? It seems that there is still an "unprecedented" communication platform.

According to the reporter’s understanding, the “2014 China (Guiyang) Medical Reform Capital Forum”, a forum for the key words “medical reform,” “social treatment,” “private hospital development,” and “hospital securitization,” will soon be June 26 was held in Guiyang. At that time, several heavyweight guests from the State Council's Health Care Reform Office, the National Health and Family Planning Commission, pharmaceutical listed companies, and financial investment institutions gathered together to give advice on China's health care reform.

The forum is divided into two sections: the keynote speech and the roundtable dialogue. The keynote speech was drafted on the following three topics: "China's medical and health industry development prospects in the next five years", "social capital for the promotion and assistance of the medical industry", "how to develop private hospitals effectively, out of the predicament"; round table dialogue set up about the medical reform The eight hot topics.

Specifically, in the keynote speech, the organizers will invite heavyweight guests to in-depth analyze and compare the development status of domestic and foreign medical industries, interpret the latest policy trends, and provide feasible insights for promoting the development of the medical industry. At the same time, in conjunction with the documents issued by various departments concerning social services, the significance of the development of the medical industry is discussed. For the development difficulties faced by private hospitals for many years, the organizers will also invite guests to explore how to effectively use current policies and explore the development of private hospitals.

At present, “difficult to see a doctor, expensive to see a doctor” and pension issues have triggered a huge market demand for the medical industry. This also provides a huge market space for social capital to enter the hospital field. On the one hand, it is necessary to build new private hospitals to increase supply, and on the other hand to participate in the reform of public hospitals to increase the efficiency of public hospitals. The upcoming rehabilitation hospitals, geriatric hospitals, nursing homes, hospice care hospitals and other specialty private hospitals have also become more selective in the model of social capital participation in medical treatment.