Today, on a whim, I searched on the Internet with "hospital, opening" and "hospital, closure" as keywords, and found a rather interesting phenomenon: there are many hospitals that have opened, some have branch hospitals, and some have opened social medical institutions, and they are all jubilant;The hospitals that have been closed are very at least, except for those that have been closed for rectification due to violations, but where there are closures, there are so few pieces of news. The search results are basically the same as what you hear and see: medical institutions are still on the "broad road" of scale expansion in general. Why put quotation marks around "Broad Road"?Because in my opinion, the pace of expansion of medical institutions should really slow down.
This involves an underlying logic, whether the current supply of the medical market is enough. China has a vast land and abundant resources, and there must be places where there is a surplus and a region where there is a deficiency. So, let's look at the overall data. On October 12, 2023, the "2022 Statistical Communiqué on the Development of China's Health Undertakings" released by the National Health Commission showed that at the end of 2022, there were 9.75 million beds in medical and health institutions across the country, and the number of beds per year increased from 670 sheets of growth reached 692 sheets. The number of beds per 1,000 people should be an important indicator to measure medical resources, and it is also the main starting point for promoting medical construction. I think we can look at this data internationally. According to Time Weekly, according to the latest data from the OECD, the number of hospital beds per 1,000 people in the United States is 28 sheets, 2 in the UK4 sheets, less than half of our country's. So the problem comes,We really need that many beds?
Behind the continuous expansion of scale,The result of the continuous increase in beds is the continued high rate of hospitalization. According to the 2022 health bulletin, the annual hospitalization rate in the country reached 175%。According to data published by the OECD, the hospitalization rate in the world's major economies averages 14%. In particular, there is every reason to believe that in 2022, under the influence of the epidemic, hospitalization behavior has been curbed to a certain extent, and if there is no epidemic, this number will definitely be magnified. In fact, the number of hospital admissions nationwide has reached 265.96 million in 2019, while from 2020 to 2022, it continued to decline under the influence of the epidemic, and only 246.86 million in 2022.
As an ordinary person, perhaps the most intuitive feeling is that the more beds, the better. However, one hidden logic is,Behind every bed, there is an inevitable demand for hospitalization, especially the demand for hospitalization that is stimulated and induced. How can any hospital, in the context of the current need for self-generated income, sit idly by and watch the beds vacant?Therefore, no matter what level of hospital, no matter which regional hospital, as long as the patient can be hospitalized, the inevitable result is hospitalization;As long as the hospital bed can generate revenue, it will inevitably make the patient and the medical insurance ** pay for it from each hospital bed. Because the physician professional group is a very unique group, its outstanding feature is the independent decision of the clinical profession, with great freedom and influence. The doctor said that the patient must be hospitalized for observation, should be hospitalized for surgery, suitable for inpatient conditioning, how many patients will not be obedient?As a result, those who should not be hospitalized and those who should not be admitted were admitted to the hospitalIt has increased the burden on the masses and caused a waste of medical insurance.
In the past, it was often criticized that the medical insurance policy could only be reimbursed for hospitalization and not paid for outpatient services, so the ideal model is that when the outpatient co-ordination policy is implemented, the hospitalization rate should be reduced. Since the beginning of this year, the co-ordination of outpatient services for employees has been fully implemented, and the co-ordination of outpatient services for residents has always existed, but the hospitalization rate will decline from this yearWill this logic be implemented?I'm not optimistic, and what I saw from the hospital didn't seem to have such a substitute. Again, back to the above question, there are beds that are generally not vacant, and the more beds there are, the more admissions and admissions. In fact, with such a scale-up, it would be difficult to effectively regulate any other measures, whether medical or medical. For example, the highly anticipated DRG DIP reform, although the average charge of a disease group (species) is determined based on historical data, this can only promote the rational diagnosis and treatment of a single case, and can only promote the cost control of a single case. That is, it is difficult to manage the quantity if the quality is managed. Even if the payment standard is low, some patients with chronic diseases and mild symptoms may still be admitted to the hospital, and they will always make money within your standard. After all, whether it is big data or experts, it may be difficult to define whether a patient has an indication for hospitalization, and there is no ability to audit it one by one.
At present, the phenomenon is that the medical and health industry is busy doing addition, but few people seem to be doing subtraction. After all, it's not hard to be a good person, and the expansion of medical institutions is a happy outcome for all in the short term. However, to carry out structural adjustment and scientific planning, that is to offend many people, and it is very difficult to wipe this ass. However, isn't it contradictory to only do addition and not subtraction, on the one hand, grassroots medical institutions need to support and expand, and on the other hand, various medical centers and various large hospitals need to increase supply and strengthen resources?The key question is: where do patients come from?In the case that the number of beds per 1,000 people is already relatively optimistic, they are still busy doing additions and allowing them to do additions, and I am afraid that they will have to suffer the consequences in the long run.
From the perspective of the general logic of medical reform, it should be relatively clear: on the one hand, it is necessary to improve the health level of the masses and enjoy more equal, more accessible and better medical services;On the other hand, it is necessary to base ourselves on the basic national conditions and the actual situation of the stage, and we must not allow the excessively rapid growth of medical expenses and the excessive burden on the public. As a result, strategic purchasing measures such as the reform of medical insurance payment methods, centralized volume procurement, pharmaceutical and drug negotiations, and the adjustment of medical service projects in the medical insurance department will be implemented. All of this, everythingOn the premise of ensuring the overall quality of medical services, we will promote the refined management of medical institutions, reduce the cost of medical services, and improve the satisfaction and sense of gain of the masses.
In fact, the logic behind it is too complex to be explained in a small article. However, in the context of the current strategic purchase of medical insurance, under the logic of the reform of medical insurance payment methods, one of the most cruel realities is that the growth rate of inpatient medical expenses in a region will be steadily controlled, and the best place is there. The days of more beds and more income in the past are gone, and medical institutions really need to adjust their concepts, change their habits, tap their potential inward, practice their internal skills, and achieve high-quality development while being rewarded with surplusesLocal governments must realize that medical resources must be rationally planned, adjusted in structure, controlled in total, and promoted in standardization, and medical resources must not be as much as possible, and medical institutions must not be as big as possible. Because medical resources and inpatient beds are a special resource, its expansion is constantly paid by the local people. Everything is people-centered, and many questions should be better solved and better answered.
Not long ago, I visited two leading local medical institutions, one took the initiative to cut 150 beds at the beginning of DRG's start-up, and the other took the initiative to cut 100 beds after the implementation of DRG one year later, with the aim of improving service efficiency and optimizing resource allocation. Personally, I think this kind of foresight is particularly valuable in the context of the larger context. I look forward to more of these welcome changes!
* |The medical road is forward, and the medicine is shared by you.
Edit |Yang Zixuan, Zhang Wenqing.
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