Beijing Mandates All Tertiary Hospitals to Establish Rehabilitation Departments Amid Public Hospital Transformation Wave with Dedicated Fiscal Subsidies
Recently, at the Third Academic Forum on Rehabilitation Medicine held in Beijing, Xi Shuyan, Director of the Rehabilitation Nursing Division of the Beijing Municipal Health and Family Planning Commission, revealed that by 2020, Beijing is expected to have basically improved its rehabilitation medical service system, mechanisms, models, and policy and regulatory frameworks, with a rehabilitation medical service network largely established.
For a long time, Beijing has faced the problem of excessive concentration of large hospitals, while institutions providing rehabilitation, nursing, and palliative care have been severely inadequate. To reduce the average length of stay in large hospitals, improve bed utilization rates, alleviate difficulties in hospital admission, and appropriately triage rehabilitation patients, Beijing has taken the lead in actively exploring the development of a rehabilitation medical system.
This news is undoubtedly a positive development for the rehabilitation medical sector, which is already experiencing a surge in popularity.
According to a report by the Beijing Daily, all tertiary hospitals in Beijing will establish departments of rehabilitation medicine in the future. The Beijing Municipal Health and Family Planning Commission is currently conducting a comprehensive survey of tertiary hospitals and formulating evaluation standards for their rehabilitation medicine departments, with the aim of urging these hospitals to promptly improve their rehabilitation services. Meanwhile, secondary hospitals are being actively encouraged to set up rehabilitation medicine departments. Performance evaluation criteria have been developed for the rehabilitation capabilities of community medical institutions and incorporated into their performance assessments.
At the meeting, Xi Shuyan also revealed that to facilitate the transformation of public medical institutions toward rehabilitation services, the municipal finance department provides a subsidy of 15 million yuan to each transforming institution, earmarked specifically for talent development, procurement of equipment and facilities, and renovation and repair of premises. The Municipal Health and Family Planning Commission has also actively coordinated with tertiary hospitals possessing advanced rehabilitation expertise and strong capabilities to assign partner support hospitals to each transforming institution, establishing one-on-one assistance relationships. Meanwhile, the Commission has instituted a monthly regular meeting mechanism to share difficulties encountered and experiences gained during the transformation process by various medical institutions. The transformation initiative has been included as a key priority project (“Zhezi Project”) of both the Municipal People’s Government and the Municipal Health and Family Planning Commission, with monthly supervision conducted to ensure implementation.
Furthermore, the cultivation of rehabilitation professionals will be a key focus in future initiatives. By 2020, all rehabilitation therapists in this city must be certified to practice. Medical and health technical personnel engaged in rehabilitation therapy shall obtain professional titles in rehabilitation therapy technology. Those who have not obtained such professional titles must acquire the "Certificate of Completion for Rehabilitation Therapist On-the-Job Training" issued by the Beijing Municipal Health and Family Planning Commission before they are permitted to practice in medical institutions.
As early as June last year, nine departments including the Beijing Municipal Development and Reform Commission jointly issued the “Guiding Opinions on Strengthening the Construction of Beijing’s Rehabilitation Medical Service System” (hereinafter referred to as the “Guiding Opinions”), launching the first batch of public medical institutions’ transformation into rehabilitation facilities. The Beijing Municipal Health and Family Planning Commission has been promoting the transition of selected public medical institutions into rehabilitation medical institutions in phases, with secondary and primary-level medical institutions given priority in participating in the reform.
The first batch designated six medical institutions, including the Xizhanlu Hospital in Xicheng District and the Nanmofang Community Health Service Center in Chaoyang District, clarifying that some public hospitals in Beijing would transition into rehabilitation hospitals, with certain treatment beds in these facilities converted into rehabilitation beds. In 2017, another six medical institutions, such as the Guangwai Hospital in Xicheng District and the Yangfangdian Hospital in Haidian District, were selected to undergo transformation. It has been reported that Beijing will launch a third wave of public hospital transitions by 2018. Once the full list of 18 public hospitals across the three batches is announced, each district in Beijing will have one or two public rehabilitation hospitals.
Coincidentally, as early as 2013, during Shanghai’s 12th Five-Year Plan period, the city had already achieved a total of 1,500 rehabilitation beds through the overall transformation of rehabilitation medical institutions. In ten districts and counties, including Xuhui and Changning, where geriatric medical and nursing resources were severely scarce, one geriatric care hospital was newly established or transformed in each area, with 300–500 beds per facility. In seven other districts and counties, including Huangpu and Jing’an, one geriatric care hospital was similarly added or converted in each, providing 200–300 beds per facility.
To encourage eligible secondary hospitals to undergo functional transformation, relevant departments of the Shanghai Municipal Government have introduced a series of supportive policies. The health authorities have clarified that rehabilitation institutions and elderly care institutions resulting from such transformations will retain their original medical institution classification levels. Hospitals that actively establish medical consortium partnerships with tertiary hospitals after transformation will be appropriately allocated additional bed capacity and allowed to expand their scale. In accordance with the chronological order of transformation, these institutions will be granted the primary designation of “Shanghai No. X Rehabilitation (Elderly Care) Hospital.” Furthermore, active collaboration with municipal agencies, including the Shanghai Municipal Education Commission and the Shanghai Municipal Human Resources and Social Security Bureau, will be strengthened to advance the development of rehabilitation disciplines and carry out vocational training and skills assessment for nursing aides engaged in elderly care services.
According to incomplete statistics, the number of outpatient and emergency visits to rehabilitation medicine departments in Chinese hospitals reached 21.417 million in 2012, an increase of 4.548 million from 2011, representing a year-on-year growth rate of 26.96%. By the end of 2014, the number of such visits had reached 31.093 million, and in 2015, it exceeded 40 million. These figures indicate that the rehabilitation medical industry faces substantial market demand.
Liang Ying, Vice President of Beijing Xiaotangshan Hospital, pointed out in a media interview that the three-tier rehabilitation healthcare system should have “clear division of labor.” Rehabilitation departments established within large hospitals handle the acute phase; patients who have passed the acute phase and whose conditions are stable should be transferred to specialized rehabilitation hospitals; after receiving treatment at rehabilitation hospitals for a period, patients in the recovery phase can be transferred to community settings for basic rehabilitation services.
It is the ideal state for implementing tiered diagnosis and treatment that hospitals at all levels fulfill their respective responsibilities while remaining interconnected to ensure smooth referrals, thereby providing convenient services to patients; however, China’s three-tier rehabilitation system remains highly underdeveloped.
In 2011, the Ministry of Health issued the "Guidelines for the Construction and Management of Rehabilitation Medicine Departments in General Hospitals," mandating that all general hospitals at Level II and above establish rehabilitation medicine departments. Despite these policy requirements, rehabilitation departments in general hospitals remain undervalued in practice. Unlike healthcare institutions in developed countries, where revenue is primarily derived from patients paying for physicians' expertise and technical skills, medical institutions in China rely mainly on drug sales for income. Since rehabilitation therapy predominantly employs physical modalities, it does not generate this type of revenue for healthcare facilities.
Patients receiving rehabilitation medical services are generally in a relatively stable phase of their disease, requiring fewer surgical interventions and placing lower demands on medical technology. Consequently, expenditures on pharmaceuticals and consumables are comparatively low (the average proportion of pharmaceutical costs in rehabilitation hospitals is approximately 20%, significantly lower than the roughly 40% observed in general hospitals). It is understood that a single rehabilitation bed in a general hospital can generate daily revenue of RMB 300–500 for the institution, whereas assigning the same bed to a surgical department would yield daily revenue of RMB 3,000–5,000. As a result, some large general hospitals establish rehabilitation departments merely to comply with policy requirements, going through the motions without genuine commitment. These departments often have very few beds and incomplete equipment, rendering them unable to provide effective treatment.
As early as 2014, while visiting the Shiyetown Health Center in Zhenjiang to learn about grassroots medical reform and services, General Secretary Xi Jinping pointed out that the public has a strong desire for equitable access to medical services. He noted that some large hospitals in major cities are perpetually in a “wartime state,” plagued by overcrowding, and emphasized the need to effectively address this issue.
Currently, China’s healthcare system faces a pronounced mismatch between supply and demand: patients seek care in a disordered manner, tertiary hospitals are overcrowded, primary and secondary hospitals have underutilized resources, and grassroots medical institutions remain largely deserted.
Both domestic and international experience have demonstrated that rehabilitation institutions serve as a critical channel for diverting patients from large hospitals. The presence of specialized medical rehabilitation facilities provides an alternative pathway for certain rehabilitation patients, effectively alleviating the "wartime status" often experienced by major hospitals.
Developing rehabilitation medicine can help alleviate the difficulties and high costs associated with seeking medical care at large hospitals. It not only improves the utilization efficiency of healthcare resources in these major institutions but also revitalizes existing assets in secondary hospitals, enabling better use of idle medical resources and ensuring that more patients receive effective rehabilitative treatment.
Based on the current state of rehabilitation medicine, the primary obstacles remain the three long-standing constraints:
First, the imperfection of medical insurance qualifications;
Second, the referral mechanism is imperfect;
Third, the impact of talent shortages.
Although a series of favorable policies for the rehabilitation market have been introduced recently, if the referral channels between acute care hospitals and rehabilitation hospitals are not established, if health insurance payments cannot facilitate transfers between these institutions, and if responsibilities and authorities remain unclear, the improvement of the three-tier rehabilitation medical system will continue to face a situation where it is “well-received in principle” but “lacks practical uptake.”