Medical Circle Weekly No.14: Healthcare Reform Requires Professionals Doing What They Do Best

Topic: Professional Matters Should Be Handled by Professionals

Location: Physician Group Chat

Contributors: Wei Wei, Lin Feng, Mu Tong

Physicians’ expertise lies in clinical techniques, not in policy research; therefore, they should not be involved in formulating healthcare reform policies within the public policy domain.

When their interests are compromised, farmers can “vote with their feet” by ceasing cultivation; likewise, physicians can “vote with their feet” by leaving the profession when their interests are harmed. This is unproblematic. However, designing agricultural reform plans is not farmers’ forte, just as offering valuable opinions or suggestions on healthcare reform is not physicians’ forte. Rather, these are matters that require impartial, professional policy expertise.

Professor Zhong Nanshan is undoubtedly a world-class expert in the field of respiratory medicine, but this is precisely why he is largely unable to offer sound recommendations when it comes to healthcare policy.

Healthcare reform policies must respect physicians’ choices and give voice to their concerns.For instance, if the interests of farmers are disregarded, numerous problems will arise in agricultural cultivation, thereby exerting adverse effects on society. Similarly, if the interests of healthcare professionals are overlooked, they will seek ways to safeguard their rights and interests, which may consequently have negative repercussions on medical care. Therefore, their practices and perspectives are highly valuable.

From the perspective of selecting leaders for healthcare reform, individuals with a medical background who also possess professional expertise in economics and public policy are undoubtedly highly beneficial to the cause. Their experience in healthcare services likely gives them an advantage over those with solely economic expertise. As for physicians who possess only medical knowledge, although they may not directly participate in the policy-making process, their recommendations are nonetheless invaluable and warrant serious consideration.

It is meaningful only when professionals handle professional matters. Greater heed should be paid to the recommendations of physicians who understand economic policies, while their interests must also be taken into account. However, ordinary physicians often lack sufficient judgment, just as they lack the ability to design hospital IT systems. Of course, physicians who have learned and acquired programming skills certainly hold an advantage over general IT personnel.

Topic: Warm Congratulations on the Official Approval of Business Registration for Shenzhen Bodestar Medical Group Co., Ltd.

Participants: Liao Xinbo, Zhou Guopeng, Lin Feng

Location: Sina Weibo · Dayi Cloud Valley

 China’s first business license for a “doctor group” in the medical sector was issued in Shenzhen.

Many people may not yet have taken action and thus remain unaware of the challenges involved. An individual physician signing a contract with a hospital is referred to as an “equal-pay-for-equal-work” employment contract; a physician group entering into a contract with a hospital is considered a service agreement. An individual registering to practice independently establishes a clinic; a physician group establishing medical services constitutes setting up a medical institution. Under current laws, a “Physician Group Medical Company” can sign contracts with hospitals and should also be permitted to establish medical institutions.

(Repost) In my personal opinion, the term “Physician Group” is inappropriate; this is open for discussion. Physicians, like lawyers, accountants, and architects, constitute professional human resources. If they practice independently, they must bear unlimited liability in their professional practice. A consortium of such professionals operates under a licensed qualification and should be structured as a special general partnership, wherein the professional partners assume unlimited liability. Law firms, accounting firms, and licensed architectural firms all fall into this category: they have no registered capital but bear unlimited liability. Physicians provide medical care based on their limited knowledge, and thus their liability should necessarily be limited; physicians are not omnipotent.

A limited liability company is constituted by capital and asset elements, with shareholders bearing limited liability to the extent of their capital contributions, and subject to liquidation in the event of bankruptcy. If a physician group neither requires capital contributions nor assumes unlimited liability, would there not be a complete lack of protection in the event of medical accidents? This would contravene both legal justice and social justice.

To facilitate physician mobility, the primary prerequisite is security assurance. This protection must extend not only to patients but also to physicians. Unlimited liability is one of the major causes of current medical misconduct and violence against healthcare professionals.

“Doctors are always the legal subjects; it is merely a matter of compensation mechanisms. To put it plainly, regardless of where they practice, the liable party remains the doctor.”This is what a responsible physician should possess.

Topic: Should Healthcare Reform Focus on Transforming the Systemic Ecosystem or Improving Basic Medical Security?

Contributors: Xie Rushi, Wei Wei

Location: Dayi Cloud Valley

 The concept of healthcare reform is currently in disarray. What needs to be improved first: the systemic ecosystem, or the basic medical security and the pseudo-public status of public hospitals? If it is the former, a unitary administrative planning approach will certainly not work. If it is the latter, it is understandable under China’s current system for the government to define payment boundaries, service limits, medical staff salaries, and even regulated materials based on its fiscal capacity. Medical professionals who choose stability must accept this reality, though they always have the option to leave. Basic healthcare is funded by taxpayers’ money, so expectations should not be excessively high. In other words, if I am paying the bill, how can your unlimited expectations be met? Therefore, when discussing “healthcare reform,” we must define what exactly is being reformed. If it concerns basic healthcare, it is a government responsibility. As for medical professionals themselves, they do not inherently possess public welfare attributes; their role is merely a choice of professional practice.

Our healthcare system requires diverse models. The first involves physicians in public hospitals who provide basic care; these doctors should be supported by an annual salary system, rather than being burdened with both clinical duties and revenue-generation targets. The second model pertains to physicians practicing independently in the future.

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