Marketization Is the Key to Tiered Diagnosis and Free Practice: Official Perspective
VCBeat (ID: vcbeat）
At the “2015 Evergreen Centennial Hospital Forum,” co-hosted by Health界 Media and Wuhan Central Hospital, and jointly organized by the Hubei Provincial Hospital Association, two government officials also delivered insightful speeches. They put forward their own recommendations for healthcare reform, with one commonality being thatHealthcare reform must be integrated with market mechanisms to maximize efficiency and ensure effective implementation.. Here, VCBeat cites the summary of Director Han Xiaofang’s speech compiled by Health界.
Let’s dive into the key insights!
▲ Han Xiaofang, Former Director of the Beijing Municipal Healthcare Reform Office
The overall allocation of medical resources corresponding to tiered diagnosis and treatment should be pyramid-shaped, encompassing both patient distribution and supply structure. However, the current situation is precisely the opposite—All resources are in an inverted pyramid structure.。
First, high-quality experts are essentially monopolized within the large hospital system.. This is not difficult to understand. Our management model dictates that the higher a hospital’s tier, the higher its compensation and benefits, and the greater the proportion of staff with intermediate and senior professional titles; resources from all sectors are skewed toward large hospitals. Since healthcare delivery relies on human expertise, patients naturally gravitate toward large hospitals where experts converge.
Next is medication; primary healthcare institutions only have access to essential medicines.The revocation of prescribing rights for non-essential medicines at primary healthcare institutions has left patients with no access to necessary medications. Given that medical care often relies on pharmaceutical treatment and patient service needs are multi-layered, they are inevitably driven to seek care at large hospitals. This trend is corroborated by data, which shows that over 30% of patients visiting large hospitals do so solely to obtain prescriptions.
"Furthermore, considering fiscal and pricing factors, the management system of tertiary hospitals is linked to service accreditation and scale, which objectively encourages hospital expansion.". The larger the scale, the more services a hospital can offer and the greater its revenue from medical insurance funds; naturally, everyone strives to “move up the ladder.” In pursuit of upgrading, some hospitals have even resorted to falsely reporting their bed counts.
Han Xiaofang said, “‘Position determines perspective.’ If I were the president of a hospital, I would also expand its scale and compete for patients, because to support staff and achieve development, it is essential to secure resources from all fronts.”
Han Xiaofang believes that the current situation is primarily due to flaws in the system and mechanisms, with the government bearing the main responsibility. She stated that the prerequisite for tiered diagnosis and treatment is to “Reassessing the Design of the Entire Healthcare Service System and Its Related Policies and Regulations。”
First, the classification criteria for tiered diagnosis and treatment should be clearly defined.“, not by hospital tier, but by service function; not by level, but by division of labor.”
The most basic primary healthcare institutions must serve as health gatekeepers and must absolutely not become hospital-like.. A people-centered, health-focused approach should be adopted to gradually develop an integrated and humanized system encompassing health management, public health prevention, health promotion, diagnosis and treatment of common diseases, and rehabilitation for serious illnesses. Primary care should serve as the “broad foundation,” with 80% of patients receiving their medical care at this level.
Next are regional medical centers, which should achieve balanced distribution of resources and standardized training of physicians.. We should not allow patients to flock to Beijing and Shanghai for medical treatment, as this will never resolve the difficulties in accessing healthcare or the disputes between doctors and patients. “This is certainly not an issue that hospitals can solve; rather, it should be addressed by the government.”
At the apex of the pyramid are the National Key Clinical Specialties and Key Disciplines.. Key specialties should focus on tackling key scientific and technological challenges, driving technological innovation, and cultivating high-level talent, rather than competing with smaller hospitals for patients.
In terms of fiscal investment, the government should also allocate funds based on functional division of labor, rather than by scale or headcount.. Fiscal support shall not be provided for activities that do not align with the designated functional positioning.
▶ Building True Independent Practice
Han Xiaofang believes that resource allocation is also a crucial aspect, particularly concerning human resources—freeing medical personnel to enable them to truly practice independently.“Only through mutual selection and the market-driven discovery of talent value can physicians truly attain professional dignity and serve where they are most needed by the public.”
Han Xiaofang believes that only multi-site practice characterized by a correspondence between responsibilities, rights, and interests, mutual selection, and compliance with laws and regulations constitutes genuine multi-site practice.She predicts that a large number of physicians will inevitably leave major hospitals to join specialized hospitals, rehabilitation hospitals, primary care institutions, and other sectors.. Of course, this also awaits the dismantling of the traditional employer-based system and the emergence of a flexible employment framework.
“Only when medical personnel are allowed to flow freely can the physician workforce be strengthened, enabling doctors to receive appropriate compensation and patients to obtain corresponding medical care, thereby making tiered diagnosis and treatment possible,” said Han Xiaofang.
▲Liao Xinbo, Inspector of the Guangdong Provincial Health and Family Planning Commission
The national push for tiered diagnosis and treatment, the streamlining of public hospitals, multi-site practice for physicians, and the socialization of physician benefits are all compelling public hospitals to adapt to the “Internet+” policy. Consequently, the internet will bring about significant shifts in healthcare delivery models. In my personal view,Most importantly, it drives a shift in mindset among physician leaders., Following the advent of “Internet Plus,” or as the internet has become a tool for hospital management, hospitals must undergo an adaptation process to the market.
How can public hospitals retain patients in the future market, rather than pursuing extensive expansion as they do now? How to attract more patients or recruit physicians—this is market competition. Regarding talent acquisition, the mindset must shift from an inward-out approach to an outside-in approach.Future hospital directors should think from the perspectives of hospital management, corporate management, and service marketing.。
Therefore,The most critical factor in the reform of public hospitals lies with the hospital president. The president must embrace an enlightened, open, and digitally savvy internet mindset to effectively align with and support national initiatives, thereby delivering better services to patients.
All hospitals are currently in a state of market competition, with everything being market-oriented. The internet will make the market transparent,Therefore, whether at county-level hospitals or tertiary hospitals, the focus must remain on physicians., where the doctors are, where the patients are, what it will compete for in the future is the doctors.
If a doctor leverages the internet effectively, they will build a large and relatively stable patient base. By providing better services to this patient base, their practice can achieve exponential growth.
I believe the greatest challenge for tiered diagnosis and treatment is political. Internet Plus + general practitioners + physician freelancing + hospital payment reform,Recommendations for county-level hospitals: Seize the opportunities presented by the internet to develop your general practitioners, particularly online general practitioners.