Call development space again! 91 medical institutions have obtained class a equipment allocation license, but there are few private enterprises

Author: Kang Bao From the notice on the configuration license of class a large medical equipment in 2019 issued by the national health and Health Commission on October 9, 2019, the health community found that there are 5 institutions that have obtained the configuration license of proton radiotherapy system, 28 institutions that have obtained the configuration license of positron emission magnetic resonance imaging system (PET / MR) and 58 institutions that have obtained the configuration license of high-end radiotherapy equipment Among the 91 licensed institutions, there are few social medical institutions A senior professional in the industry told the health sector that there are few social medical institutions in the list of class a large-scale medical equipment configuration licenses This is a deviation from many policies issued by the state in recent years to encourage the development of sufficient space for social hospitals, but also reveals the difficult situation that social hospitals do not achieve equivalence with public hospitals in the approval mechanism Data shows that the number of social medical institutions in China has exceeded that of public medical institutions, but the service volume only accounts for about 20% of the total China's medical environment is still in the status quo of "public hospitals as the main and private hospitals as the auxiliary" It can be seen that there is still a long way to go for social medical institutions to catch the banner of improving China's medical services The service ability of medical institutions depends on technology Sometimes the improvement of technical level depends on the "helper" of large-scale medical equipment Since 2005, the state has implemented configuration management for large-scale medical equipment according to the plan According to the opinions on the clearance of non administrative licensing approval items deliberated and passed at the 91st executive meeting of the State Council in 2015, it is clear that the allocation of large-scale medical equipment will be changed from non administrative licensing to administrative licensing items through the implementation of legal procedures "Non administrative license approval" was once referred to as "system back door" or "gray area" For large medical equipment with large capital investment, after entering the "administrative approval items", the configuration organization can apply for administrative approval openly and transparently in accordance with relevant regulations In May 2017, the State Council issued the decision on Amending the regulations on the supervision and administration of medical devices (Order No 680 of the State Council), redefining large-scale medical devices as "large-scale medical devices with complex technology, large amount of capital investment, high operation cost, great impact on medical expenses and included in the catalogue management" Large medical equipment is also divided into class A and class B the class a catalog contains 4 categories of equipment, including heavy ion radiotherapy system and proton radiotherapy system, which are allocated and managed by the national health and Health Commission; the class B catalog contains 6 categories of equipment, which are allocated and managed by the provincial health and health administration department According to the national policy, there are many explorations on the approval of class B large medical equipment in each province, and the approval process and method are different For example, in Zhejiang Province, when applying for the allocation of class B large-scale medical equipment, the system of notification commitment can be implemented; Shanghai Pudong free trade zone has been piloted first, and the approval of private medical institutions for the allocation of class B large-scale medical equipment has been released; Gansu Province has begun to adopt the way of centralized procurement for the allocation of class B large-scale medical equipment Compared with various forms of class B large-scale medical equipment, the situation of class a large-scale medical equipment configuration license is more severe for social medical institutions Among the 15 national policies in the past six years sorted out by the health sector, 9 policies mentioned to some extent that space should be reserved for the planning of large-scale medical equipment for social medical institutions For example, in the opinions on accelerating the development of social medical services issued in December 2013, it was specifically put forward that "planning space should be reserved according to the proportion of equipment of non-public medical institutions not less than 20%; in November 2017, the former director of Planning Information Department of the national health and family Planning Commission also publicly pointed out that" space should be reserved for private medical institutions according to the proportion of 20% - 25% " "I think there is still a lot of work to be done in order to achieve real equality and policy implementation We look forward to the relevant ministries and commissions of the state, as well as the introduction of (specific) policies and regulations by local governments " Wu Xinchun, vice president of Cr healthcare, once gave an example in an interview with relevant media: "for example, how to reserve enough space? It is difficult to implement supporting policies." In the top-level design, there are two obvious supports for the social medical service The first is to reduce the bed size, outpatient and emergency visits and other business volume index requirements for the allocation of large-scale equipment by private institutions, mainly focusing on quality safety and technical capabilities; the second is to explore the implementation of notification commitment system for the allocation of class B large-scale medical equipment by social medical institutions in the pilot free trade zone approved by the State Council At present, the above two support policies have been put into practice For example, in the evaluation criteria of experts, the scale of beds and the number of people in outpatient and emergency departments were removed from social medical institutions However, for "new private medical institutions, the allocation review can be carried out first according to the conditions of departments, personnel, etc proposed in the construction plan We have not seen more practice Cai Changhua, head of the social development department of the national development and Reform Commission, said at a briefing in June 2019 that in the future, when adding or adjusting medical and health resources, all social forces that have the will and ability to run medical services should give priority to social forces to run and operate It can be seen from this statement that it seems to be a specific way to reserve space by giving priority to the approval of the application for the configuration license of large medical equipment by the medical institutions run by the society On the other hand, in the application process of large-scale medical equipment configuration license, the number of public hospitals and private hospitals can be separately counted, which can also provide enough space for social medical institutions from the source The health sector has learned that at present, in the list of class B large-scale medical equipment configuration licenses in Guangdong Province, separate statistics have been made on public hospitals and medical institutions run by social organizations Statistics show that by the end of 2018, the number of private hospitals in China has reached 21000, accounting for 63.5% According to the data released by the national health and health commission from January to November 2018, the total number of patients in hospitals nationwide has reached 3.23 billion, with private hospitals accounting for 14%; the total number of discharged patients in hospitals nationwide has reached 179 million, with private hospitals accounting for only 18% "Class a medical equipment should also be released at an appropriate time, and approval such as the issuance of configuration license should be cancelled." Xie Rushi, a former CEO of bodegalian group and now chairman of Shenzhen shangyihui Health Management Co., Ltd., has put forward such a view Taking proton radiotherapy related equipment as an example, according to the statistics of proton China, as of October 21, 2019, there are 77 proton heavy ion treatment projects in China, including 4 operated projects, 27 under construction projects and 46 proposed projects, the total number of which is the same as that in 2018 However, in the notice on the release of large medical equipment configuration planning for 2018-2020, it is proposed that the national overall planning and configuration of proton radiotherapy system in the past three years should be controlled within 10 At present, five medical institutions have obtained the proton radiotherapy system configuration license, and all of them are public medical institutions As for how to solve the practical problem of "more under construction and less approved", some people in the industry told the health sector, "based on the actual situation of social medical institutions and other declaration subjects, we can implement the national class a medical equipment configuration license system in advance." At the same time, he suggested that: it can be pre sent to the applicants with the investment amount in place, treatment equipment parameters up to standard, personnel training and qualified reserves Within the limited period, the national health and Health Commission organizes the expert review group to carry out the project quality acceptance one by one Only after the qualified unit obtains the formal configuration license, can it start to treat patients Taking Guangdong Province as an example, on October 10, 2019, the health and Health Commission of Guangdong Province announced the configuration license of class B large medical equipment of the health and Health Commission of Guangdong Province in September 2019 The total number of approved institutions was 107, including 14 social medical institutions, accounting for 13.08% On May 30, 2018, the notice on printing and distributing the implementation rules of class a large-scale medical equipment configuration license management clearly stated that if it is necessary for the review and evaluation work, experts with high professional quality and good professional ethics in relevant fields can be invited to serve as the review experts outside the expert database On September 23, 2019, the office of Guangdong Provincial Health and Health Commission released the list of experts in Guangdong class B large-scale medical equipment review database, of which almost 69 were from public medical institutions in Guangdong Province Because most of the experts participating in the review come from the public medical institution system, and they lack a comprehensive understanding of the actual situation of the social medical institution system, it is difficult to carry out an objective and real review of the social medical institution from the actual situation in the review process In addition to the diversification of the composition of review experts, the design of review indicators also needs to be constantly improved For example, according to the requirements of class a large-scale medical equipment configuration access standard, medical imaging centers with independent legal person qualification are not included in the evaluation scope of "functional orientation" and "clinical service demand" indicators However, in the actual evaluation process, because there is no special reference for the evaluation standard of independent image center, the experts participating in the evaluation still scored the two indicators, resulting in possible missing items This kind of unequal situation can be changed with the help of measures such as "increasing a certain proportion of experts from medical institutions run by social organizations in the expert review process, and improving and refining the review standards" "To make more fair rules of the game is the power to promote the development of social run medicine, and also to avoid the embarrassing situation that social run medicine has to walk in the gray area in order to adapt to the survival difficulties." Guo Jun, senior hospital operation and management professional Dean and chief physician, once wrote an article "In my opinion, the process of private hospitals will be simpler when it comes to the allocation of large-scale medical equipment." A staff member of a large medical equipment enterprise told the health community that Shanghai International Medical Center has proved by practice that under the support of the policy, the overall process of large equipment configuration has been greatly facilitated "In the past, the introduction of a medical equipment of ten million level needs at least two years in a public hospital, which involves various complex links such as project approval, bidding, procurement, installation and commissioning, decoration and protection, environmental assessment, etc it is necessary to first apply to the Pudong New Area Health and Family Planning Commission, then to pass the Shanghai Health and Health Commission, and then to apply to the national health and Health Commission Only after all of these are approved can the equipment be formally introduced." According to Ding Gang, vice president of Shanghai International Medical Center, with the support of national policies, it is only necessary to apply for the record in Pudong New Area Health and Family Planning Commission, which can be introduced quickly Ding Gang said that radiotherapy is an indispensable part of the treatment of cancer patients But even in a big city like Shanghai, there are still few radiotherapy equipment If patients want to receive radiotherapy, they have to wait in line From the perspective of capital, the purchase price of class a large-scale medical equipment is high, and the purchase of such equipment by public hospitals will increase financial pressure The social medical institutions have the advantages of capital stability Shanghai International Medical Center has been able to introduce large-scale medical equipment preferentially because of the double efficiency of self financing, so that more tumor patients waiting for radiotherapy can benefit The case of Shanghai proton heavy ion hospital, the first proton therapy center in China, is worth learning It is understood that the construction cost of the hospital in the early stage is from