Huang Qifan: suggestions on the reform of China's public health and epidemic prevention system under the epidemic situation

Novel coronavirus pneumonia was diagnosed in 37626 cases and suspected cases in 21675 cases as of 24 February 10th There were 428438 cases of close contacts Novel coronavirus pneumonia has brought great impact to China's society and economy The state attaches great importance to the epidemic prevention work and has set up a central leading group headed by Premier Li Keqiang The general secretary of the has personally commanded many important instructions for the prevention and control of the epidemic Since January 20, 2020, the epidemic prevention and control system established by the central government is playing a huge role, reflecting China's ability to respond to such a huge public health disaster and the responsibility of a large country At present, the epidemic prevention and control campaign is in full swing, and the national control mode of strict prevention and defense is taking effect Although the number of infections is still on the rise, we have reason to believe that the central government can lead the people of the whole country to save the infected people and completely defeat the epidemic However, in the face of such a huge public health event, we have to reflect on whether it is possible for us to fundamentally put an end to such a large epidemic and eliminate it in the bud? Does this mean that there are many systematic problems in our existing public health system and prevention and control of infectious diseases? Many experts and scholars have put forward a large number of opinions and suggestions on the epidemic response in Wuhan, Hubei Province, all of which have certain reasons But from a macro perspective, Wuhan's epidemic response is not unique to Hubei Province The field of public health and infectious disease prevention and control is the backward field, even blind spot, of China's supply side structural reform Novel coronavirus pneumonia in China from the SARS of 2003 to 2020 has not been well filled in China's public health system The public health system is far behind in personnel, technology and equipment This is the fundamental reason for our lack of capacity to prevent and control the epidemic At present, the great epidemic is a bad thing, which forces us to reflect deeply The state should vigorously strengthen the comprehensive reform of the supply side in the field of public health and infectious disease prevention and control, solve the directional, systematic and basic problems in this field, and make this field an important engine for promoting China's social and economic development The government should expand investment in public facilities and improve the quality of supply in the field of public health After 40 years of reform and opening up, China's economy has entered a critical period of development In 1978, China's GDP was 367.9 billion yuan, reaching 90 trillion yuan in 2018 In the past 40 years, an important engine of China's economic development has been to continuously release all kinds of consumption and attach great importance to consumption to promote economic development In 2010, consumption, export and investment accounted for almost one-third of each contribution In the past 5-10 years, China's economy has been experiencing rapid growth driven by consumption through supply side structural adjustment By 2019, consumption has accounted for about 60% of GDP, while exports and investment account for another 40% If we want to further maintain the long-term growth of the national economy and form new growth momentum, we must continue to maintain or expand the pulling effect of consumption on GDP Consumption driven economic development includes two parts: personal consumption and government public consumption Although there is still some room for personal consumption to rise, the proportion of growth space is small, and the government public consumption has great potential In the past, government investment accounted for a large proportion in the field of infrastructure, and the proportion of public facilities investment and consumption was insufficient Public consumption includes education, health and culture, and the proportion of government investment in this area is often low Taking hospitals as an example, the number of hospitals in China was 9293 in 1978 and 33009 in 2018, an increase of 3.55 times Under the background of 240 times of GDP growth in the past 40 years, we see that investment in health is not enough In 2018, the government expenditure in the field of health in China was 1.6 trillion yuan, accounting for less than 1.7% of GDP Therefore, after the epidemic, the state should increase investment in public facilities such as education, health and culture, especially in public health service facilities There is a concept here If the government invests 100 billion yuan in infrastructure projects such as highways and railways, the GDP of that year will be only about 30% at most; but if the 100 billion yuan is invested in public services and facilities such as education and health, the GDP of that year will be 60% - 70% In this sense, if the same financial investment is invested in public health, the GDP will be better At the same time, it can meet the needs of the people and form a balance of social services Therefore, the government finance should transfer part of the original money invested in infrastructure to the public health and other public facilities, improve the supply quality of public health, and use this government consumption to promote the sustainable and high-quality development of China's economy China novel coronavirus pneumonia epidemic situation shows the current medical and public health system in China Besides the large city with relatively large medical facilities such as North Canton, Shenzhen and Hangzhou, there are still many medical facilities that are not sound enough on the whole The number of top three hospitals in many big cities is not in place, and the allocation of medical institutions at all levels in medium-sized cities and small cities is also very inadequate, unreasonable and unbalanced Why are big hospitals in big cities so busy? The actual reason is that the establishment of medical resources in the whole city is not complete and reasonable, the existing medical facilities at all levels are too different, and the facilities of small hospitals are too poor, so the common people run to large hospitals Compared with the medical system of developed countries, we can see that even small hospitals in the United States and Japan are equipped with the same facilities as large hospitals Therefore, the completion of the medical and epidemic prevention system and the investment in high-quality equipment in each city are the specific content of the consumption of public facilities, and each equipment invested by the government has become a public service facility for the convenience of the people Like the construction of Railways and expressways, the state should build infrastructure in the field of public health in China More than 33000 medical institutions in China may become 50000 and 60000 The high-quality equipment investment of government led medical institutions is a huge incremental market, which can greatly promote economic development In addition, in addition to the hardware configuration is not in place, the configuration of medical staff is far from enough At present, doctors and nurses in many hospitals are generally short of staff In general, doctors and nurses outside the staff are equal to 50% of the staff inside the staff That is to say, two thirds of the medical staff in a hospital are in the staff and one third are out of the staff Then why don't we add 100000 or 200000 staff to let the doctors and nurses outside the staff into the staff? On the surface, it seems to increase the government's financial expenditure, but in fact, on the one hand, it is what I call to expand the government's public health consumption investment; on the other hand, the government's staffing subsidies have a leverage effect It is important to know that the medical staff do not completely eat the royal food Now the doctors treat people in the hospital, and the government's staffing Investment often accounts for only one-fifth of the actual income of the hospital, so on the whole, the government's input in the establishment is a reasonable public investment, and it also brings huge social benefits In more than 2000 counties, 400 cities and prefectures, hospitals at all levels and other medical systems are not perfect and the number of people is not in place If we improve the system and expand the establishment, we can not only greatly alleviate the shortage of doctors and nurses for 1.4 billion Chinese people, but also stimulate government consumption, which is more efficient than infrastructure investment It led to GDP growth By the end of 2018, the total number of health workers in China is 12.3 million According to the total number of 19 million health workers in the United States, there is still a huge development space in our country If the total number of health workers reaches 60-80 million through government investment, it will greatly promote China's future GDP growth The establishment of a preventive public health and epidemic prevention system is a great plan for a hundred years Although the country now has relevant institutions for the prevention and control of infectious diseases, from the perspective of social system governance, there is still a lack of a complete set of public health system, infectious disease prevention system and ICU severe isolation resource management system in every city of China You can say that these three concepts can be found in every conventional hospital, but after all, a conventional hospital is a conventional hospital, which often does not have the infrastructure to control infection Novel coronavirus pneumonia in 2003, a large number of infected people can not be treated in regular hospitals, because their infrastructure, such as air conditioning, sewage and so on, can not control infection, what is more, they can not treat patients with infectious diseases Therefore, a country and a city need an independent public health and epidemic prevention system, including various hospitals with sufficient number of beds set up according to the standards for the treatment of infectious diseases, as well as other infrastructure related to infection control Many of these investments may seem like a waste, because there may be some facilities that we won't use for ten years But for a country or a city, with these facilities, we can avoid the once-in-a-century devastating impact on the city Just like the flood control dyke of Huangpu River in Shanghai, we must build it according to the flood standard of 300 year return period and 500 year return period Otherwise, once there is a flood, it is the life and death of tens of millions of people Therefore, to establish such a public health and epidemic prevention system, you must take the once-in-a-hundred-year event as a real thing, build the system with high quality, and do well in the future, it would rather have some idle waste, than spend 100 billion yuan, and its depreciation interest is very high, but this is the improvement of the overall operation quality of the society and the social public security capacity The promotion of This concept is the same reason that we spent hundreds of billions of yuan to do environmental protection, greening and ecological protection You can't look at the current input-output ratio with quick success and instant benefit It doesn't mean that if you have this system, you want to have a plague every year to let me play a great role But we should see the investment benefit of this system in the long run It is a strong guarantee for a country to face a huge public health disaster As such a system of public service, of course, it can not be built entirely by the market, by the people and by the enterprises, but by the public investment of the state and the city Because public consumption is what the government, especially the central government, should do, especially this year This system of the United States is directly under the administration of the president The public health system reports to the president's health and safety committee and reports to the president It has jumped out of the conventional medical and health management system and is an independent system Therefore, China also needs to establish a complete social emergency response organization system Once there is an emergency epidemic prevention problem, the emergency response system from one county to one city, to one province, to the whole country will be launched It's like the national disaster Committee Once something goes wrong, the emergency response office of the State Council will report it to the first report of several levels Therefore, the national public health and epidemic prevention system should also rise directly to the national level, led by the state and governments at all levels