Large hospitals have entered the era of one hospital with multiple districts!

Medical Network News on March 11 Since the new medical reform, it has been consistent to control the scale of public hospitals, but there are still many hospitals expanding under control.

 

It is understood that during the "14th Five-Year Plan" period, the state will support and standardize the development of multiple districts within one hospital.
This year, the state will issue guidance documents for the construction and management of one hospital and multiple districts, and the naming, registration, technical access, capital investment guarantee, and personnel establishment management of one hospital and multiple districts will be clarified.

 

The recent meeting of the Central Deep Reform Commission made it clear that it is necessary to accelerate the expansion of high-quality medical resources and the balanced distribution of regions, which is considered to be the fundamental guideline for the development of multiple districts in one hospital.

 

With the support of the policy of allowing "one hospital with multiple districts", it is estimated that some public hospitals may find it difficult to curb the impulse to expand in the future.
As the hospital management and related departments, when considering expansion, they must carefully consider the problems they may encounter, and do a more adequate and complete pre-plan consideration.

 

One is the problem of debt.
Although the state clearly prohibits borrowing in the construction of a hospital in multiple districts, according to past experience, almost all places will be greedy and demanding in infrastructure construction.
Therefore, it is necessary to think clearly about borrowing.

 

The second is operational issues.
The country hopes for the high-quality development of public hospitals, and hopes to realize the expansion of high-quality medical resources and the acceleration of the balanced distribution of regions through the "one hospital with multiple districts" of large hospitals.
The purpose is to complete the hope of promoting the sinking of high-quality medical resources through the medical consortium and medical community for many years.
Promoting the formation of a hierarchical diagnosis and treatment system, but it may not be easy in practice.
After the outbreak of the new crown epidemic, the multi-hospital model suddenly showed great advantages, so the idea of ​​building a large hospital with one hospital and multiple districts was proposed.

 

　　However, due to the large scale, the unified management of multiple campuses may encounter certain difficulties.
There have been studies and analysis that the scale of the hospital has the most appropriate scale, and that the number of beds between 800 and 1,200 is the best.
Therefore, the "National Medical and Health Service System Planning Outline (2015-2020)" proposes that the number of beds in municipal general hospitals is generally about 800, and in principle no more than 1200; the number of beds in general hospitals run by provinces and above is average Appropriate about 1000 sheets, in principle, no more than 1500 sheets.
If it is too large, the operating efficiency will diminish.

 

　　Although it is said that one hospital and multiple districts should expand the capacity of high-quality resources, not dilute and dilute.
But even if it is a top tertiary hospital, national medical center or national medical center, once one hospital and multiple districts are split, it may be impossible not to dilute.
Therefore, from a management perspective, there may be some problems.

 

　　The third is that the cost may rise.
In the 1970s, Professor Tuchs of Stanford University in the United Kingdom and Professor RGEvans of Canada first proposed a theory called Induced Demand Theory.
This theory believes that the medical service market has the particularity of passive demand and monopoly on the supplier, and the supplier’s doctors play a decisive role in the use of health services and can influence consumers’ choices.

 

　　In this kind of service where patients lack medical knowledge and doctors have their own financial interests, doctors are both consultants and service providers, so they can create additional demand, that is, the supplier creates demand (Supply Creats D).
As a result, there is a phenomenon that if the number of doctors in a certain area is increased, both the price of doctor services and the number of services provided will increase accordingly.

 

　　This theory has also been confirmed by "practice" since my country's new medical reform.
Since the new medical reform, the state has continued to increase its investment in health services for more than a decade in order to solve the problem of people’s medical treatment.
On the one hand, it has supplemented the supply side and increased infrastructure construction.
The number of public hospitals has increased rapidly, on the other hand, the demand side has been continuously increased.
For medical insurance subsidies, although the proportion of personal payment has decreased, the medical expenses of the masses have also increased.
The medical service income of public hospitals has increased simultaneously, and the annual hospitalization rate has also doubled.
After the construction of "one hospital with multiple districts" in public hospitals, after the scale expansion, how to avoid the continued increase in medical expenses also needs to be considered.

 

　　Fourth, the pressure on medical insurance control fees may increase.
Public hospitals are expanding, and medical expenses may rise.
This puts pressure on medical insurance control fees.
Although the current medical insurance is very strong, there are not many methods for large hospitals.

 

　　On the one hand, because medical insurance itself has limited professional capabilities, on the other hand, to do DRGs well, large hospitals must cooperate.
When a large hospital is in a hospital with multiple districts and a medical consortium model, or in the DIP model, many medical institutions are After becoming a family and forming an iron plate, the strength of medical insurance may lose its might.
In the face of a large aircraft carrier hospital, can medical insurance be able to manage it?

 

　　Fifth, there is the issue of the space for social medical services.
With the completion of multiple public hospitals in multiple districts, the survival and development of some social hospitals may face problems.

 

　　Sixth, the promotion of hierarchical diagnosis and treatment.
Due to the expansion of large-scale hospitals, when high-quality medical resources are already in short supply, their efforts to siphon patients and doctors will be even greater.
What is expected by grading clinics is "grading according to the severity of the disease and the difficulty of treatment.
Medical institutions of different levels undertake the treatment of different diseases, and gradually realize the medical process from general practice to professional.
The first consultation at the grassroots level, two-way referral, Whether the situation of "rapidly slow divide and conquer, and upper-lower linkage" can be formed, also needs to be considered.

 

　　Sichuan Provincial People 's Hospital , vice president Wang Li bluntly, and more challenging hospital district management, the key is how to build the homogenization of management system, and more efficient functioning of the hospital district.
However, because human, financial and material are not managed in a unified manner, and the information system has not been opened up, it is difficult to achieve homogeneous management.
In the development of the four closer hospitals, they were also troubled by the lack of homogeneous development.
Therefore, it is simple to say but not easy to achieve the homogenization of multiple districts in one hospital and the expansion of high-quality resources.

　　Medical Network News on March 11 Since the new medical reform, it has been consistent to control the scale of public hospitals, but there are still many hospitals expanding under control.

 

　　It is understood that during the "14th Five-Year Plan" period, the state will support and standardize the development of multiple districts within one hospital.
This year, the state will issue guidance documents for the construction and management of one hospital and multiple districts, and the naming, registration, technical access, capital investment guarantee, and personnel establishment management of one hospital and multiple districts will be clarified.

 

　　The recent meeting of the Central Deep Reform Commission made it clear that it is necessary to accelerate the expansion of high-quality medical resources and the balanced distribution of regions, which is considered to be the fundamental guideline for the development of multiple districts in one hospital.

 

　　With the support of the policy of allowing "one hospital with multiple districts", it is estimated that some public hospitals may find it difficult to curb the impulse to expand in the future.
As the hospital management and related departments, when considering expansion, they must carefully consider the problems they may encounter, and do a more adequate and complete pre-plan consideration.

 

　　One is the problem of debt.
Although the state clearly prohibits borrowing in the construction of a hospital in multiple districts, according to past experience, almost all places will be greedy and demanding in infrastructure construction.
Therefore, it is necessary to think clearly about borrowing.

 

　　The second is operational issues.
The country hopes for the high-quality development of public hospitals, and hopes to realize the expansion of high-quality medical resources and the acceleration of the balanced distribution of regions through the "one hospital with multiple districts" of large hospitals.
The purpose is to complete the hope of promoting the sinking of high-quality medical resources through the medical consortium and medical community for many years.
Promoting the formation of a hierarchical diagnosis and treatment system, but it may not be easy in practice.
After the outbreak of the new crown epidemic, the multi-hospital model suddenly showed great advantages, so the idea of ​​building a large hospital with one hospital and multiple districts was proposed.

 

　　However, due to the large scale, the unified management of multiple campuses may encounter certain difficulties.
There have been studies and analysis that the scale of the hospital has the most appropriate scale, and that the number of beds between 800 and 1,200 is the best.
Therefore, the "National Medical and Health Service System Planning Outline (2015-2020)" proposes that the number of beds in municipal general hospitals is generally about 800, and in principle no more than 1200; the number of beds in general hospitals run by provinces and above is average Appropriate about 1000 sheets, in principle, no more than 1500 sheets.
If it is too large, the operating efficiency will diminish.

 

　　Although it is said that one hospital and multiple districts should expand the capacity of high-quality resources, not dilute and dilute.
But even if it is a top tertiary hospital, national medical center or national medical center, once one hospital and multiple districts are split, it may be impossible not to dilute.
Therefore, from a management perspective, there may be some problems.

 

　　The third is that the cost may rise.
In the 1970s, Professor Tuchs of Stanford University in the United Kingdom and Professor RGEvans of Canada first proposed a theory called Induced Demand Theory.
This theory believes that the medical service market has the particularity of passive demand and monopoly on the supplier, and the supplier’s doctors play a decisive role in the use of health services and can influence consumers’ choices.

 

　　In this kind of service where patients lack medical knowledge and doctors have their own financial interests, doctors are both consultants and service providers, so they can create additional demand, that is, the supplier creates demand (Supply Creats D).
As a result, there is a phenomenon that if the number of doctors in a certain area is increased, both the price of doctor services and the number of services provided will increase accordingly.

 

　　This theory has also been confirmed by "practice" since my country's new medical reform.
Since the new medical reform, the state has continued to increase its investment in health services for more than a decade in order to solve the problem of people’s medical treatment.
On the one hand, it has supplemented the supply side and increased infrastructure construction.
The number of public hospitals has increased rapidly, on the other hand, the demand side has been continuously increased.
For medical insurance subsidies, although the proportion of personal payment has decreased, the medical expenses of the masses have also increased.
The medical service income of public hospitals has increased simultaneously, and the annual hospitalization rate has also doubled.
After the construction of "one hospital with multiple districts" in public hospitals, after the scale expansion, how to avoid the continued increase in medical expenses also needs to be considered.

 

　　Fourth, the pressure on medical insurance control fees may increase.
Public hospitals are expanding, and medical expenses may rise.
This puts pressure on medical insurance control fees.
Although the current medical insurance is very strong, there are not many methods for large hospitals.

 

　　On the one hand, because medical insurance itself has limited professional capabilities, on the other hand, to do DRGs well, large hospitals must cooperate.
When a large hospital is in a hospital with multiple districts and a medical consortium model, or in the DIP model, many medical institutions are After becoming a family and forming an iron plate, the strength of medical insurance may lose its might.
In the face of a large aircraft carrier hospital, can medical insurance be able to manage it?

 

　　Fifth, there is the issue of the space for social medical services.
With the completion of multiple public hospitals in multiple districts, the survival and development of some social hospitals may face problems.

 

　　Sixth, the promotion of hierarchical diagnosis and treatment.
Due to the expansion of large-scale hospitals, when high-quality medical resources are already in short supply, their efforts to siphon patients and doctors will be even greater.
What is expected by grading clinics is "grading according to the severity of the disease and the difficulty of treatment.
Medical institutions of different levels undertake the treatment of different diseases, and gradually realize the medical process from general practice to professional.
The first consultation at the grassroots level, two-way referral, Whether the situation of "rapidly slow divide and conquer, and upper-lower linkage" can be formed, also needs to be considered.

 

　　Sichuan Provincial People 's Hospital , vice president Wang Li bluntly, and more challenging hospital district management, the key is how to build the homogenization of management system, and more efficient functioning of the hospital district.
However, because human, financial and material are not managed in a unified manner, and the information system has not been opened up, it is difficult to achieve homogeneous management.
In the development of the four closer hospitals, they were also troubled by the lack of homogeneous development.
Therefore, it is simple to say but not easy to achieve the homogenization of multiple districts in one hospital and the expansion of high-quality resources.