Liu Guoen: public hospitals need to lose a lot of weight to achieve strict public welfare

Source: China Youth Daily on June 1, 2015, the general office of the State Council issued guidance on pilot comprehensive reform of urban public hospitals, proposing to change the compensation of public hospitals from three channels of service charge, drug markup income and government subsidy to two channels of service charge subsidy and government subsidy, and emphasizing to reduce the burden of medical treatment for the masses How to maintain the public welfare of public hospitals while ensuring the efficiency of hospital operation and the income of medical staff? The reporter of China Youth Daily interviewed Liu Guoen, director of China Health Economics Research Center of Peking University and professor of economics of National Development Institute of Peking University If we raise the medical service charges, it will be difficult for the common people to reduce the medical burden, and even aggravate China Youth Daily: this reform especially emphasizes the public welfare orientation of public hospitals How do you understand the public welfare? Liu Guoen: in my opinion, in a broad sense, public welfare refers to the extent to which the public can benefit from medical reform For the public, there are three main aspects: first, the accessibility of medical services, that is, the convenience of people to see a doctor, without having to go to the outpatient line of a large hospital, waiting for a long time to see a doctor, there is a good community hospital at the door of their home; second, the reduction of the burden of public medical treatment, that is, the government increases the investment, through the improvement of the medical security system and the strengthening of medical insurance investment Third, the improvement of medical service quality In a broad sense, public hospitals and private hospitals can help to achieve public welfare At present, China's medical reform emphasizes the public welfare of public hospitals, which is mainly realized by government funding China Youth Daily: the reform emphasizes cutting off the profit seeking chain of public hospitals and ensuring that people's medical burden is not increased Does this mean that financial investment should be greatly increased? Liu Guoen: it's OK to completely cut off the profit seeking chain of public hospitals and make them return to public welfare The normal operation of public hospitals and the income of medical staff need the state finance to fully cover the bottom of public hospitals But it's not realistic for public hospitals to rely on financial support On the one hand, there are a large number of public hospitals, more than 10000 On the other hand, the fixed assets of public hospitals have been accumulated for decades At present, the annual investment in public hospitals accounts for only 5% - 10% of the total demand, and 90% is raised by public hospitals themselves Nowadays, it is very common to support doctors with drugs The drug revenue of large hospitals accounts for about 50% of the total revenue In addition, there is also the revenue from equipment and consumables If we raise the medical service charge, it is difficult for the common people to reduce the medical burden, or even increase it, which is not consistent with the pursuit of public welfare Therefore, within the scope of financial expenditure capacity, if we want to achieve the public welfare in the strict sense of public hospitals, the only way is to significantly reduce the weight of public hospitals The first is to reduce the number of public hospitals to less than 1 / 3 of the current level, so that the finance of each public hospital can be guaranteed In fact, China does not need so many large public hospitals In 2014, only about 10 out of every 100 people needed hospitalization services, most of them only needed outpatient services, and most of them did not need to be carried out in large hospitals China Youth Daily: will financial support lead to inefficient public hospital services? With the decrease of the number of public hospitals, where should doctors go? Liu Guoen: there is an old saying in China that fish and bear's paw can't have both Efficiency will certainly have an impact, but it can be addressed pertinently, and service efficiency should be more reflected in the level of social medical management If we mobilize social forces to establish more and more efficient outpatient clinics in the community, the common people will find that the time of seeing a doctor has been shortened, the service attitude of doctors has been improved, and the medical institutions themselves can operate well It's not efficiency what is it? For doctors, if they can practice freely, have their own clinic and team, and each person can earn tens of thousands or even hundreds of thousands of yuan a month, how to persuade them to leave the public hospital, or worry about their income security? The state should spend money on the key areas of public hospital services China Youth Daily: what are the reasons for the formation of the mechanism of public hospitals supporting medical care with drugs? Liu Guoen: in the past, the policy hoped to control the medical service cost to a reasonable level that people can afford through administrative means This has the most direct impact on more than 2 million medical personnel, because they are established by public institutions As a result, their basic wage level has been controlled, and the hospital's various service charges have also been controlled However, in the process of social and economic development, the wage income of medical staff is not enough, their wage growth needs to be consistent with the staffing of other institutions, and medical service charges can not be released, because medical service is the place that best reflects the public welfare of the government Therefore, the policy has opened a gap in medicine, which has become a way for hospitals to generate income China Youth Daily: there are many achievements in the process of China's medical reform, but there are also some problems that recur What do you think are the root causes? Liu Guoen: in recent years, the financing of medical reform has made great progress in the medical insurance system, while the public welfare reform of medical service has made little progress The biggest problem is that the state does not know what kind of public hospitals it wants to run, that is, the service focus of public hospitals has not been clear When the goal is not clear, the state will have problems in the exercise of duties and allocation of resources - both to promote public welfare and to intervene in hospital income, which will disrupt the reform and deployment, confuse the responsibilities of public hospitals, and present this situation This reform of public hospitals has not made clear the service focus of public hospitals As the leading force, public hospitals in our country are the objective situation of historical formation, but the next step of medical reform must be clear about what is the key intervention place of the government under the premise of public hospitals as the main force It doesn't make much sense to always emphasize the big principle and push forward the whole line China Youth Daily: what do you think should be the service focus of public hospitals? Liu Guoen: I think the reason why the country wants to run a hospital is that the society can't complete the work of running a hospital For example, at present, the development of medical services in some regions is relatively lagging behind, the purchasing power of the people is relatively low, and it is impossible to rely on the society to run medical care For example, research and supply of vaccines, research and treatment of special diseases, cultivation of medical students, research of basic medicine and other fields are often highly public and have slow economic returns It may take more than 20 or 30 years or even half a century to receive returns, and have relatively low attraction for social medical services These marginal, poverty-stricken, public, external and basic areas are the focus of national medical care Because private hospitals can't and won't do it, and they have no obligation to do it China Youth Daily: what do you think should be done to promote medical reform next? Liu Guoen: at present, we have established a basic medical insurance system covering 97% of the population The system is highly inclusive, on which the country is still promoting serious illness health insurance The state can not emphasize the main body of running a medical service, and the financial investment can supplement the demander, so that the common people can choose their own medical service mode, as long as the money invested is not wasted and embezzled The state can also seize part of the public hospitals for reform to ensure public welfare Due to the limited financial capacity, the government needs to distinguish the characteristics of public hospitals and private hospitals, and spend money in the key areas of public hospital services Moreover, these areas should be fully covered by the government's public finance, even if "losing money" The non key ones can be put down and solved by mobilizing social forces to run a doctor.