The beginning trend of private medical care needs to change from quantity growth to quality growth

Medical Network June 9 - With the rapid growth of investment in the past few years, private medical care in the number of institutions, outpatients and hospitalizations have achieved rapid growth, but as we analyzed in our previous report, the growth of private medical services mainly depends on the accumulation of quantities, the average number of outpatients and hospitalizations per institution has not actually increasedUnlike in previous years, the number of institutions in private hospitals has maintained a relatively fast growth rate (6.9%), but the overall decline in non-public health care with private-owned core, both in terms of annual growth, overall share and the number of patients in the average institutions"2019 China's healthhealthcareer development statistics bulletin" shows that the tertiary hospitals, whether from the number or outpatient and inpatient growth have returned to the level before 2016, while other hospitals at all levels and grass-roots in outpatient although there is a certain growth, but generally negative growth in hospitalization, which led to a further decline in the proportion of hospitalizationAs private hospitals are mainly primary and secondary hospitals, 74% are first-level hospitals, 24% are secondary hospitals, and tertiary hospitals account for only 2%, which shows that its original development model has encountered a great bottleneck and urgently needs to be transformedIn 2019, the number of outpatient visits nationwide was 8.72 billion, with an annual growth rate of 4.93%Among them, the number of outpatient visits in tertiary hospitals was 2.06 billion, with a double-digit growth rate of 11.35 percent, the first time since 2014 that it has rebounded to double digits and 12.9 percent in 2014Moreover, health care providers at all levels are growing at a slower rate than the national average, though generally better than in 2017 and 2018For example, outpatient growth in Primary Hospitals was 4.76 per cent in 2016, but zero growth in 2017 and 2018, reaching 4.55 per cent in 2019In terms of outpatient proportion, the number of tertiary hospitals increased significantly, from 19.51% in 2015 to 23.62% in 2019Secondary hospitals grew only slightly, slowly rising from 15.21% in 2015 to 15.37% in 2019There was negative growth in primary hospitals and at the grass-roots level, with the proportion of outpatients falling from 2.73% and 56.44% in 2015 to 2.64% and 51.95%, respectivelyAmong them, the grass-roots decline was most pronounced, by nearly 5 percentage pointsThis also means that the initiative of graded diagnosis and treatment has not been effective, and it is difficult to promote the development of graded diagnosis and treatment by policy alone in the case of long-term poverty at the grass-roots levelThere are two main reasons for the overall rebound in outpatient volume in 2019,drugcollection and drug retail ingressFirst, with the promotion of national drug collection, drug prices fell faster, patients' demand for low-cost drugs concentrated in medical institutions, promoting the overall increase in outpatient volumeBecause theof tertiaryhospitals is the focus of drug collection, users in tertiary hospitals are more likely to obtain low-cost drugs, which promotes the concentration of patients to tertiary outpatient sendingSecond, with the advance of outpatient co-ordination, especially after the retailpharmaciesthe non-prescription purchase of prescription drugs, the rate of population return to outpatients acceleratedFrom the trend point of view, with the cancellation of urban and rural residents, the size of urban workers and the continued promotion of outpatient accounts and outpatient co-ordination, outpatient patients to medical institutions will continue to increase the return, but the three-level hospitals will continue to be the biggest beneficiaries, not only in the tertiary hospital's high-quality medical resources more attractive, but also in the tertiary hospital's complete list of drugs and can ensure the priority use of low-cost drugsIn terms of hospitalization, the number of hospitalizations nationwide was 266 million, an annual growth rate of 4.49 percentBut only the second- and third-tier hospitals are growing positively, the rest are negative, while tertiary hospitals have maintained year-round double-digit growthThe number of hospital admissions in tertiary hospitals was 12.55 per cent in 2016 and, although it fell to 9.24 per cent and 10.67 per cent in 2017 and 2018, it returned to 12.82 per cent in 2019The growth rate of secondary hospitals fell from 6.31% in 2016 to 2.48% in 2019The number of primary hospitals fell from 8% in 2016 to -4.8% in 2019, and although the number of hospitalizations in Primary Hospitals grew by 12.51% in 2017, this was a flash in the pan, followed by a sustained declinePrimary hospital admissions have been negative since 2018, dropping from 3.17 percent in 2016 to -1.85 percent in 2019In terms of the proportion of hospitalizations, the number of tertiary hospitals increased significantly, from 32.44 percent in 2015 to 39.42 percent in 2019 Secondary hospitals continued to decline, from 33.82 percent in 2015 to 31.51 percent in 2019 There has been a decline in primary hospitals and at the grass-roots level, with the proportion of hospitalizations falling from 4.57 per cent and 19.17 per cent in 2015 to 4.33 per cent and 16.15 per cent, respectively Among them, the grass-roots decline was the most obvious, down by 3 percentage points This shows that even through various forms of health associations and the promotion of the MSC, still can not change the patient's low trust in the grass-roots status quo, which also reflects the grass-roots medical capacity is still largely lacking, it is difficult to attract patients back 　　It is worth noting that the growth rate of non-public medical hospitalizations has been negative for the first time in recent years, with the number of hospitalizations in 2016 and 19.25% in 2016 and 2017 falling to 10.7% in 2018 and -0.74% in 2019 This means that the pattern of high growth through the overlay of numbers in the past has suffered a serious decline, even though the number of private hospitals remains high, but the overall number of hospitalizations has shown negative growth, which reflects a negative growth in the average number of patients in the annual hospital 　　In 2019, the number of private hospitals has reached 22,424, the number of public hospitals has shrunk to 11,930, and the number of private hospitals is nearly double that of public hospitals Although the number of private hospitals will grow at 6.9 percent in 2019, compared with the double-digit growth in previous years, the growth rate is still relatively rapid However, the increase in the number did not bring about an overall increase, which is the most obvious manifestation of the decline of private hospitals In the last five years, the average number of hospital admissions in private hospitals has risen from 1629 in 2015 to 1770 in 2017, and has since continued to decline, with the average admission slow to 1748 in 2018 and 1648 in 2019, which is back to 2015 levels 　　In the face of the continued decline in passenger flow, private hospitals have to further reduce efficiency in order to obtain income, which is reflected in the length of hospital stay and the continued decline in bed utilization The bed occupancy rate in private hospitals fell further to 61.4 per cent from 63.2 per cent in 2018 and slightly to 91.2 per cent in public hospitals from 91.1 per cent The length of hospital stays in private hospitals increased further to 9.4 days from 8.9 days in 2018, while in public hospitals it fell from 9.3 days to 9.1 days 　　Facing the upcoming REFORM of THE DRG payment system, private hospitals are not only not ready to improve efficiency, but also continue to reduce efficiency, which will have a greater impact on their future operations Of course, drug collection will have a more direct impact on private hospitals, which will directly erase the profits of medical institutions in medicine, prolonging hospital stay is essentially a hedge against the decline in drug profits From this point of view, private hospitals will become a trend to extend hospital stay, until the DRG fully pushed away before it may be reversed 　　From the simple data combing point of view, even if there is no payment system reform, the development of private medical care itself has encountered a greater challenge, if not early to develop a more quality operating model, relying on long hospital stay overlay drugs and inspection to obtain income, the future under payment pressure will face a sustained market shuffling, a large number of private hospitals operating by simple and inefficient model will have to be out