Why has Hainan's gradual abolition of general outpatient clinics in tertiary public hospitals caused widespread concern?

Recently, the news that Hainan has gradually cancelled the general outpatient clinic of tertiary hospitals has attracted people's attention
.
This news stems from the "Implementation Plan for Promoting the High-quality Development of Public Hospitals in Hainan Province" issued by the General Office of the Hainan Provincial Government not long ago, which proposes to strictly control the number and scale of tertiary public hospitals in the next three to five years, and gradually cancel the general outpatient clinics
in these hospitals.

 

Why does Hainan's proposal to cancel the general outpatient clinics in tertiary hospitals cause widespread concern in the industry and patients? How can the local planned health care reform initiatives really benefit more patients?

 

Mr.
Han came to Hainan to work after graduating from university and has settled in Haikou for many years
.
Some time ago, he heard the news that Hainan will cancel the general outpatient clinic of tertiary public hospitals, and he is somewhat worried about how to enjoy high-quality medical resources
in the future.
Mr.
Han said, "I don't agree! The better medical resources are Haikou City, after the cancellation, how do those cities and counties see a doctor? You can only run to the big city, and it is certainly not convenient to
seek medical treatment.
”

 

In the "Implementation Plan for Promoting the High-quality Development of Public Hospitals in Hainan Province", it is proposed that through 3-5 years of efforts, the institutional mechanism of public hospitals will be gradually improved, the shortcomings of the system will be basically completed, and the development mode will shift from scale expansion to quality and efficiency
.
The implementation plan also proposes 7 key tasks, the most interesting of which is the gradual elimination of general outpatient clinics
in tertiary public hospitals.

 

The doctor of a provincial third-class hospital in Hainan said that at present, they have not received any notice of the cancellation of ordinary outpatient clinics, asked whether he agreed to the cancellation, as a front-line doctor, he is very entangled
in his heart.
He said: "The first aspect is that we really want to cancel the general outpatient clinic, because the tertiary hospital mainly treats the suspected and critical diseases
.
Now all the ordinary outpatient clinics have come to the tertiary hospital, and what is done is what can be done in the primary and secondary hospitals, and the workload is too large
.
The second aspect, because the pressure of hospital income generation is still relatively large, if the general outpatient clinic is cancelled, it may have an impact on the hospital's income, and it is also directly related to the front-line doctors
.
”

 

The front-line doctor also said that in Hainan, the number of visits in large hospitals is large, while the phenomenon of grass-roots hospitals is more obvious, while the outpatient volume of grass-roots hospitals in large cities such as Beijing, Shanghai, Guangzhou, and Shenzhen is relatively good
.
"The more there are no patients in the primary and secondary hospitals at the grass-roots level, the income of doctors cannot keep up, and the medical technology cannot keep up, and over time, the level of primary medical care will become weaker and weaker
.
"

 

In fact, controlling the scale and number of ordinary outpatient clinics in tertiary public hospitals, and even canceling the ordinary outpatient clinics in these hospitals, many places have proposed similar statements before, but many industry insiders told reporters that the promotion effect is not obvious
.

 

Over the years, how to guide high-quality medical resources to sink to the grassroots level has become one of
the problems in vigorously promoting graded diagnosis and treatment.
For the attention of the outside world, the relevant insiders of the Hainan Provincial Health Commission told the Voice of China that the relevant expressions in the implementation plan are not new proposals, and the key tasks proposed in the current plan, how to advance, are still in the top-level design stage
.
However, the health department of Hainan Province has actually planned and thought systematically for a long time, and a lot of preparatory work
has been done in the early stage.
The foundation of reform is being further consolidated
.

 

The informed person said: "Since 2018, we have promoted the standardization of grass-roots medical and health institutions in the province, and the capacity improvement project of grass-roots medical and health institutions has done a good job
.
We have improved our capabilities through 5G technology and telemedicine, so that the people in the village clinic can be connected remotely and with experts in large hospitals
.
We have a lot of foundations for reform, including the ability to drive city and
county hospitals.
This year, a document will also be issued to promote the sinking of high-quality medical resources in provincial and municipal tertiary hospitals to the
grass-roots level.
”

 

The insider also admitted that the local medical reform has entered the deep water area, especially the sinking of high-quality medical resources is not an easy task
.
At present, they are widely soliciting opinions and expect to introduce specific implementation measures
next year.
"The big hospitals must be willing to put it, the grassroots must be able to catch it, and the people must be willing to go
.
" This is not simple, we have prepared before, the next step may be this year to do a good job of institutional arrangements, we are now actively planning, ready to introduce next year to gradually promote the sinking of the specific landing plan
.
”

 

Relevant insiders of the Hainan Provincial Health Commission also said that in fact, this work was proposed as early as last year in the relevant plan they released, but it did not cause widespread concern
from the outside world at that time.
But what is certain is that the abolition of ordinary outpatient clinics in tertiary public hospitals will never be "one-size-fits-all", but rather gradual
.
"We want the people to volunteer, he feels that the experts who go to the grass-roots health centers and communities around them are equivalent to the experts who go to the big hospitals to see the experts, or go to the health center to do B ultrasound, go to the county hospital to do B ultrasound or go to the big hospital to do B ultrasound, the level is similar
.
"

 

Chen Qiulin, deputy director of the Health Industry Development Research Center of the Chinese Academy of Social Sciences, said that the cancellation of ordinary outpatient clinics in tertiary public hospitals is only one of the ways to promote graded diagnosis and treatment, and the effect depends on how to gradually cancel it, focusing on "gradually"
.
Chen Qiulin said: "Why we should do it step by step, it is nothing more than to do preparatory work inside, then it depends on what work
is prepared to be done inside.
" From the patient's point of view, it is also normal to have opposition, it is actually a process of changing medical behavior, as well as institutional problems, to have time precipitation
.
”

 

Chen Qiulin also said that specialists and general practitioners should only be professional, not at the level, and the difference in hospital level should not become a label
for the level of diagnosis and treatment in hospitals.

 

Yang Yansui, a professor at the Institute of Hospital Management of Tsinghua University, also told the Voice of China that at present, relevant departments are promoting the construction of a close-knit medical community and promoting the integration of community general practitioners and specialists, which may become an effective measure to
promote the sinking of high-quality medical resources.
"As long as the whole professional integration, and there are general practitioners who understand you, and there are specialist doctors who are diagnosed and ordinary surgery, as long as the quality is relatively good, why do people have to run to the tertiary hospital to queue, so this is a process
of outpatient under-diagnosis.
" That is to say, which department is mature, can go down to the grassroots, which community of family doctors fully integrated team built, which community can be the first diagnosis at the grass-roots level, this is not a one-time achievement, it needs a process, so it is called gradually
.
In the future, people maintain health and see a doctor throughout the life cycle, no longer an individual to find a doctor, it is a system, in fact, from health maintenance to medical treatment, it is an orderly thing, so that the quality is good, the cost is low
.
”