This article is from the public number:Arterial Network (ID: vcbeat), author: Zhang Xiaoxu, from the title figure: Oriental IC

In May this year, the National Health and Health Commission and other five ministries and commissions issued the “Opinions on Promoting the Pilot Development of Clinics” (hereinafter referred to as “Opinions”), pilot projects in 10 pilot reform cities in Beijing, Shanghai, Shenyang, Nanjing, Hangzhou, Wuhan, Guangzhou, Shenzhen, Chengdu and Xi’an The Opinions streamline the process of starting the clinic and has developed a number of initiatives to encourage the opening of clinics. It also encourages physicians who have been in medical institutions for five years and have intermediate or above titles to run specialist clinics either full-time or part-time.

On November 8, the National Health and Health Commission also issued the “Span class=”text-remarks” label=”Remarks”> (2019 revised edition) This is a new version of the standard that has been launched since 2010 and is aimed at 10 reform pilot cities announced in May this year. The document has been adjusted and updated in terms of medical staff title requirements, cancellation of building area settings, and construction of information systems.

In fact, in recent years, the state has successively introduced policies to gradually simplify the access process for social medical treatment, and to implement the “two-in-one combination” for the establishment and approval of medical institutions under the second level; the free practice of physicians has also been put Open and continue to encourage. This year’s new clinic regulations are further clarified and refined on the basis of the previous ones.

Now, the “Opinions” have been published for half a year. What is the situation in the pilot areas? After simplifying the admission process, will a large number of clinics emerge overnight? Encourage doctors to open clinics, will it lead to the entrepreneurial tide of doctors opening clinics? The reporter interviewed a number of medical institution managers, combined with the data, with the following findings.

The pilot area is advancing the new regulations of the clinic

According to the data released by the National Health and Health Commission, there are currently nearly 220,000 registered and actual clinics in the country, with an average of more than 7,000 clinics per province; the average number of practitioners in the clinic is 2.6, of which the average physician is 1.4. The average number of people and nurses is 1.2; the common diseases of internal medicine, stomatology, traditional Chinese medicine, Chinese medicine surgery, orthopedics, gynecology, and gynecology account for more than 90% of the clinic business, playing an important role in primary medical services.

But at the same time, clinic development faces major problems such as tight human resources, low medical service capacity, and difficulties in industry supervision.

In this context, in May this year, the “Opinions on Promoting Pilot Development of Clinics” was introduced. The Opinions put forward a number of measures to promote clinics and strengthen clinic supervision, mainly to simplify clinic admission procedures, adjust basic clinic standards, and encourage qualified physicians.Several clinics were set up in clinics and clinics to establish information systems. Ten cities including Beijing, Shanghai and Shenyang were also piloted.

Subsequently, several pilot areas followed suit and implemented corresponding implementation plans for local conditions.

Policy to promote clinic development pilots, arterial network mapping

In the May Notice of the Health and Health Commission, it was proposed to adjust the clinic standards. In early November, the newly released “Clinical Reform Pilot Area Clinic Basic Standard (2019 Revised Edition) finally arrived, compared to the previous 2010 version. There are mainly changes in the following aspects:

1. The new standard requires clinicians to obtain the qualifications of practicing doctors. After registration, they have been practicing in medical institutions for 5 years and have the title of above-mentioned physician and above. Previously required to be a practicing physician.

2. Clinical examination, medical imaging, ECG, pathology, disinfection supply, etc., and other medical institutions have signed relevant service agreements. If other institutions provide services, they may not be equipped with relevant equipment. Compared with the 2010 version, it has increased ECG, pathology, and medical imaging.

3. The use area and building layout of the clinic can meet the medical needs of the medical subjects. The 2010 version requires a building area of ​​no less than 40 square meters.

4. Newly added “establishing an information system and interconnecting with the medical service supervision information system in accordance with the requirements of health and health administrative departments and standards.”

It can be seen that the standard continues the principle of the Opinions. Compared with the old version, the biggest change is to adjust the hardware from the key equipment and facilities to the review of the qualifications and capabilities of the doctors, and improve the clinic clinicians. Qualifications, the threshold for practice in clinics has increased, and the need for information systems has increased.begging.

The difference between the two versions of the standard, arterial network mapping

Simplified process, lower clinic costs

It takes a long time and a lot of processes to run a clinic. It used to be a headache for a lot of starters. Yu Yu, CEO of You Neighborhood Clinic, complained on Weibo about the difficulty of approval of the clinic. Has the clinic starter experienced changes during the landing of the above new regulations? We interviewed a number of medical institution managers in Shanghai, Chengdu and other places, combined with past policies, to sort out the changes in the clinic’s bidding process, as shown below:

Start Process Comparison Chart, Arterial Network Mapping

According to the Regulations on the Administration of Medical Institutions, in general, the process of opening a clinic involving the health administration requires seven steps; in these steps, there are many uncertainties: for example, the location cannot be close to restaurants, schools, Can not share the access channel with other businesses or residents, otherwise it will not be able to obtain the approval of the medical institution through the address, and it will not be able to carry outThe latter steps; even if the website is passed, the publicity stage is a test. If there is any objection, it will affect the subsequent process. These factors lead to long approval processes and high risks. Problems in one of these links may result in the clinic being unable to start.

According to the “Opinions” issued this year, it takes only 4 steps to open the clinic, canceling the application, publicity and other aspects of the general process (ie canceled In the figure above, the steps in the dotted line) , at the same time, change the setting approval to the record management system, execute according to the clinic standard of the pilot area and submit the material for the record, where the county (District) Health and health administrative department can issue the “Medical Institution License” after passing the examination.

“We are in Shanghai’s Sijun Surgery Clinic, which is based on the new regulations. Currently, we have obtained a practice license.” Dr. Bao Yuke, Vice President of Dr. Zhang Qiang Group, introduced the clinic from the site preparation to the license. For half a year, it took only 20 working days to file the certificate. “Under normal circumstances, our construction period only takes three or four months, but the Shanghai Sijun Surgery Clinic has a certain impact on the construction progress in order to cooperate with the park management. Otherwise, the whole process from site selection to obtaining the certificate will be faster. Experience, the whole process may take a year.”

The Opinions also stipulate that the chain-based and group-based clinics that operate across administrative regions shall be uniformly filed by the higher-level health and health administrative departments, and the provincial-level administrative regions shall be filed separately by the provincial health administrative departments. Bao Yuke said that because the cross-provincial operation involves the relationship between the business mother, the subsidiary or the general and branch companies, the next step is to try the specific start-up process.

The Convenience of the Opinions for the opening of the clinic is affirmative. It is not only the efficiency of the process simplification, but also the direct reduction of costs. Since the medical institution’s plan does not impose restrictions on the clinic, it means that the clinic has a wider range of sites and can choose a more cost-effective place. For example, Bao Yuke said: “According to the previous requirements, medical institutions must have independent channels. In most cases, they can only choose the first floor, but the rent on the first floor is high; now we can choose the second floor or above, directly Save a rent.”

At the same time, the new clinic standards are no longer mandatory for the clinic area. For small clinics run by individuals, they can also be sited and laid out as needed to save costs.

Under the new regulations, this year, Zhang Qiang’s doctor group not only quickly completed the landing of the Shanghai clinic, but also many clinics across the country entered the preparatory stage. “One of them has completed the site selection, and several others are selecting sites.” Bao Yuke revealed.

The short-term outbreak did not form

The new rules seem to lower the threshold for running clinics, and encourage physicians who have been practicing in medical institutions for five years and who have obtained intermediate or higher professional titles, and run specialist clinics full-time or part-time. It seems to indicate that another wave of clinic construction boom has arrived.

However, we inquired about the registration of clinics in various pilot cities since the introduction of the new regulations in May this year. Compared with the same period of last year, the overall number has not changed significantly. This is probably related to the doctor’s lack of motivation to open a clinic, access conditions and stricter supervision. The simplification of the approval process does not mean that the clinic is easier to start, and the doctor has to consider the market, the environment and its own capabilities.

Doctors don’t flock to the clinic

First, there is not enough motivation for doctors to open a clinic full time. About this point, Bao Yuke’s view is that for doctors who are still in the system, big experts are well-known, have a large number of patients, and have good research platforms and benefits, not necessarily I need to go to the clinic myself. The general doctors don’t have such a good personal brand. Once they leave the system, especially after leaving the big three hospitals, the appeal to patients is small. There is a certain risk in opening a full-time clinic.

Second, the environment for doctors to open a part-time clinic is immature. Although the country has introduced a series of policies in recent years, it is more and more open to doctors’ free practice. However, in reality, doctors are still regarded as “units”. Hospital administrators must hope that doctors serve hospitals full time. If doctors open a clinic part-time, whether to use the main practice agencies to “drain” their clinics and how to deal with medical malpractices in medical malpractices, these problems are difficult to define in the short term, so that doctors should open clinics, hospitals and doctors on a part-time basis. It is difficult to deal with each other’s relationship.

Third, a good doctor may not be a good manager. Opening the clinic requires a lot of energy and financial resources, site selection, brand building, handling doctor-patient relationship, public relations, medical disputes, etc. The test is far more than the doctor’s diagnosis and treatment level, including management and management capabilities, crisis management. ability. However, there are specialties in the surgery industry. Most doctors in the system have strong medical treatment ability, but they do not have the ability to manage and manage. They may not be able to manage a clinic. At the same time, doctors have to undertake a large number of clinical, scientific research and other work, lack of skills, no energy to open a clinic part-time.

So, doctors also rationally recognize these questions.Pass_ticket=ydrVVIhjRLZHcLa7n%2FGSwvtXqfIrqLYe8d1%2BqqhYPCl12gts8L2DAPkM%2BVKLpXce” target=”_blank” rel=”nofollow” style=”text-decoration: none;”>Arterial Network (ID: vcbeat) , author: Zhangxiao Xu