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On July 17, an official from the Central Ministry of Medicine publicly admitted at a meeting established by the School of Medicine and Public Health of the Peking Union Medical College Medical School that “strong grassroots” was only a slogan in the past and has not been implemented.
1. The number of township hospitals and village clinics has decreased
In the past 11 years, the number of medical institutions in China has not grown rapidly, but the increase in hospitals far exceeds that of primary medical institutions, which can be described as a blowout. From 2009 to 2019, the number of medical and health institutions in my country increased from 916,600 to 1.00.75 million, a growth rate of 9.93%. Hospitals increased from 20,300 to 34,400, a growth rate of 69.3%, and primary medical institutions increased from 882,000 to 954,000, a growth rate of 8.19%. The growth rate of hospitals was 8 times that of primary medical institutions.
Since 2011, the growth rate of outpatient visits in primary medical institutions has continued to decline. In 2015 and 2018, the growth rate of outpatient visits in primary medical institutions was once negative. In addition to the decrease in clinics, infirmaries and village clinics, the shortage of medicines in primary medical institutions is also one of the reasons.
Especially in the first two years of the implementation of the new medical reform, after the implementation of the essential drug system in 2009, although the medication behavior of primary medical institutions was regulated to a certain extent, the use of only 307 essential drugs was also restricted. The ability to provide primary medical services. On the other hand, due to the false high or shortage of some products, patients cannot buy them at the grassroots level and can only go to the pharmacy or higher-level hospital.
In addition, because the new medical reform abolished the drug markup and replaced it with a zero markup subsidy for basic medicines and basic public health subsidies, this relatively fixed subsidy method has also led to a “big pot of rice” for village doctors’ income, and basic medical services are provided. The enthusiasm of the patient is reduced, and there is even a case of shirking the patient. Recently, Rugao County, Jiangsu Province, requires village clinics to implement “separate revenue and expenditure” management. That is to say, even in the most open economic provinces, the policy still encourages village doctors to “pudge up”.
Liu Guiping, director of the Liuzhuang Town Health Center in Yancheng City, Jiangsu Province, also had this concern. He told Caijing that hospitals at county level and above, taking advantage of technology and equipment, expanded rapidly over the same period, and the phenomenon of siphoning of personnel was also obvious. Medical staff went to county hospitals in pursuit of professional title promotion and changes in salary structure. Patients also went to county hospitals above the county level because of the high proportion of reimbursements for the new rural cooperative medical system.
4. Hospitalization: the grassroots beds are empty and people run to the hospital
From 2009 to 2019, the total number of hospitalizations has doubled from 133 million to 266 million. Among them, the number of inpatients in hospitals increased from 8,500 to 212 million, an increase of 149.6%; primary medical institutions increased from 41.11 million in 2009 to 42.95 million in 2019, an increase of only 4.48%.
From a specific year, the number of hospitalizations in primary medical institutions has been one after another. The number of hospitalizations in primary medical institutions dropped from 41.11 million in 2009 to 37.75 million in 2011, and then rapidly increased to 43 million from 2011 to 2012, and has since stabilized to 42.95 million in 2019.
At the beginning of the new medical reform, the “reinforcement of bricks” (ie: supplementary provider) became the first choice at the grassroots level, and the number of grassroots medical institutions increased and the scale expanded , The number of beds increased. However, the construction of the aforementioned mechanism is backward, the growth of the number of primary medical institutions has slowed down, and the growth rate of the number of beds has also fallen. Compared with the difference in outpatient visits, the decline in the proportion of inpatients in primary medical institutions is even more unbalanced. From 2009 to 2019, the proportion of inpatients in primary medical institutions fell from 31% to 16.1%, while the proportion of inpatients in hospitals during the same period increased from 64 % Rose to 79.6%.