Medical reform has been implemented for 3 years.

The medical reform program has been implemented for three years. In the past three years, to what extent has the Chinese medicine community participated in the medical reform? How has the status of Chinese medicine hospitals changed? Did the first-line Chinese medical staff feel the change? How can Chinese medicine better participate in medical reform?

Chen Jun, the deputy director of the Chinese Medicine Development Research Center of China Academy of Chinese Medical Sciences, led his team to the "China Health Statistics Yearbook" of the Ministry of Health for the last three years (2008-2010) and the "Statistical Abstracts of Traditional Chinese Medicine" of the State Administration of Traditional Chinese Medicine. The authoritative data in the Survey Report on the Basic Status Quo of Traditional Chinese Medicine published last year was carefully analyzed and systematically summarized, and the trajectory of the three-year change in medical reform was sought.

A number of Chinese medicine practitioners working in the field are also confirmed by their personal experience. At the same time, Chen Hao was invited to comment.

Initial "out of poverty"

Due to too many debts, "blood transfusions" are needed

[Digital Change] TCM Hospital's average fixed assets of 2,166,640 yuan, average fixed assets of 183,200 yuan, and employee's per capita annual business income of 120,200 yuan from 3 years ago, to 3,367,100 yuan after 3 years, 225,500 yuan, 18.84 Ten thousand yuan is the fastest-growing three-year period since the founding of New China.

At present, in the total income of public hospitals of public TCM hospitals, the financial and superior subsidy income is 5,760,700 yuan, accounting for 11.22% of the total income, and the average annual subsidy is 32,800 yuan. Three years ago, these three figures were 2,476,200, 9.49%, and 18,700 yuan, respectively.

[First Line] Liu Qiquan, Director of the Department of Spleen and Gastropathology at the Hebei Provincial Hospital of Traditional Chinese Medicine, had just been established in 1982 when he started work. There are only two small buildings, and the outpatient building is served by a small clinic built in the 1970s. Liu Qiquan said that it was too shabby to catch the rain and drip water down the wall in the out-patient building. “In the past two years, the hospital has finally undergone major changes.” “Large changes” in the mouth of Liu Qiquan means that the 16-storey new outpatient building, funded mainly by the government, was completed. Now, Liu Qiquan’s spleen and gastroenterology department has expanded from three previous consulting rooms to eight, and the diagnosis and treatment environment has significantly improved.

What is more exciting for Liu Qiquan is that with the advancement of medical reform, the state has begun to pay attention to Chinese medicine research. “In the past, there was hardly any investment in Chinese medicine, and there was no input. Now, our department has received 500,000 yuan as the key specialty of the 11th Five-Year Plan, 3.5 million yuan as the key subject, 1.5 million yuan as the national key research laboratory, and department-level clinics. The key speciality is 3 million yuan. ... This will allow you to conduct scientific research with peace of mind."

[Expert Review] In recent years, the hospital has been developing rapidly in terms of scale and resources. This is inseparable from the government's strong investment. The central government's special funds for investing in traditional Chinese medicine were set at RMB 100 million during the establishment of the State Administration of Traditional Chinese Medicine in 1987, RMB 580 million in 2006, and RMB 5.9 billion in 2011. The intensity and breadth of the scope are unprecedented. The condition of most Chinese medicine hospitals has been improved, the scale has been expanded, the “out of poverty” has been achieved, and its own development ability has been greatly enhanced.

However, the gap between traditional Chinese medicine hospitals and general hospitals is still not small. At present, the general hospital beds have 11.15 million more fixed assets than traditional Chinese medicine hospitals, and the average financial and superior subsidy income is 10.2312 million yuan, nearly twice that of traditional Chinese medicine hospitals. Since there are too many debts to TCM hospitals, governments at all levels need to further increase their investment.

Increased medical treatment

Obvious changes in outpatient treatment still need to be strengthened

[Digital Change] The annual outpatient visits of TCM hospitals increased from 254 million people three years ago to 328 million people, an average annual increase of 8.88%. The total number of discharged hospitals of TCM hospitals increased from 7.44 million three years ago to 11.6 million. The average annual growth rate is 15.94%. Bed utilization increased from 73.03% to 84.10%. The average length of stay was from 10.63 days to 10.64 days, which was basically the same.

[First-line feeling] “The hospital's outpatient service situation has been getting better and better in recent years, but the emergency and hospitalization are worse.” Dr. Liang, director of the emergency department of a county-level traditional Chinese medicine hospital in Jiaozuo City, Henan Province, said that it is relatively special to the hospital’s specialty department of Chinese medicine. It is the status quo of acupuncture, massage, and doctors who are very busy. The emergency department is slightly "idle." "In the emergency department, we were able to get out of the bus very quickly. However, even if a car accident or sudden cardiovascular and cerebrovascular disease occurs, even if they get on the train, the family members still ask to go to the People's Hospital. Don't mention vomiting!"

“But sometimes patients with chronic diseases who are treated in people’s hospitals will turn around again. The beds are not tense anyway and the patients stay for a long time and the leaders of the hospital are not in a hurry,” Dr. Leung said.

[Expert Review] The work efficiency, ward medical care, and utilization efficiency of Chinese medicine hospitals have all improved significantly. This is a very good change. However, 84% of bed usage is only moderate. Hospitals that affect the use of hospital beds in Chinese medicine hospitals are county hospitals. This is the place that will be intensified in the future. At the same time, the average length of hospital stay has not been shortened, which is related to factors such as the rapid growth of beds in the past three years, the reasons for the treatment of diseases, and the absence of major changes in emergency treatment. While expanding the beds, TCM hospitals should pay attention to the two key indicators of hospital bed usage rate and average length of stay. Expanding the number of beds should be coordinated with the development of the use of beds and the reduction of the average hospital stay.

The cost is still low

There should be reasonable compensation for Chinese hospitals

According to the latest figures, the average medical treatment fee per public hospital for public TCM hospitals is 137.53 yuan, which is 36.23 yuan more than before the medical reforms; the per capita medical expenses for discharged hospitals is 4878.33 yuan, an increase of 1158.44 yuan compared with 3 years ago. At present, the total medical treatment fee per person for public hospitals is 173.82 yuan, which is 26% higher than that of traditional Chinese medicine hospitals; the per capita medical expenses for dischargers is 6652.62 yuan, which is 34% higher than that of traditional Chinese medicine hospitals; the per capita annual business income of public Chinese medicine hospitals is 188,400 yuan, compared with 2007. The annual increase of 68,200 yuan, 74,000 yuan less than the general hospital. (Next to the third edition) (Continued from the first edition)

[First-line feeling] The doctor of the respiratory department of the Dongzhimen Hospital Affiliated to Beijing University of Traditional Chinese Medicine discovered that in recent years, although there were only a few patients who came to the hospital for treatment, they began complaining that "seeing Chinese medicine is also expensive." So he took care of the comparison. Take him for treatment of chronic bronchitis as an example. At present, it takes about 110 yuan a week to open a decoction slice, which only cost about sixty to seventy yuan three years ago; but if you open a western medicine, you must have more than 150 yuan. “Because the overall price level has been raised and the price of Chinese herbal medicines has skyrocketed, it is indeed more expensive to open up the decoction. However, compared with similarly rising western medicine prices and patient income levels, decoction is still more cost-effective.”

Qi Jun said: “All the top three hospitals in Beijing are overcrowded, but the income of doctors in traditional Chinese medicine hospitals is middle and lower reaches, and the best is just the middle reaches.”

[Expert Review] With regard to the issue of low hospital charges, we believe that we should look at it from two perspectives. On the one hand, it reflects the anxiety of the TCM Hospital in its effort to control or reduce medical expenses, relieve medical insurance and the burden on urban and rural residents, and has contributed to easing the cost of visiting patients. At the same time, it also shows the characteristics of "conciseness, convenience, examination, and honesty" of traditional Chinese medicine. On the other hand, Chinese medicine hospitals have low fees and save money for patients and medical insurance, but they cannot afford to sacrifice the reasonable income of Chinese medicine hospitals and doctors. How to better mobilize the enthusiasm of medical staff in TCM hospitals and ensure their reasonable income is a guide and policy issue that the government should study and solve.

Characteristic gradual return

Yang "Chinese" can show value

[Digital Change] Three years ago, there were 156,600 practitioners (assistant) physicians in TCM hospitals, including 71,300 practitioners (assistant) physicians, accounting for 45.56%. The latest data is that there are 184,800 practicing (assistant) physicians in TCM hospitals, of which there are 85,200 practitioners (assistant) doctors in Chinese medicines category, accounting for 46.11%. At present, Western medicine still accounts for 65% of medicine revenues in traditional Chinese medicine hospitals, and prescriptions for traditional Chinese medicines only account for 24% of total prescriptions. Chinese medicine treatment income only accounts for 18% of medical income.

[First-line feeling] Before the medical reform, Zhao Jirong, an orthopedic expert from the Chinese Hospital of Gansu Province, developed an in-hospital preparation of Eucommia low back pain pills. Even though the efficacy was significant and the word of mouth was good, it sold more than 1,500 bottles a year. "A lot of patients have to go to the remote field to register for this drug. It is inconvenient." Zhao Jirong met the most exaggerated patients in the field and took a sack and asked for 200 bottles at a time. After the start of medical reform, Gansu Province introduced a policy permitting preparation of Chinese medicine preparations throughout the province. In 2011, Eucommia backache pills sold a total of about 6,000 bottles in the province.

Speaking of the changes brought about by the medical reforms, Zhao Jirong, a deputy dean of the hospital, spoke in numbers: The hospital's characteristics of traditional Chinese medical treatment items increased by nearly one-fold to more than 60; Outpatient specialty technical services accounted for the proportion of total outpatient visits from About 10% increase to 21%.

[Expert Comments] In recent years, Chinese medicine authorities at all levels have focused on practicable and pragmatic styles in the treatment of traditional Chinese medicine. The characteristics of Chinese medicine in Chinese medicine hospitals are returning. However, due to the arduous difficulties, there are still many problems in this area. For example, Chinese medicine doctors account for 60% of the requirements of the State Administration of Traditional Chinese Medicine in terms of the proportion of physicians, and the proportion of prescription prescriptions for traditional Chinese medicines is also lower than the 30% required by the State Administration of Traditional Chinese Medicine. In traditional Chinese medicine hospitals, traditional Chinese medicine has become a “minority”, which is one of the key reasons that restrict the use of Chinese medicine. In the next stage of medical reform, how to play a good role in Chinese medicine will greatly affect the role and value of Chinese medicine hospital in medical reform.