“Our best affiliated hospital here, used to be hard to find the number one file, and even opened a special window at the peak, and only put 8 numbers a day. It’s even harder than grabbing high-speed rail and plane tickets during the Spring Festival. Now they’ve all been released, and we must actively promote patients to go to them.”
Introduced by Wang Luo, chief physician of the obstetrics department of a tertiary hospital in Guangzhou, “The number of pregnant women in the country is declining, and everyone is trying their best to win patients.”
At the same time, Dingxiangyuan Weibo released voting data showing that nearly 70% of users said that “the number of inpatients in the obstetrics department of their hospital has decreased compared with the same period last year.”
Image source: Lilac Garden Weibo
The feeling of clinicians is consistent with the trend of fertility data published in my country.
In 2016, when the two-child policy was opened, the new population reached a peak that year, and the number of new population in my country has shown a downward trend in the following five years. According to data released by the National Bureau of Statistics, in 2021, the country will have a net population increase of 480,000 people, and the annual birth population will be 10.62 million, the smallest year since the founding of New China.
Note: my country’s net population increase data from 2015 to 2021,
Shows a clear trend of first rising and then falling
The overall decrease year by year, the epidemic highlights the downward trend
Such a change is not surprising to Liu Yan, Deputy Chief Physician of the Obstetrics Department of Tianjin First Central Hospital. The number of months has decreased significantly, and the overall decrease in recent years has been highlighted by the epidemic.”
Image source: Zhanku Hailuo
In December 2020, my country launched a large-scale COVID-19 vaccination campaign. From March 2021, the daily number of new vaccine doses in my country has almost exceeded 3 million.
“Although the National Health and Health Commission mentioned that the vaccine will not affect pregnant women, from our clinical point of view, newborns are not abnormal. However, some parents may think that, The health of the child requires a longer-term observation, so it is more inclined to wait for a while before trying to conceive.”
Image source: National Health Commission
According to the pregnancy cycle, “We actually knew about the decline in the number of people at the end of 2021 from the beginning of the year. During the period from March to April last year, when all staff were vaccinated, it was common for everyone The idea is to suspend and delay the birth plan, and these people are usually born in December.”
Yang Jinrui, deputy director of the Population and Family Department of the National Health and Health Commission, mentioned in an interview with People’s Daily that he believes that the decline in births in recent years is caused by multiple factors. The decline in the number of women of childbearing age is the main factor driving the decline in births.”
During the “Thirteenth Five-Year Plan” period, the number of women (20-34 years old) in the prosperous period in my country will decrease by 3.4 million annually, and in 2021, it will decrease by 4.73 million compared with the previous year. At present, there are about 330 million women of childbearing age (15-49 years old) in China, which is expected to drop to 200-240 million by 2050.
While the number of births has declined, the willingness to have children has continued to decline. Ms. Chen Li, the chief obstetrician of Shanghai Pudong Hospital, told Dingxiangyuan, “In the overall environment, the younger generation’s willingness to bear children is low, especially in big cities. Our hospital has collected local and non-local production data this year. Only 1/3 of the local population.” According to the National Bureau of Statistics, the average number of children planned by women of childbearing age in my country has dropped from 1.76 in 2017 to 1.64.
Data from the National Bureau of Statistics shows that the average number of children planned by women of childbearing age in my country has dropped from 1.76 in 2017 to 1.64.
In contrast to the decline in fertility in women of childbearing age, the number of older women admitted to hospitals has increased significantly.
Image source: Zhanku Hailuo
Chen Hanyu, an obstetrician from a tertiary hospital in a first-tier city in the north, revealed that a woman in her 60s was admitted to her department this year. In border port county hospitals, it is more common for mothers to give birth to four or five children.
In the border county town of Guangxi with a population of 280,000, an obstetric nurse in a primary hospital told Dingxiangyuan: “The proportion of elderly mothers in the hospital is high, and there are still many third or fourth births. The number of deliveries in the whole county is high. The highest should be 3300 in 13 years, 2674 in 2020, and the downward trend in 7 years is very slow.”
The increase in advanced age and multiple births also increases the corresponding pregnancy risk. Strengthening patient education has become a concern of clinicians. Dr. Liu Yan said that in clinical work, it is often found that many women “have no reproductive conditions at all, neither assessing their physical condition nor conducting regular pregnancy tests.”
“For example, we recently treated a pregnant woman with five births, and she gave birth to one in 2015, 2017, 2019, 2020, and 2021. Because of her rich experience, this birth has never been I didn’t have a check-up, and didn’t come to me until 33 weeks. In the end, the child had a gastroschisis, and the entire liver and intestines were all outside.”
Primary hospitals have the greatest impact, while maternal and child health care hospitals are more robust
From the perspective of geographical distribution, first-tier cities such as Guangzhou and Shanghai, which are economically developed and have a large inflow population, can attract patients from other provinces in addition to local residents, and the decline in hospital admissions is relatively small.
According to the 2021 Statistical Yearbook data, the four first-tier cities in Beijing, Shanghai, Guangzhou and Shenzhen rank among the top four in terms of net population inflow. Among them, Shenzhen and Shanghai had a net inflow of more than 10 million people, and Guangzhou ranked third with a net inflow of 8.89 million. Correspondingly, local doctors in Guangzhou said that the drop in hospitals was between 10% and 20%, and the overall drop in hospitals in Pudong District was between 6% and 30%.
Image source: First Financial
From the perspective of hospital level, grass-roots hospitals that use delivery volume as their main revenue method are most affected; top hospitals with high levels and strong comprehensive strength fluctuate relatively little; resource integration Maternal and child health care hospitals with high level and service level and good reputation are relatively stable.
For hospitals that do not take delivery volume as the main indicator and accept chronic high-risk pregnant women for a long time, the hospitalization period of patients is long, and the reduction in the number of patients is not obvious.
Taking Shenzhen as an example, Yu Xin, an obstetrician from a local tertiary hospital, said, “The best time is 2017, when the monthly delivery volume is close to 1,000, and the maximum bonus that can be obtained in one month is 18,000. +, there are 18 surgeries in one day.
Since last year, our hospital has had a negative growth in the birth rate, and now it is very good to have 10 surgeries a day. At present, there are two or three hospitals that maintain positive growth in delivery volume, all of which are maternity and child care hospitals with a stable reputation. ”
The overall delivery volume is reduced, high-level hospitals are more inclined to actively strive for it, and the upward referral of patients is strengthened. Basic hospitals are more likely to lose patients due to insufficient technology and service levels.
Image source: Zhanku Hailuo
Liaoning Chaoyang Hospital, for example, has seen an increase in the number of people in recent years. Ju Wei, the attending physician of the obstetrics department of the hospital, said: In recent years, there has been a steady upward trend. The population of our city is relatively fixed, so it is possible that the number of hospitals at the county and district level will be relatively reduced.”
Zhang Liran, an obstetrician at a primary hospital in Tianjin, gave an example, “We have a patient with a history of spinal cord injury. In our hospital, there is no problem with cesarean section, and general anesthesia is enough. But as soon as her family thought about the city, the city immediately issued a hospitalization certificate for him and made an appointment for hospitalization. We were all very surprised. Before, our patients were transferred to the city, and 10 patients were often transferred to the city. 4 came back, but not this year.”
Public data shows that in 2016, when the comprehensive two-child policy was opened, the number of local midwifery institutions in Tianjin was 92, and the current number under the impact of the epidemic is 60. “Some grassroots hospitals with weak technical skills even cancel the obstetrics department directly, leaving only the gynecology department.” Zhang Liran said.
However, for large hospitals with good comprehensive strength and strong treatment capabilities, from the perspective of hospital operation pressure and safety factor, the reduction in the number of inpatients is not entirely a bad thing.
Image source: Zhanku Hailuo
Liu Yan shared a set of data that in 2016, the monthly number of newborns in Liu Yan’s hospital nearly doubled,
“Almost 300 to 600, doubling the workload. We have 66 beds in our department, but we usually add to 100. At our worst, we Will lead the patient up to see and tell her that if you can put your feet down, you will be admitted.”
At present, with the decrease in the number of patients currently being treated, “the patient goes up and down the operating table, and the patient does not see the doctor after giving birth”, “adds an extra bed at the elevator door and in the case discussion classroom”, “critically ill” The phenomenon of pregnant women traveling all over the city and not being able to find a hospital to collect them has eased.
From this perspective, this is a good sign.
(Note: Wang Luo, Chen Hanyu, Yu Xin and Zhang Liran are all pseudonyms in the article.)
Planning
Author: Mangosteen | Editor-in-Chief: gyouza
Cover image source: Zhanku Hailuo