The province’s tertiary hospitals cancel general outpatient clinics, how will they see a doctor in the future?

The tertiary hospitals will no longer accept outpatient clinics in the future, which has been implemented in some provinces.

Since the beginning of September, the news that Hainan will gradually “close down” general outpatient clinics in tertiary public hospitals has continued to ferment in the industry: the Hainan Provincial Government has released the document “Implementation Plan for Promoting the High-Quality Development of Public Hospitals” In the next 3-5 years, will strictly control the number and scale of tertiary public hospitals, and gradually cancel the general outpatient clinics in these hospitals.

At present, tertiary hospitals across the country account for more than 1/4 of the diagnosis and treatment volume each year, and general outpatient clinics are the top priority. Cancellation of outpatient clinics will cause a chain reaction: how to solve the problem of seeing a doctor? How is the hospital benefit distribution and referral received?

“It looks simple, but it actually involves a comprehensive transformation and upgrade of the medical service system”. Xu Yucai, a medical reform expert, told the Health Knowledge Bureau.

The Health Knowledge Bureau has learned from various sources that, because of this, the national and local initiatives to cancel general outpatient clinics in tertiary public hospitals have long existed, but Due to the difficulty of implementation, the volume in the past two years has not been large.

Hainan made the first attempt to travel for other regions.

Cancellation of general outpatient clinic ≠ no medical treatment

The general outpatient clinics and specialist outpatient clinics mentioned in the Hainan document are also the “common number” and “specialist number” in various specialties that we usually understand. What Hainan will gradually cancel is the general outpatient clinic that sees common diseases and has the most registered people, and the registration fee is also cheaper.

A doctor from a tertiary hospital in Guangdong introduced to the Health Knowledge Bureau that a doctor’s career promotion will generally go through the process of a regular practitioner, attending physician, deputy director and director.

strong>The general outpatient clinics of tertiary hospitals are mainly attending physicians, which is also a relatively large group in a hospital.

According to the vision of Hainan Province, the abolition of general outpatient clinics in tertiary public hospitals is to promote the sinking of high-quality medical resources in the province and city, and “make up for the shortcomings of county-level public hospitals’ medical services and management capabilities.”

The public is worried: Can they still go to big hospitals to see a doctor after the cancellation?

In this regard, many doctors and industry professionals believe that the cancellation of general outpatient clinics is just “cancellation of this business segment”, and does not mean that doctors are fired or no longer see a doctor. Doctors generally have departments to which they belong. After the general outpatient clinic is cancelled, doctors can return to the emergency department or inpatient department to receive patients in a different way.

Some doctors laughed and said: “It may also be renamed to specialist clinics, but the rank still needs to correspond, but the cost will increase accordingly.”

Primary care is indeed evolving, but patients still prefer tertiary hospitals: Domestic tertiary hospital admissions have risen from less than 1.5 billion in the past 6 years to 2.23 billion person-times, accounting for 26.3% of the country’s total diagnoses from 18.4%.

The Health and Knowledge Bureau learned that as early as early 2017, when the State Council issued the “Notice of the “Thirteenth Five-Year Plan” Health and Health Planning”, it once “improved the level of medical services”. It mentions that the scale of general outpatient clinics in tertiary hospitals should be controlled, and patients should be supported and guided to seek medical treatment at primary medical and health institutions. and other services.

Subsequently, Guangdong, Qinghai and many other places have successively issued relevant documents. For example, Dongguan City, Guangdong once stipulated in the document to promote the construction of medical alliance that three First-level hospitals and Zhenjie hospitals should “gradually compress and close general outpatient clinics, and in principle only retain specialist (expert) outpatient clinics”; while the former Qinghai Provincial Health and Family Planning Commission required that starting from July 1, 2017, three The number of general outpatient clinics in high-level public hospitals will be reduced by 25% compared with the previous year.

However, when it comes to specific implementation, many areas are quite a bit “thunder and rain”.

A doctor who used to work in a well-known tertiary public hospital in China told the Health and Knowledge Bureau that in 2019, there had been rumors that the general outpatient clinic would be cancelled, but it did not attract attention. Also not really implemented.

Can the big hospital let go

Aside from the big concepts of macro reform, for public hospitals, there is a more realistic consideration for the difficulty of canceling general outpatient clinics: benefits.

Data released by the National Health and Medical Commission shows that the average outpatient cost of domestic tertiary public hospitals in 2021 will be 370.1 yuan, a year-on-year decrease of 0.9%, but higher than that of the previous year. In terms of the national average of 329.2 yuan, it still remains at a high level.

The above-mentioned doctors from the top three hospitals told the Health Knowledge Bureau that outpatient income is one of the most important sources of income for most hospitals, and hospitals cannot easily give up; Cao Jian, a researcher at the Hospital Management Research Center of Renmin University of China, is receiving In an interview with Caijing magazine, 30%-40% of the income of tertiary hospitals generally comes from outpatient clinics’.

Health and Knowledge Bureau has learned that many patients in the inpatient department of large hospitals are admitted through outpatient clinics. Once the general outpatient clinic is cancelled, the number of patients will decrease, affecting the overall hospital admissions. Although grassroots referral is also one of the channels, the referral process is not smooth, and it is not possible to receive patients without an outpatient examination.

With the cancellation of outpatient clinics in tertiary public hospitals, it is difficult to ensure that the interests of the hospitals are not damaged at present.

Xu Yucai believes that the price gap between medical services in large hospitals and grassroots units is “not too big, especially for some difficult operations and treatments.” If the general outpatient service is abandoned, the income from difficult treatment may not make up for this loss. After the cancellation of general outpatient clinics, large hospitals need to continue to improve their technical capabilities, develop specialties, and increase the price of supporting services.

In addition, it is also worrying that primary medical institutions can handle these triaged patients well.

Some industry figures bluntly told the Health Knowledge Bureau: At present, the level of primary doctors in China is not high, and the medical facilities are not enough, “the investigation is not accurate, and the rate of misdiagnosis is not accurate. high”.

Data from the National Health and Medical Commission shows that although the number of patients in primary medical and health institutions has continued to rise in recent years, as of 2021, the number of patients has exceeded 4.2 billion, exceeding the sum of domestic public and private hospitals. In addition, the total number of primary medical and health institutions of various types is as high as 977,800, which is close to 27 times the total number of hospitals in the country, but the number of professional health technicians is less than half that of hospitals.

This person believes that it is an unavoidable problem to abolish the general outpatient clinics of tertiary public hospitals and improve the capacity of primary medical institutions. In the final analysis, can patients “can trust primary doctors”?

The core is to promote hierarchical diagnosis and treatment

Xu Yucai told the Health and Knowledge Bureau: The intention to cancel the reform of general outpatient clinics in tertiary public hospitals is actually to “promote hierarchical diagnosis and treatment in a beneficial, effective and orderly manner”, and it is not easy to implement .

Hainan has certain special advantages to cancel general outpatient clinics first. There are not many tertiary hospitals in Hainan Province. According to the 2021 edition of the China Health Statistical Yearbook, as of 2020, the total number of public hospitals in Hainan Province is 123, and the number of tertiary public hospitals is 21, ranking third in the country from the bottom.

In terms of the number of patients admitted, only Tibet, Qinghai and Ningxia are ranked behind Hainan Province.

Hainan will be one of the provinces least affected by the cancellation of general outpatient clinics in tertiary hospitals.

Xu Yucai believes that this release of Hainan Province is only a document to guide development, and this plan is directional and continuous, “it is a process rather than a result”, and the follow-up still needs to be seen What are the specific policy arrangements?

Under ideal conditions, if “the reforms are carried out more thoroughly”, doctors in tertiary public hospitals can be transferred to county-level medical institutions for regular circulation, and “patients will not be seen in tertiary hospitals. Ordinary diseases are gone, or the proportion should be getting smaller and smaller.”

This situation has obviously not become a reality: the latest data released by the National Health and Medical Commission shows that despite repeated epidemics in the first half of the year, three-level hospitals across the country from January to May this year. The number of consultations reached 909 million, a slight increase of 0.3% year-on-year. This compares with a 0.6% and 4.8% decline for first- and unclassified hospitals, respectively.

Health and Knowledge Bureau understands that in order to truly keep patients at the grassroots level, various supporting policies are needed. Taking the connection of medical insurance reimbursement as an example, for example, in the case of simple diseases, you can try to be reimbursed in primary medical and health institutions, but not in tertiary hospitals, so that patients “look along this order and look all the way” .

However, if you really want to achieve this goal, if you encounter an emergency or difficult disease, and ensure that the referral is smooth and accurate, “there is still a lot of work to be done.”

Writing | Gu Yue

Editing|Jiang Yun Jia Ting

Operation | Twenty-Three

Illustration | Visual China

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