Medical service reform has become a perennial topic during the government’s Two Sessions, and this year is no exception.
In a government work report released by Premier Li Keqiang, relevant governmental departments are being urged to push forward a medical service classification system in more than 70 percent provinces and cities.
“A medical service classification system would be a significant measure to relieve difficulties that prevent public to access medical services. We see it as a key step in evaluating the development of our ongoing medical service reform,” said a spokesperson for the National Health and Family Planning Commission at a press conference held by the National People’s Congress.
The classification system would be used to decide which hospitals patients should enter according to the extent and urgency of their ailment. On the surface it sounds rational and efficient, but it has been difficult to achieve since the State Council rolled out a nationwide trial last May.
Hubei was among the provinces urged to adopt the new system.
When the Hubei Daily visited Wuhan University People’s Hospital in February, all seats were taken in the waiting area of the hospital’s respiratory medicine section. Many patients stood or wandered about the halls.
“A classification system to route hospital traffic could easily fail to achieve its original goals of relieving pressure on large hospitals given the country’s unequal medical resource distribution,” said Ba Yuanming, party committee secretary of Chinese Medicine Hospital in Hubei province.
Many medical practitioners and medical reform specialists shared his concerns.
“The way our medical resources are allocated is not rational. Patients tend to shy away from community hospitals, but the large hospitals are routinely filled to capacity. This phenomenon has turned into a vicious circle,” said Wu Ming, a professor from Peking University Health Science Center, at the fourth session of the 12th China’s People’s Political Consultative Conference (CPPCC) on March 4.
Because they lack premium medical resources and advanced medical equipment, community healthcare institutions have a hard time winning trust from patients.
“What if, under the new system, community medical institutions refuse to transfer patients they are unable to treat to a higher-level hospital? Isn’t this handing them a monopoly?” a patient surnamed Huang told the Hubei Daily.
In order to encourage rural patients to prioritize community healthcare centers, some local governments have offered better rates on insurance coverage. But for patients who see recovery as most important, better prices can hardly dissuade them from visiting bigger hospitals.
But the essential drug system, which strictly controls medicine distribution at primary-level medical and healthcare institutions, can pose another obstacle to the promotion of community medical services.
“The implementation of China’s essential drug system objectively crippled which services a community medical institution can provide,” Tu Mingxuan, the administrator of a community health service station in Wuhan, told Hubei Daily.
In 2014, the number of inpatients at large hospitals swelled to more than four times that of community medical institutions. The 2015 Medical and Health Service Development Report found that traffic to the community medical centers continued to slip.
“China has been attempting medical reform for a decade, but those efforts remain blighted. For instance, our drug control efforts have not delivered substantial results. We need to strike a breakthrough in medical reform,” said Cheng Ping, director of the Safety and Quality Supervision and Management Department of the Ministry of Transport.
Administrative measures have been woefully ineffective at solving the medical industry’s many practical problems.
Liu Guoen, a scholar of medical reform, put forward an idea that would thoroughly renovate the current medical service system and encourage doctors to become private practitioners. The community-level medical centers would be removed from China’s health landscape.
“If we allocated a group of general practitioners to local communities and make sure their patients had access to medical insurance, then their income would not be less than their counterparts at large hospitals. This could encourage doctors to leave the hospitals and work at the community level,” Liu said.
In fact, many developed countries rely on similar, small private clinics to complement their national medical service system.
Zhu Yuanpeng, deputy chief of the Institute of Economics Chinese Academy of Social Sciences, said Americans make 1.2 billion visits to the doctor each year, and that 81 percent are solved at a private practice.
“With more than 1.3 billion people, China’s population simply puts too much pressure on its public hospitals. From specialized clinics to general clinics, large hospitals are always overcrowded. But the truth is that only 10 percent of the patients need inpatient services, and the other 90 percent could be seen by any general practitioner,” Zhu said.
“Larger hospitals could focus on specialized care and let smaller clinics handle the rest. If we reform the medical service system like this, it will free many general practitioners fro the large hospitals and strengthen community-level care,” he said.
Zhu’s idea is just a proposal – for now.
China’s current Physician Act requires that doctors can only practice medicine in one hospital at a time. Even though some local governments have implemented policies to knock these limitations aside, there are still hidden obstacles that keep doctors tied to major hospitals. And those don’t appear to be vanishing any time soon.