Medical reform should abandon the "flashlight thinking"

The mention of Xu Shuqiang has many titles: the president of the China-Japan Friendship Hospital of the Ministry of Health and the deputy party secretary. SARS prevention and treatment specialist hospital deputy commander, member of the All-China Youth Federation, standing member of the Central State Organs Youth League. Representative research projects: theoretical and practical research on post-performance evaluation system in general hospitals; representative academic papers: "Discussion on Post Management in Public Hospitals under the New Medical Reform Situation", "Exploration of Modern Hospital Governance Structure", and "Innovative Hospital Management Promoting Public Affairs" Hospital Science Development etc.

People familiar with Mr. Xu Shuqiang will see a lot of labels and symbols on him: the nationwide model of fighting against floods in 1998, the national leader in combating SARS in 2003, the Xing Lin master of benevolence and the hospital administrator with outstanding achievements.

However, whether it has been awarded the title of "Advanced Individual in Central Health Care Work" by the CPC Central Committee Health Care Committee or the "May Fourth Youth Medal for Chinese Youth" or during the congress of the 15th National Congress of the Central Committee, it was received by the party's highest leader in Zhongnanhai. Xu Shuqiang, like most ordinary medical workers, is accustomed to maintaining a plain and persistent heart and converting the external honors into the most pristine inner drive. For 26 years of his career, he has practiced the lofty beliefs and sacred responsibilities that his profession has given him.

After graduating from the graduate school in 1988, Xu Shuqiang entered the internal medicine department of China-Japan Friendship Hospital. During this period, Xu Shuqiang experienced a total of three important changes in his identity. From chief physicians who took the lead in fighting at the front line of clinical sciences to vice presidents who are talented in talent management and continuing education, and then to the presidents who carefully created famous doctors, famous subjects, and famous hospital brands, Xu Shuqiang step by step and walked steadily. No exaggeration.

As one of the two hospitals directly under the Ministry of Health, in the past 10 years, the young Sino-Japanese Friendship Hospital has achieved remarkable results under the leadership of Xu Shuqiang—the nation’s first holiday hospital, Beijing Top Ten Hospital, and National Hundred Hospitals Wait. “In recent years, the hospital has attached great importance to the improvement of the two aspects of work: one is hospital marketing, and the other is to ease the problem of expensive medical treatment for the common people.” Xu Shuqiang, who has 16 years of experience in hospital management, told reporters.

"As far as hospital marketing is concerned, in the current medical environment, hospitals must survive and develop. It is necessary to expand the medical population, expand our medical market, and increase the popularity of the hospital. The China-Japan Friendship Hospital therefore established a dedicated department. A strong organization was formed to carry out this work.By taking advantage of the situation, the hospital set up the nation's largest community medical center-Wangjing Community Medical Center, through vertical development, to increase the amount of outpatient services and create service brands; to solve the problem of “expensive medical treatment”, Since 2003, the China-Japan Friendship Hospital has strictly controlled the cost of single-disease disease and has become a top-ranking control model in the Beijing area, said Xu Shuqiang.

Under the new medical environment, especially after the reform of public hospitals entered the deep-water area, the Sino-Japanese Friendship Hospital is further exploring ways that are more conducive to the development of the hospital itself, and at the same time it is in line with the general direction of the medical reform. Xu Shuqiang believes that macro problems are important, but micro issues, especially those involving hospital management, are also very important. "Cultivating the hospital system may be more important than reforming the hospital," said Xu Shuqiang.

Conversation>>>

Conversion reform thinking

Medical Economics News: The China-Japan Friendship Hospital has taken a solid step in the reform of public hospitals. This is inseparable from your leadership. It is enough to see that you have a lot of practical experience in hospital management and medical reform, and also summarized many Theoretical results, how do you see the achievements, problems, and future direction of China's public hospital reforms?

Xu Shuqiang: In 2009, the Party Central Committee and the State Council issued the new opinion on medical reform, and we started a new round of medical reform. The problem that the new medical reform is trying to solve is "how to provide the people with more satisfactory and better medical and health services." During the four or five years of medical reform, it should be said that we have achieved amazing results, but there are many places that need improvement. In particular, our current thinking is still a kind of "flashlight thinking".

Especially in the reform of public hospitals, it is more important to grasp system construction and grasp the fundamentals of hospital construction and development than to grasp hospital reforms. Especially at this stage, public hospitals need to solve the problems encountered by the patients during their visits through refined management and through their own perfection.

I have always emphasized the "five systems and two grasping hands" of hospital system construction. Including playing "integrity card" - service system, "safety card" - quality system, "intensive" economic management system, and talent system and technical innovation system. The first point is to closely focus on patient safety and focus on patient safety and quality and medical service system. The second focus is on the development of information technology, use information technology to improve the hospital's own management and ability levels, and improve the refinement of the hospital. Level and security.

In the past few years, our understanding of information has become clearer, but there is still a lack of understanding of patient safety. At present, in the construction of medical service systems and medical reforms, we must place special emphasis on patient safety and safety. We should calm down and think about how the medical service system can be more beneficial to patients, and more conducive to international standards, and truly solve the global problem of medical reform.

Pharma Economic News: Can you give us some typical examples of system development?

Xu Shuqiang: I give an example of the construction of a technological innovation system. In fact, a very prominent phenomenon can also be seen from our hospital is that most medical equipment in public hospitals are imported. However, it is not our country that does not have the ability to produce such high-end equipment. However, our thinking on medical technology innovation is not enough, and joint cooperation is not enough. If we think boldly and innovate, we will be able to give a good boost to the country’s GDP growth and to the country’s scientific and technological innovation, especially the development of the biological sciences.

Recently, I visited the medical city of Houston (a medical city consisting of 54 hospitals) in the United States. During my visit to the Institute of Clinical Medicine at a local Catholic hospital, I was deeply impressed. Unlike our domestic research institutes, which focus mainly on basic physiology and cases, the research projects of such institutions in the United States are closely integrated with the clinic. An orthopaedic surgeon at a local hospital performed a postural examination in the clinic and found that the device failed to achieve the desired results when the patient was in a fixed position. After receiving the feedback, the institute immediately organized related personnel to discuss and design a better solution to meet the clinical needs. At the same time, because this research is common to the industry, it can also be sold to other hospitals to achieve economic value.

This example also illustrates the innovative thinking I emphasized above from another perspective. When it rises to the system level, it will promote the hospital management of the entire medical industry.

Mixed system is not suitable for property rights reform

Medical Economics News: In the context of China's further encouragement of private capital to enter the medical service sector, as a postdoctoral economist, how do you view the pros and cons of this trend? What do you think about governance of property rights organizations?

Xu Shuqiang: This is a deeper problem behind several system constructions that I just talked about. We often say that the economy cannot rely on a single entity to develop, or that if an industry is a monopoly industry, there is no way to achieve rapid development. After the entry of different economies or joint-stock companies, it will certainly play an impetus to the industry. There is no doubt about this. In the deeper medical reforms, different ownership systems and different ownership structures have entered the medical industry.

My opinion is that when the issue of ownership and property rights is not clarified, simply considering the governance structure does not make much sense. However, if different investors, different shares or different ownership structures are involved, corporate governance structure is very important.

Recently, many state-owned enterprises like China Resources and Sinopharm acquired and merged with some public hospitals. I think that although this is an exploration of a model and method, it is not necessarily a good way to reform public hospitals in China, especially in the form of partial acquisition of public hospitals. Because of the different attributes of hospitals and enterprises, it is difficult to assess and judge the value of a hospital, which easily leads to the loss of state-owned assets. Personally, I personally do not advocate such mixed system reform. Of course, if all were acquired, it would be another matter.

Medical Economics: Payment control fees have become a global trend. What do you think of China's existing fee control model?

Xu Shuqiang: The payment method solves the problem of the balance between economic methods and patient treatment safety.

I personally think that the reform of the payment method in China is lagging behind. Although payment methods have been actively explored throughout the country, the progress at the national level has been slow. In the future medical reforms, we must step up the pace of progress.

At present, the five types of payment methods commonly used in the world are combined in two broad categories: post-payment systems and pre-paid systems. The prepayment system is a worldwide trend, with total prepayment, DRGs, etc. Each payment method has its advantages, and it also generates corresponding problems. This is certain. For example, the problem of paying the most according to the project is obviously the overproduction of medical care. If we can apply the five methods in a comprehensive manner, we can better avoid weaknesses.

At present, DRGs are the payment methods suitable for China's national conditions, especially for hospitalized patients. But why do you talk about the total amount of prepayment? Because it's simple. If there is no such thing as a medical record system, ICD9, etc., it is very difficult to implement DRGs.

Chinese medicine should take a broad path of development

Medical Economics News: China-Japan Friendship Hospital is a hospital with equal emphasis on Chinese and Western medicine. What experience do you have with Chinese medicine in the development of innovation and technology?

Xu Shuqiang: China-Japan Friendship Hospital has a total of 68 departments, including 13 Chinese medicine departments and 400 Chinese medicines or beds called integrated Chinese and Western medicine.

The integration of traditional Chinese and western medicine in the hospital solved three major problems: First, it solved the problem that Chinese and Western medicine could sit together and discuss difficult and serious diseases together. In fact, not only in China, but also in the world of all ethnic therapies and natural therapies, and modern Western medicine must face a common problem - can not sit together face to face. But in reality, the health problems we face are common. The Sino-Japanese Friendship Hospital has set a good example in this regard and can be said to be second to none in the world.

Second, we also encountered problems that are worthy of discussion, such as the trend of the development of Chinese medicine. In fact, if we are in a general hospital like ours, from a purely economic point of view, the operation of the hospital depends mainly on the income of Western medicine, and the income share of TCM is small and the proportion of medicine is also low. Although the State Council's policy on fostering the development of Chinese medicine is very clear, there are still many practical difficulties in the actual landing of medical institutions.

Two days ago, when we visited the Jinsha County Hospital of Guizhou Province, it was discovered that the cost of the Chinese medicine treatment service for the deputy director of the hospital was 5 yuan for acupuncture and 20 yuan for 10 minutes for a massage therapist. Although it is higher than Beijing's fees, it is clear that prices and values ​​can be very different. Therefore, our hospital has been pondering how to put the cultivation policy of TCM on the ground, not just stop at the slogan.

Thirdly, our hospital has been exploring ways to expand traditional Chinese medicine on a healthy level. It is obviously not enough to confine TCM to the narrow concept of “prevention of disease” and it will be frustrated. Of course, this aspect still needs more exploration.