Health will improve the overall level power big hospitals further expansion

Accelerating in health care reform, improve the overall level is an integral part of the overall reform, which will enhance the ability of financing and control cost but also inevitable to increase the siphon power of the large hospital. The payer and service launches the game will continue. Because the original fragmentation of the main health care management, both in terms of fundraising efforts or the ability to control cost are facing greater pressure. Change the fragmentation of health care management and strengthen the concentration has become the most realistic option. After national health insurance bureau was established, further straighten out the relationship between urban and rural residents medical care combined, accelerate the merger of medical insurance and maternity insurance, civil affairs and other health-care aid into medical insurance bureau, these measures are for this purpose. But as the cross protection management of centralized, highly fragmented overall level of health care in different regions of the increase will become the next important goals. According to published in March 2020, 'the central committee of the communist party of China the opinions of the State Council on deepening the reform of medical security system' : unified collection in accordance with the unified system of policy, fund expenditure, management services for the integration of the standard, unified old-age insurance of primary medical treatment ShiDeJi overall. Explore the propulsion ShiDeJi vertical management the following health care department. Encourage conditional province ( Autonomous regions and municipalities directly under the central government) According to the classification, as a whole to adjust, budget management, Shared accountability appraisal idea, promote the provincial plan as a whole. City as a whole will be health-care reform, the focus of the next several provinces of the nation's cities began ShiDeJi plan as a whole, the basic goal of identified three years to complete. According to documents of these cities, as a whole the goal is to realize the basic medical insurance and maternity insurance policy management, fund management, handling, treatment standard, unified management and information system of six. This means that the original different payment policy in different regions is broken, the risk of fraternal pool to further expand, the fairness of financing and payment, balance the level of security in the same city. Overall level of improve on the one hand, will help to close the region is not caused by the average health in some parts of the deficit, on the other hand can also help decision-making control up to promote integrity, to increase their service for the products and negotiation skills. However, with the overall level of service, with original county as the unit of the medical mode also will be broken. In the same city medical no longer calculate different ground, patients will be poured into the local quality of medical institutions, so as to promote with the big hospital usher in a new round of expansion of high quality medical resources. From the point of the past five years, the county medical service market growth is second only to the growth of the third class hospitals plates. Although only 2500 tertiary hospital, the number of institutions from 2014 to 2018, the average annual growth rate reached 7%. A total of more than 1 at the county level hospital. 5 m, the number of total hospital close to half of their institutions quantity growth was close to tertiary hospital, to 6%. Public class hospital and public, by contrast, the number of secondary hospital overall downward trend year by year. Number of county-level hospitals is the cause of the high growth is in line with the tertiary hospitals, mainly through the service level of service to siphon patients, only tertiary hospitals to absorb the whole of the urban and rural areas, but the county hospital mainly absorbed in the county township hospitals and village clinics. However, the advantage of county-level hospitals in hospital outpatient service to absorb and conventional real service ability is still weak. From the point of service efficiency, at the county level hospital sickbed utilization rate is not low, nearly 90%, but the hospitalization days close tertiary hospital. Because of county-level hospitals service capacity is much lower than the third-level hospital, processing is more normal disease, but the hospitalization time is close to the tertiary hospital, this shows that the county hospital service efficiency is low, mainly by stretched the length of time for a profit. Due to the county hospital mainly concentrated in a narrow local, not like in the cities or higher level city of tertiary hospitals can cover a wide area, services growth cannot match and tertiary hospital. From 2014 to 2018, the county hospital of outpatient emergency care the number of visitors and residents of average annual growth rate of 4% and 5% respectively, but the tertiary hospitals were 7% and 10%, respectively, and has the very big disparity. Moreover, due to the concentrated treatment of conventional disease, on the cost, city at the county level comprehensive hospital and general hospital at the county level is only 2 respectively. 1 and 400 million yuan. 700 million yuan, the courts of tertiary hospital income is as high as 8. 800 million yuan. As from county to the municipal medical insurance plan as a whole level, reimbursement available throughout the cities and all health care institutions. County health service market will be impacted by the obvious. In addition to the eastern part of developed areas, especially in Yangtze river delta and the pearl river delta region, other parts of the county medical service market is generally weak, unable to contend with municipal tertiary hospitals, patients were cities tertiary hospitals siphon phenomenon will become increasingly obvious. In the face of big hospitals continuous expansion, the county has integrated medical service market. The integration of the county market mainly from the administrative power, emphasis on serious illness not county, hope that by taking financial input, internal organization structure adjustment and power means to build the medical body. Medical body of structures, there are advantages and disadvantages, the one hand does enhance the patient flow and income level of the county-level hospitals, improve the overall scale, but on the other hand, are all taking grass-roots power, from coverage to drug purchase, lost revenue control at the grass-roots level, it weakens the practical ability of grassroots.