The results of the "national examination" of second- and third-level public hospitals are released, what aspects do hospital managers need to pay attention to?
Written by | Song Kunlun
Source | "Medical Community" public account
At the end of March 2021 and the beginning of January 2022, the Medical Administration Bureau of the National Health Commission reported on the performance appraisal of tertiary and secondary public hospitals respectively (hereinafter referred to as the "circular").
The circular is based on the results obtained from the assessment of 2413 tertiary public hospitals and 3074 secondary public hospitals (including 908 TCM secondary public hospitals) by the National Health commission.
Through the analysis of the results of the two assessments, the "medical think tank" has obvious differences in the number of patients transferred up and down and the types of diseases they are good at, and there are still major adjustments in talent institutions and salary management.
Graded diagnosis and treatment
It's easy to turn up, it's hard to turn down
Compared with the two notifications, in 2019, the number of patients transferred from tertiary public hospitals to secondary hospitals or primary medical and health institutions within the medical federation was 14.9604 million (an increase over the previous year), of which the number of patients transferred from outpatient emergency departments was 12.51 million, and the number of patients transferred from hospitalization was 2.4504 million.
Image source China Health Magazine, the same below
According to the total number of outpatient emergency patients (688 million) and the number of discharges (43.2198 million) of the 2166 secondary hospitals participating in the assessment, the number of patients receiving downward transfer accounted for 1.81% and 5.66% respectively.
It should be added that the "downward transfer patients" here does not necessarily represent the total number of downward referrals from all tertiary hospitals in the country, and the "secondary hospitals" here are not the entire number of all secondary hospitals in the country, and the circular mentions that "a total of 3074 secondary public hospitals (including 908 secondary public hospitals of traditional Chinese medicine) in the country participate in the 2019 annual performance appraisal work, accounting for about 53% of the total number of secondary public hospitals in the country".
However, the above data still reflect to a certain extent that the outpatient emergency patients in tertiary public hospitals have less downward transfer, and the inpatients have generally transferred downward. The overall explanation is that graded diagnosis and treatment is still an "upward movement" trend, and secondary hospitals and tertiary hospitals show a "referral surplus" phenomenon.
From another perspective, it can also be explained that after the patient is sick, the motivation to choose the tertiary hospital for the first time is more obvious, and the motivation of "minor illness at the grassroots level" and "rehabilitation back to the community" is not obvious.
In addition, the growth rate of expenses needs to be controlled. In 2019, the average medical expenses of outpatient and inpatient drugs in secondary public hospitals increased by 6.75% and 6.08%, respectively, and the average cost of outpatient and inpatient drugs increased by 8.36% and 3.31%, respectively. During the same period, the average cost increase of outpatient visits and the average cost of hospitalization in tertiary hospitals increased by 6.28% and 5.27%, respectively, and the increase in average drug costs of outpatient visits and the average cost of inpatients was 5.98% and 3.23%, respectively.
To borrow the original comments of the "Learning Times", "the average annual growth rate of public hospital revenue and outpatient emergency expenses is more than 1 times higher than the average annual growth rate of GDP and CPI in the same period."
According to the public announcement of the National Health Commission, the medical surplus rate of the 3074 secondary public hospitals participating in the assessment is 2.07%, but 16.88% of them have a negative medical surplus rate and a loss rate of 24.59%; in contrast, the average medical surplus rate of tertiary hospitals is 3.00%, and the loss rate is 17.61%.
On the one hand, facing higher growth rates of medical costs and pressure on medical insurance funds, on the other hand, public hospitals are facing losses and want to increase the price of medical services, but they cannot "simply turn their left hand to right hand, one-sidedly raise the price of medical services, and dilute the people's sense of reform."
In such a context, how to obtain the optimal solution between the overall stability of the burden on the masses, the affordability of medical insurance funds, and the sustainable development of public medical institutions, and how to enhance the sense of gain, happiness and security of the masses in the field of medical security, is a problem that all public hospital managers must seriously consider.
There are many patients with conventional surgery and chronic diseases in secondary hospitals
High satisfaction in individual regions coexists with high outward transfer rates
Overall, the secondary hospital still carries out routine surgery and treats more patients with chronic diseases, and the more complex surgery needs to be completed with the support and guidance of the tertiary hospital.
According to the notification, at present, patients with common non-surgical medical diseases such as hypertension, coronary atherosclerosis, bronchitis and other common non-surgical treatment are mainly concentrated in secondary public hospitals.
In secondary public hospitals, the top 5 diseases diagnosed and treated are cerebral infarction, pneumonia, chronic ischemic heart disease, other chronic obstructive pulmonary diseases, and acute bronchitis.
In secondary public hospitals, the top 5 surgeries are low lower uterine cesarean section, open reduction of fractures with internal fixation, appendectomy, other recent obstetric laceration repair, and bone insertion device removal.
The median case combination index (CMI value) of secondary public hospitals is 0.98, and there is still room for improvement. On the basis of the tertiary surgery that was originally possible, in 2019, some secondary public hospitals carried out new technologies such as common carotid artery repair, endoscopic sphenoid artery ligation, partial excision of popliteal artery with artificial vascular replacement, and conjoined twin unequal dissection, etc., of which about 50% of the newly carried out tertiary surgeries were completed under the support and guidance of the corresponding support hospital.
At the same time, according to the circular, in 2019, the satisfaction of outpatients and inpatients in tertiary public hospitals nationwide was 85.41 points and 91.01 points, respectively, an increase of 1.41 points and 1.01 points year-on-year.
Among them, the five provinces with the highest outpatient satisfaction are Zhejiang Province, Hunan Province, Fujian Province, Shandong Province and Sichuan Province;
The five provinces with the highest satisfaction with inpatients are Zhejiang, Jiangsu, Fujian, Shandong and Hunan.
According to statistics, the provinces with the largest number of outflow patients are still Anhui Province, Hebei Province, Jiangsu Province, Zhejiang Province and Henan Province, and the number of outflow patients has increased.
That is to say, although Zhejiang Province is the province with the highest satisfaction of outpatients and inpatients, it is also the province with the highest outflow of patients.
In 2019, the satisfaction of outpatients in secondary public hospitals participating in the assessment was 84.43 points, the satisfaction of inpatients was 89.32 points, and the satisfaction of medical staff was 76.48 points.
Compared with the satisfaction of tertiary public hospitals in the same year, the satisfaction of outpatients, inpatients and medical staff in secondary public hospitals was 0.98 points, 1.69 points and 2.36 points lower, respectively.
The satisfaction of inpatients in tertiary hospitals with meals, admission and exit information and procedures is relatively low.
Talent organization, compensation management
More scientific adjustments are urgently needed
The talent structure and number of second- and third-level public hospitals need to be adjusted.
According to the notice, the proportion of anesthesiologists in most secondary public hospitals is about 3% to 5%, pediatricians account for about 3% to 8%, and traditional Chinese medicine physicians account for about 5% to 15%. The number of TCM physicians is about 2-3 times that of anesthesiologists and paediatricians, respectively.
Critical care physicians and pathologists showed a relatively shortage of situations, accounting for about 0.2% to 1% and 0.4% to 1.6% respectively.
In 2019, the medical care ratio of second-level public hospitals nationwide was 1:1.55, exceeding the target requirement of 1:1.25 in 2020 proposed in the planning outline of the national medical and health service system. This data alone does not tell whether there are fewer doctors or more caregivers. No matter which side is replenished, it will face the embarrassing situation of "more than 40% of personnel funds". Personnel structure adjustment and salary reform are imperative.
According to the Circular, secondary public hospitals account for 0.38% of the investment in talent training, and continuing education and learning lack financial support from hospitals.
In terms of satisfaction, although patient satisfaction has stabilized at a high level, the overall satisfaction of medical staff is still low. The data shows that in 2019, the satisfaction of medical staff in second- and third-level hospitals was 76.48 points and 78.76 points, respectively, and the enthusiasm of medical staff needs to be further mobilized.
In short, the purpose of the "national examination" is not only for assessment, but to find problems and improve the level of hospital management. Problem-oriented, find out the gaps in hospital management and medical services, improve the management level of public hospitals, continuously improve medical services, and continuously meet the medical and health needs of the people.
In the eyes of hospital managers, the annual performance appraisal has become the "baton" of hospital operation and development, and has also become an invisible "sword of Damocles" hanging over the heads of managers. But after the "national examination" results come out, the key is how to use the results, which is the most important. Public hospitals should correctly view and use the results of performance appraisal to learn from each other's strong points.
Finally, it should be reminded that 47% of the second-level public hospitals have not participated in the "national examination", and their experience in preparing for the war is limited, which needs to be improved and level.
Source: Medical Community Think Tank
Author: Song Kunlun
Editor-in-charge: Wan Shunshun
Proofreader: Zang Hengjia
Plate making: Xue Jiao