A hospital with more than ten branches, the top three hospitals have entered the "era of large branches"

In the last week of 2021, with the official integration of Huashan North Hospital, Huashan Hospital will have 5 campuses in Shanghai and 1 branch in Fujian;

On October 13, 2021, the West China Tianfu Hospital of Sichuan University was officially opened, and the "branch hospital" under the name of West China in the province and outside the province has increased to double digits, and some local doctors jokingly called "now all sichuan is a branch of West China";

At the beginning of October 2021, the "First Hospital of the Universe" ZhengDa First Affiliated Hospital was incorporated into the Henan Provincial Hospital, occupying the "One Hospital and Four Districts" in Zhengzhou City, with 12,000 beds;

On December 6, 2021, the Ophthalmology Center of the Second Affiliated Hospital of Zhejiang University School of Medicine was opened, and the Second Hospital of Zhejiang Medical College has 5 campuses in Hangzhou, and its territory has also expanded to multiple counties in the province, with double-digit branches;

On December 5, 2021, the Second Affiliated Hospital of Zhengzhou University was inaugurated, and it was jointly built with a number of county hospitals in Henan Province, with 11 branches;

In 2019, Anhui Provincial Hospital invested 7 billion yuan to build Binhu Branch, the number of hospitals increased to 7, according to the plan, in 2022, the scale of beds in Anhui Provincial Hospital will reach 10,000, covering an area of 1158 acres, claiming to be "the dance of elephants";

……

Whether it is self-built or self-managed, or taking over the "turnkey" project of the local government, the trend of large hospitals setting up branches and building campuses has been going on for many years.

Running medical doctors across provinces and cities is no longer the privilege of "Zhongshan Department", "Peking University Department" and "West China Department". Any of the top three hospitals with local capabilities have stretched out their tentacles and tried to extend outward.

Is it a high-quality expansion, or a compound monopoly? Is it a balanced regional layout, or a grassroots pumping? The only thing that can be assured is that the "big branch era" of the top three hospitals has quietly arrived.

Gao Xiechun, director of the Institute of Hospital Management of Fudan University, told Eight Point Jianwen: "In the big hospitalS I went to, there was not a single one who did not build a branch hospital in a different place. ”

This is not difficult to understand. In the first year of the 14th Five-Year Plan, the top three hospitals were required to "develop high-quality", and the inward-looking and refined development also stepped into the difficult deep water area. In the stock era, on the one hand, hospital managers still desire increments, and it is difficult to suppress the instinct of expansion; on the other hand, another understanding of "high-quality development" can be "copying high-quality medical resources", which is easier than "digging potential" - therefore, the construction of branches has become a common option for the head players.

Among the top ten hospitals in the "2019 China Hospital Rankings", only the branches of people and property have an average of 3.5 hospitals per hospital.

Using "chain" and "franchise" to explain the concept of a courtyard and multiple districts may be slightly sloppy, but this metaphor is still vivid.

In the era of the large branch, there are not only "chain hospitals" that integrate people and property, but also "franchised institutes" that provide technical support, output management, and participate in dividends.

"Chain" and "franchise" are two-pronged, and the territory of the top three is getting bigger and bigger.

A dozen days ago, at an industry meeting, Hu Ruirong, director of the Medical Institution Division of the Medical Administration Bureau of the National Health commission, revealed that documents related to the construction and development of a hospital and a hospital of public hospitals will be introduced soon. The new policy will give birth to such beautiful visions as "expansion of high-quality medical resources", "balanced layout of high-quality medical resources", and "solving uneven development in a single region".

Like a handful of new firewood, it will surely push the development boom of the "Great Branch Era" to a higher place again.

Farewell to "Dark Crossing Chen Cang"

"Shanghai has not liberalized the construction of multi-campus areas until 2020, when the policy was relaxed." In mid-2021, Chen Erzhen, vice president of Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, publicly said that he felt the change in the direction of policy.

At the end of 2021, in a president exchange meeting on "one hospital and multiple district construction", the presidents and secretaries of several large hospitals wrote the policy background that has surfaced in the past two years into the PPT to show the policy support for the construction of the branch hospital.

The covid-19 pandemic in 2020 is an accelerant for changes in the direction of policy.

In May 2020, when the epidemic situation in Wuhan subsided, Jiao Yahui, then director of the Medical Administration Bureau of the National Health Commission, said in an interview with the media, "Like Wuhan Tongji and Wuhan Union Hospital, they are all one subject and multiple campuses." In the event of COVID-19, a separate campus can be quickly requisitioned and converted into a designated hospital for severely ill patients. ”

Jiao Yahui pointed out at the time that public general hospitals will explore a single multi-campus model.

Since then, this passage is considered to be the signal of the National Health Commission's public support for the construction and development of "one hospital and multiple districts" for the first time.

Image source: Visual China

In October 2020, the Fifth Plenary Session of the 19th Central Committee pointed out that it is necessary to accelerate the expansion of high-quality medical resources and the balanced layout of the region. This is considered to be the official guideline for the development of "one hospital and multiple districts".

According to the incomplete statistics of Eight Points, since 2020, there have been nearly 20 regions and 102 third-class public hospitals in the country that have started a wave of branch hospital construction, with 128,000 new beds and an investment amount of up to 180 billion yuan.

The change in the direction of policy has made many presidents of the top three hospitals feel unexpected.

At the exchange meeting at the end of the year, the president and secretaries unanimously and deliberately emphasized the support of the policy side, which was nothing more than because of the expansion of the branches of large hospitals, and experienced a period of "secret crossing Chen Cang" era.

On the front, the third-class hospital built a new campus out of the impulse to expand, full of joy to meet the "family Tim Ding"; on the back, the call to control the scale expansion of public hospitals has never stopped, when the construction of branch hospitals and scale expansion are equated, the pressure of the president is not small.

"Horse racing" is a common word that is accused of being built in a big way.

"The First Affiliated Hospital of Xi'an Jiaotong University has 4 campuses at the city and county level." Xu Yucai, an observer of medical reform and former deputy director of the Health Bureau of Shanyang County, Shaanxi Province, told Eight Points Jianwen that the president of the large hospital first secretly expanded the scale of the single body, and after the policy controlled the size of the single body of the hospital, the hospital began to develop outside the hospital; later, the construction of the medical association gave the big hospital a chance to extend its tentacles.

In the years of the construction of the medical federation, there was no shortage of "olive branches" thrown by the county and local governments, introduced into the local area, and anti-customer-oriented.

However, the problem is self-evident, the hospital to the grass-roots "listing", while improving the capacity of grass-roots medical services, but also open up the patient diversion channel. Therefore, it is often possible to see discussions about whether "the construction of branches in the county of the top three hospitals is another form of "horse racing" and siphoning patients.

Xu Yucai said that in Shanyang County, Shaanxi Province, where he is located, the First Affiliated Hospital of Xi'an Jiaotong University has carried out counterpart support for urban and rural hospitals in Shanyang for more than ten consecutive years, and even if no branch hospital is opened in the local area, 70% of the patients who have been transferred up will be diverted to the First Affiliated Hospital of Xi'an Jiaotong University. This means that if the hospital can build its own branch, or strengthen the exchange and cooperation with the county-level hospital to carry out counterpart support, and be consistent with the province's medical level network, the source of patients will not be worried.

Today, although the situation of siphon patients is still common, the doubts of "running around" are fading. An epidemic has brought the credibility of large public hospitals to peak again: high-quality public hospitals are trustworthy.

What is the level of medical care in the hospital?

To try to understand this round of "one hospital and multiple districts" development, it is also necessary to return to the starting point of "high-quality development".

In June 2021, the General Office of the State Council issued the Opinions on Promoting the High-quality Development of Public Hospitals, and the key word is "expansion of high-quality medical resources".

Is the construction branch of the top three hospitals competing for the stock market of patients, or high-quality development?

The requirements of "expansion of high-quality medical resources" have made the hospitals in the past two years in the layout of multiple hospitals more and more like to put "homogenization" on their lips to highlight the original intention of their "expansion" branches - not to become bigger, but only to contribute to regional development.

In the urban center of the city, keep the high-quality main campus; in the new urban area, outside the city, build a "homogeneous" branch district, balance resources.

"What the hospital has to do is to expand the capacity of high-quality resources, not dilute and dilute." This is also a situation that policymakers want to see.

But "homogenization" is ultimately just an ideal picture for policymakers. Even in the name of the top three, it is not easy to enter a new area, and the people still recognize doctors. Especially in the "inter-provincial construction of hospitals", "homogenization" is more difficult.

As early as August 2017, after the opening of Xiamen Hospital of Zhongshan Hospital affiliated to Fudan University in Xiamen, in order to ensure the "homogenization" of the medical teaching, research and management level of the branch, the heads of clinical and medical technology auxiliary departments of the branch were dispatched by senior experts from various disciplines of Fudan Zhongshan Hospital; the head of the administrative functional department of Shanghai General Hospital also served as the first person in charge of the corresponding functional department of Xiamen Hospital.

Moreover, in order to ensure that the medical level and headquarters are on a horizontal line, doctors working in Xiamen have to return to Shanghai every two weeks for two days of shifts, and the important meetings and training of the Shanghai General Hospital also need to participate through remote video.

Even in the same city, the rush between the urban area and the outskirts of the city should not be underestimated, and many staff members of the headquarters need to get up early and go to the branch to work.

An insider of Huaxi Hospital told Eight Point Jianwen that after the operation of Tianfu Hospital, the work was adjusted to 4 days in Tianfu Hospital, only 1 day in the headquarters, and the commuting time changed from more than 10 minutes to 70 kilometers by car. A clinical staff of West China Hospital, who is also the teaching task and the discipline director of West China Airport Hospital, has five working days a week, one day each of the outpatient clinic of the General Hospital, the teaching of the West China Clinical Medical College, and the Airport Hospital, and the remaining 2 days are in another branch of West China.

At the exchange meeting on "the construction of one hospital and multiple districts", Ma Xin, vice president of Huashan Hospital of Fudan University, said that he had also experienced similar "fatigue". Even though, the four campuses of Huashan Hospital are all in Shanghai. At the beginning of the development of the branch, in order to "homogeneous development", the hospital set up a respiratory department in each branch, and each branch had more than a dozen beds. But after running for a while, I found that the efficiency of the operation was too low, "I asked the section director, are you tired, they say it's quite tired." ”

Ma Xin said to the director of the respiratory department, "Don't do this, I will give you a floor at the headquarters, more than fifty beds, and several other branches have stopped, and the business of the respiratory department will be opened in the north courtyard and the general hospital." ”

Ma Xin's vision is that it cannot be homogenized for the sake of homogenization, and under the general direction of homogenization, the "dislocation development" of different campuses is also very important.

Even so, in the highly regional medical industry, whether the branch can really achieve "homogenization" still needs to be questioned. In a larger dimension, some deans also need to face the diversity of the sources of the branches, and how to unify the management after they are all included.

The size of the new branch is larger than the mother's house – this situation is not uncommon in the construction of the "big branch era".

Some cater to the needs of the development of modern hospitals. Some hospitals are confined to a once narrow environment, and when planning the construction of new hospitals, they naturally hope to be more suitable for the development of modern hospitals, more spacious and bright. For example, in the Longdongbao Branch of the First People's Hospital of Guiyang City, which was put into use in September 2021, the new campus is in the new urban area of Guiyang, with nearly 1,300 beds, far exceeding the more prestigious old hospital.

The branch is larger than the mother's home, and some of them are inseparable from the encouragement of the local government.

In the past six years, the Number one affiliated hospital of Nanchang University has increased from 1 to 3, and 2 branches are under construction, adding up to 6,700 beds. This is because, according to the "National Medical and Health Service System Planning Outline (2015-2020)" issued in 2015, the number of beds per 1,000 population in China will reach 6 by 2020. But at that time, there were only 4 beds per 1,000 people in Jiangxi Province.

"At that time, the Jiangxi Provincial Party Committee and Provincial Government selected 5 hospitals in the province and asked us to choose a site to build a branch." In the view of Cao Li, vice president of the First Affiliated Hospital of Nanchang University, the hospital has undergone tremendous changes in less than a decade. After 5 or 6 years of construction, in April 2021, the government delivered 600 beds in the high-tech campus, 3,200 beds in the self-built Xianghu campus, and 2,900 beds in the East Lake campus.

In Qingdao, Shandong, the Affiliated Hospital of Qingdao University has successively built 5 branches. The five campuses include self-built and inherited old hospitals, as well as campuses that have been transformed after the purchase and merger, turnkey projects after the completion of the government, and even cross-ministerial hospitals after the restructuring of enterprise hospitals. "Functional positioning differentiation, post management, dynamic management and information support, etc., are all tests." Vice President Jiang Guangfeng said.

Building a branch means that there is more room to expand and adjust, for the deans, at first, it is indeed like the joy of adding ding to the family; but when it comes to the specific implementation, the "increment" of expansion has become a highly efficient "high quality", the cost is not small, and there are many problems.

Will it be the beginning of another round of expansion?

"To avoid a kind of public opinion speculation, do not be said by the outside world, the big hospital will have a new round of scale expansion."

At the exchange meeting of "one hospital and multiple districts" at the end of the year, Hu Ruirong, director of the medical institution division of the Medical Administration Bureau of the National Health and Health Commission, revealed to a number of presidents in advance that when the guiding documents for the construction and management of multiple districts of one hospital will be issued in the near future, it seems that he intends to draw a clear line between the multi-district and scale expansion of a large hospital.

This "intentional" reveals a common concern: if the trend of large branches evolves into a "national movement" of public hospital expansion, it will inevitably lead to retrogressions and problem reversals.

He also told a number of hospital managers on the spot that the purpose of this round of public hospital branch construction is to improve the accessibility of high-quality medical treatment, and the final foothold is the separation of graded diagnosis and treatment areas.

However, policies can often only play a guiding role, specific to each hospital manager, it is bound to focus on the individual interests of their own hospital development. What really guides the development of the market is a large public hospital that is a leader in the local area.

Whether and to what extent the two contradictory sides can be unified also determines whether this tide of branch construction can be settled on the predetermined track.

"High-quality development" can only be regarded as a temporarily accepted "answer".

When the "Big Mac" took advantage of the wind of policy to rise, the construction of the houses below also faced many difficulties.

Ma Xin said that a hospital and multiple districts still have to enter the enterprise management mode in the end, so they have also experienced various management problems. For example, the independence of a branch is very strong, and different branches compete with each other rather than support each other, which is actually not conducive to the development of multiple campuses.

"There used to be a branch of the hospital, because it was an independent legal person, the mother hospital sent the vice president to manage, but the new branch developed very well, did not communicate with other hospitals, and finally slowly went out independently." Ma Xin admitted that this extreme situation will be very hurtful for every hospital that builds branches.

Whether it is "chain", or "franchise", after the advent of the "era of large branches", in cities or provinces with underdeveloped medical resources, will the discourse power of the hospital group become larger, and bring monopoly, resulting in the neglect of medical quality? After the epidemic, under the heavy blow of collection and procurement, and the general loss of public hospitals, can the expanded branches operate quickly, cheaply and efficiently, without becoming a burden on the parent hospital?

These are the "Great Branch Era", the problems left to the times.

Li Lin 丨 wrote

Chen Xin | responsible editor

This article was first published on the WeChat public account "Eight Points Health" (ID: HealthInsight)

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