The National Health Commission issued a document: how many hospitals can be built in a city? How big is it?

The "Planning" has made new arrangements for the development of medical institutions during the "14th Five-Year Plan" period.

Written by | Xu Yucai

Source | "Medical Community" public account

On January 30, the National Health Commission issued the Guiding Principles for the Establishment of Medical Institutions (2021-2025) (hereinafter referred to as the "Planning").

During the "14th Five-Year Plan" period, how many tertiary hospitals can be built in a city, how large-scale medical institutions can be run, how many hospitals should be built, where should the city's second-level hospitals go, how to develop the medical community, where is the way out for social medical treatment, and how to actively cope with the aging of the population... On this series of issues, the "Planning" has made "guidance".

How many hospitals can be built in a city?

The "Plan" emphasizes that the number of public hospitals should be set reasonably. In provincial-level areas, every 10 million to 15 million population planning to set up a provincial regional medical center, while planning and layout of children, tumors, psychiatry, infectious diseases and other specialized hospitals and traditional Chinese medicine hospitals as needed, the population size in sparsely populated areas can be appropriately relaxed, and occupational disease and stomatological hospitals are set up according to the actual needs of medical services.

In prefecture-level and municipal-level areas, 1 to 2 prefectural and municipal tertiary general hospitals are set up for every 1 million to 2 million people, and strive to build tertiary specialty hospitals for children, spirits, obstetrics and gynecology, tumors, infectious diseases, rehabilitation, etc. as needed.

In county-level areas, according to the number of permanent residents, in principle, 1 county-run general hospital and 1 county-run traditional Chinese medicine hospital are set up, and ethnic minority medical hospitals are given priority in county-level areas of ethnic minority areas and ethnic autonomous areas.

Realize that there is one standardized maternal and child health care institution organized by the government at the provincial, municipal and county levels.

How large can a medical institution do?

The "Plan" clearly stipulates that the establishment of medical institutions is macro-controlled by the main indicators such as medical service demand, medical service capacity, the number of beds in a thousand population (number of Chinese medicine beds in a thousand population), the number of doctors in a thousand population (the number of Chinese medicine doctors in a thousand population) and the number of nurses in a thousand population, and the specific indicator values are determined by each province, autonomous region and municipality directly under the Central Government according to the actual situation. Among them, in the main indicators of the national medical institution setting plan in 2025, the guiding requirements for the number of beds per thousand population in 2025 are 7.4 to 7.5 beds; the number of practicing (assistant) physicians (persons) per thousand population is 3.2; the proportion of geriatric departments set up in second-level and above general hospitals is not less than 60%; the suitable bed size of county-run general hospitals is 600-1000; the suitable bed size of municipal general hospitals is 1000-1500; and the suitable bed size of provincial-run and above general hospitals is 1500~ 3000 sheets.

The "Plan" makes it clear that the size of beds in each ward of public hospitals shall not exceed 50. Those who undertake the tasks of regional medical centers may appropriately increase the size of beds according to the needs of medical services. When setting up and approving tertiary general hospitals, guide tertiary general hospitals to increase the scale and proportion of beds in critical care medicine, and rationally allocate clinical department resources. New tertiary general hospitals and their beds shall comprehensively consider factors such as bed occupancy rate, average hospital stay days, and difficulty in treating diseases, and in principle, the average hospital stay days are too long to be added.

How should multi-campus areas be built?

For the first time, the Plan clarifies the concept of "branch areas" of public hospitals. Specifically, it refers to the hospital with a certain bed size at other addresses of public hospitals other than the original campus (main campus), which are established by means of new establishments or mergers and acquisitions. The sub-district is a non-independent legal person, and its assets such as persons, property and property are all owned by the main campus.

Extension points for primary medical services, outpatient departments, health examination centers without beds, etc. held by public hospitals, as well as cooperative medical institutions such as medical associations, hospital trusteeship, cooperative holdings, agreement cooperation, and counterpart support are not sub-hospital districts.

In principle, we support public hospitals with strong comprehensive strength and build sub-hospitals on the basis of strictly controlling the scale of individual bodies.

In principle, public hospitals applying for the establishment of sub-hospitals should meet the following conditions: tertiary first-class public hospitals, the bed utilization rate continues to exceed 90%, the average hospital stay is in the top 10% of the same type of hospital in the country (the average hospitalization day is short), the difficulty degree (CMI value) of inpatients ranks in the top 10% of the same type of hospital in the province, the performance appraisal level of the existing campus has been above A+ level (A level or above in specialized hospitals) for three consecutive years, and no major medical safety incidents and serious style problems have occurred in the past three years.

Except for the national medical center, the national regional medical center and the national regional medical center construction project unit, and the project unit undertaking the task of relieving the non-capital function of Beijing's medical and health care, no branch campus shall be established across provinces.

By the end of 2025, there shall be no more than 3 sub-districts of eligible public hospitals; in new sub-districts, the number of beds in each sub-district shall not be lower than the minimum requirements of second-level hospitals of the same category, and not higher than the maximum standard of beds in general hospitals of the same level determined in this "Plan", and the total number of beds in each branch shall not exceed 80% of the number of beds in the main campus at the end of 2020. It is necessary to avoid the problem of dilution and dilution of high-quality medical resources.

Where is the city's secondary hospital going?

The "Plan" proposes to improve the urban and rural medical service system and accelerate the improvement of the hierarchical diagnosis and treatment system. Clarify the functional positioning of all types of medical institutions at all levels. Improve the urban medical and health service system based on community health service institutions, establish a division of labor and cooperation mechanism between urban hospitals and community health service institutions, and orderly guide some urban district-level hospitals to transform into specialized medical institutions such as rehabilitation, nursing, spiritual, and occupational diseases. In accordance with the urban grid layout management, the establishment is led by tertiary public hospitals or hospitals representing the medical level of the jurisdiction, and a number of hospitals, grass-roots medical and health institutions, and public health institutions constitute a close-knit urban medical group. Support the development of rehabilitation hospitals, nursing homes, and nursing stations (hereinafter collectively referred to as continuing medical institutions), encourage the transformation of some secondary hospitals in areas with abundant medical resources into continuous medical institutions, increase service coordination in the region, and expand the supply of continuous services such as rehabilitation, nursing, and palliative care.

How has the medical community developed?

In accordance with the principle of county-township integration and rural integration, actively develop a close-knit county-level medical community, county-level hospitals focus on strengthening specialized capacity building, strengthen the counterpart assistance of urban tertiary hospitals to county-level hospitals, strengthen the division of labor and cooperation and business coordination between county-level hospitals and public health institutions, and strengthen technical guidance for township health centers and village clinics. Integrate the existing medical resources in the region and promote the mutual recognition of the inspection and test results of medical institutions. Further improve the rural medical service network with county-level hospitals as the leader, township health centers and village clinics as the basis.

Where is the way out for social medicine?

The "Planning" proposes to adhere to the principle of collaborative innovation and encourage social medical services. Expand the space for social medical services, and the total amount and space of social medical areas are not limited by planning. Encourage social forces to set up independent medical institutions such as non-profit medical institutions and medical laboratory laboratories, pathological diagnosis centers, medical imaging diagnosis centers, hemodialysis centers, and rehabilitation medical centers in the field of rehabilitation, nursing, and other shortage specialties, strengthen the standardized management and quality control of social medical services, and improve the level of homogenization. Encourage medical institutions organized by social forces to take the lead in establishing or joining medical associations. Explore various forms of collaboration between social medical institutions and public hospitals. The setting of the clinic is not limited by the planning layout, and the filing system is implemented.

How to actively cope with the aging of the population?

The "Planning" will be combined with the integration of medical and nursing care, medical and prevention integration, and the combination of peace and urgency into the principle of collaborative innovation, in order to promote the integration and sharing of regional medical resources, propose to deepen the combination of medical and nursing care, strengthen the establishment of geriatric departments in general hospitals at the second level and above, encourage the establishment of geriatric departments in qualified second-level and above traditional Chinese medicine hospitals, and guide the transformation of some first- and second-level public medical institutions into long-term care institutions. Explore the construction of community (township) medical and nursing care service facilities in community health service institutions and township health centers, open geriatric departments in hospitals around pension institutions, carry out various forms of medical and nursing services, and do a good job in the diagnosis and treatment of geriatric diseases. Vigorously develop Internet diagnosis and treatment services, incorporate Internet hospitals into the planning of medical institutions, form an online and offline integrated service model, and improve the overall efficiency of the medical service system.

Basically achieve full coverage of county-run traditional Chinese medicine medical institutions

Regarding the cause of traditional Chinese medicine, the "Plan" requires the improvement of the service system of traditional Chinese medicine. Construct a traditional Chinese medicine service system with the National Center of Traditional Chinese Medicine and the Regional Center of Traditional Chinese Medicine as the leader, all types of Traditional Chinese medicine medical institutions at all levels and other medical institutions as the backbone, and the grass-roots medical and health institutions as the basis, integrating preventive health care, disease treatment and rehabilitation. Promote the construction of the National Center of Traditional Chinese Medicine, the National Regional Medical Center of Traditional Chinese Medicine, the National Center of Integrative Medicine, and the National Regional Medical Center of Integrative Traditional Chinese and Western Medicine, set up at least one provincial-level regional medical center of traditional Chinese medicine in each province (autonomous region and city), vigorously develop key hospitals with traditional Chinese medicine characteristics, "flagship" hospitals of traditional Chinese and Western medicine, county-run traditional Chinese medicine hospitals, traditional Chinese medicine clinics and outpatient departments, and basically achieve full coverage of county-run traditional Chinese medicine medical institutions. Relying on the construction of high-level TCM hospitals covering all provinces of the national TCM epidemic prevention and control base and the national TCM emergency medical rescue base, strengthen the construction of infrastructure conditions for infectious diseases, respiratory, emergency, critical care and other related departments of TCM hospitals, and improve the emergency and treatment capabilities of TCM hospitals. With the goal of promoting the progress of national medicine, relying on existing resource planning, national medical centers, national and provincial regional medical centers, clinical medical research centers, and traditional Chinese medicine inheritance and innovation centers are set up, and private hospitals are encouraged to participate.

Overall, the "Planning" has made new arrangements for the development of medical institutions during the "14th Five-Year Plan" period, adhered to the problem-oriented, put the active response to the aging of the population and major public health emergencies in an important position, and concentrated on the high-quality development of public hospitals, which is quite innovative, which is of great significance for guiding all localities to do a good job in the planning of the "14th Five-Year Plan" medical institutions, and it is also of great guiding significance for medical institutions at all levels to do a good job in their own "14th Five-Year Plan" development plan.

Source: Medical community

Editor-in-charge: Zheng Huaju

Proofreader: Zang Hengjia

Plate making: Xue Jiao