"If the average hospital stay is too long, no new tertiary general hospitals and their beds shall be added", "The conditions for setting up branch campuses should be met", "The permanent population of the county is less than 100,000, and the county-run hospitals should be integrated"...
On January 29, the National Health Commission issued the Guiding Principles for the Establishment and Planning of Medical Institutions (2021-2025) (hereinafter referred to as the Guiding Principles). The Guiding Principles put forward comprehensive requirements from the basic principles of planning, the overall requirements, the main contents, the basic rules for the establishment of public hospitals, the regulation of the establishment of branch campuses of public hospitals, the authority and procedures for planning formulation, monitoring and evaluation, and the renewal of planning.
The health community found that the "Guiding Principles for the Establishment and Planning of Medical Institutions" is updated every 5 years, and the indicators are revised according to the monitoring and evaluation situation and the development and changes of local society, economy, medical needs, medical resources, diseases and so on.
Both the version released in 2016 and the Guiding Principles mention the number of beds in public hospitals, the number of public hospitals, the encouragement of social medical treatment, and the emphasis on rehabilitation medicine, traditional Chinese medicine, and integrated traditional Chinese and Western medicine.
It is worth noting that for the first time, the Guiding Principles regulate the setting conditions, quantity, ownership, etc. of public hospital branches.
The country sets the tone! This setup in public hospitals was regulated for the first time
The "Guiding Principles" proposes to rationally allocate the size of single beds (single practice points) in public hospitals. Public hospitals should reasonably set the number of departments and wards according to their functional positioning and service capabilities. No more than 50 beds per ward. The number of beds in the newly established county-run general hospital (a single practice point, the same below) is generally about 600-1000; the number of beds in the newly set up prefectural and municipal general hospitals is generally about 1000-1500; the number of beds in the newly set provincial general hospitals and above is generally about 1500-3000. The specific bed size of provincial, municipal and county general hospitals can be determined according to the number of people in the jurisdiction and the actual needs.
In addition to "no more than 50 beds per ward", the Guiding Principles also propose to rationally allocate the number of beds in tertiary general hospitals in public hospitals. When setting up and approving tertiary general hospitals, it is necessary to guide tertiary general hospitals to increase the scale and proportion of beds in critical care medicine, and rationally allocate clinical specialty resources. New tertiary general hospitals and their beds shall comprehensively consider factors such as bed occupancy rate, average hospitalization days, and difficulty in treating diseases, and in principle, if the average hospital stay is too long, they must not be added (tertiary general hospitals and their beds).
In addition, this is the first time that a national document clearly puts forward the definition of a branch hospital: a public hospital with a certain bed size in another address other than the original campus (main campus), established by means of new establishments or mergers and acquisitions. The Guiding Principles put forward strict and clear requirements for the basic conditions for applying for the establishment of branch campuses of public hospitals, the development stage of public hospitals, and the size of beds in branch campuses.
In terms of the ownership of the branch, the branch district is a non-independent legal person, and its assets such as people, property and property are all owned by the main campus.
At the same time, public hospitals applying for the establishment of sub-campuses should, in principle, meet the following conditions:
Grade III Grade A Public Hospital,
Bed occupancy continues to run at a high level of more than 90%,
The average hospital stay is in the top 10% of the same type of hospital in the country (the average hospital stay is shorter).
The difficulty degree (CMI value) of inpatients ranks in the top 10% of hospitals of the same category in the province.
The performance appraisal level of the existing campus has been above A+ for three consecutive years (A+ level in specialized hospitals),
In the past three years, there have been no major medical safety incidents or serious problems.
The Guiding Principles further clarify and lead the development of the connotation of public hospitals.
On the scale of the sub-districts. In principle, by the end of 2025, there will be no more than 3 branches of eligible public hospitals.
In terms of the number of beds, in the new sub-hospital area, the number of beds in each sub-hospital is not less than the minimum requirements of the second-level hospital of the same category, not higher than the maximum standard of beds in the general hospital of the same level determined by these Guidelines, and the total number of beds in each branch does not exceed 80% of the number of beds in the main campus at the end of 2020.
Project units undertaking the task of relieving non-capital functions of medical and health care in Beijing may be adjusted according to the actual situation.
Country Oriented! There are four major standards for the allocation of medical resources
The standardization of the establishment of branch campuses for public hospitals is generally based on the basis of hierarchical diagnosis and treatment and promoting the high-quality development of public hospitals, and continuously optimizes the allocation of regional medical resources.
The Guiding Principles put forward four major criteria for resource allocation:
First, the criteria for the allocation of total medical resources have been determined:
The number of beds per thousand people in the country has increased from 6.5 in 2020 to 7.4-7.5 in 2025, an increase of about 15%, reflecting the principle of continuous growth in meeting the medical needs of the people.
The second is to determine the standards for single hospitals in public hospitals:
There are 600-1000 beds in county-run general hospitals, 1000-1500 beds in prefectural and municipal general hospitals, and 1500-3000 beds in provincial-run and above general hospitals, and the resource allocation standards of the three types of hospitals have been improved by a certain extent compared with the 13th Five-Year Plan, reflecting the principle of seeking truth from facts, combining with China's actual situation, and using information technology to improve management level.
The third is to determine the standards for high-quality public hospitals (which can be held in sub-hospitals):
In addition to the above-mentioned standards such as bed occupancy rate, average number of days in hospitalization, difficulty of inpatients, and performance appraisal level, the construction standard of a fixed proportion of patients in other places (R≥1.3) has also been introduced, reflecting the principle of "only by strengthening the hospital in the new era can we become a large hospital".
The fourth is to determine the standards for the branch areas of public hospitals:
In principle, by the end of 2025, there shall be no more than 3 sub-campuses of eligible public hospitals. Where new sub-districts are added, the number of beds in each sub-campus shall not be less than the minimum requirements of second-level hospitals of the same category, and shall not be higher than the maximum standard for beds in general hospitals of the same level determined in this "Plan", and the total number of beds in each sub-campus shall not exceed 80% of the number of beds in the main campus at the end of 2020. The setting of these construction standards reflects the principle of solid branch hospitals, matching the name and reality, and developing public hospitals with high quality.
The country is clear! The total amount and space of social medical areas are not regulated
The "Guiding Principles" once again clarify the general direction of the simultaneous development of government medical care and social medical treatment, and guide social medical treatment to become a useful supplement to government medical treatment.
The Guiding Principles emphasize that the regional total number and space of social medical institutions are not limited by planning, and encourage social forces to set up independent medical institutions such as non-profit medical institutions and medical laboratories, pathological diagnosis centers, medical imaging diagnosis centers, hemodialysis centers, and rehabilitation medical centers in the shortage of specialties such as rehabilitation and nursing.
This is a more appropriate and realistic strategy in the context of the large-scale development of public medical institutions.
The "Guiding Principles" proposes to encourage social forces to set up non-profit medical institutions and independent medical institutions in shortage specialty fields such as rehabilitation and nursing, strengthen the standardized management and quality control of social medical services, and improve the level of homogenization.
National Innovation Methodology! Fine guidance on the allocation of health resources in various places
Compared to the 2016 version, the Guiding Principles are groundbreakingly using multiple mathematical models. Guide all localities to accurately grasp the current situation and measure future needs.
Mainly including:
1. Propose a model for measuring the number of necessary beds, and comprehensively evaluate the total population and structure, hospitalization rate, bed occupancy rate, bed turnover, inflow and outflow population and other factors;
2. Propose a model to measure the number of required physicians, and comprehensively evaluate the total population and structure, the number of diagnoses and treatments, the number of hospitalizations, the inflow and outflow of diagnosis and treatment and hospitalization, and the adjustment coefficient K;
3. Put forward the bed demand coefficient R, which is used to assess whether public hospitals should set up sub-campuses at the current stage of development, and comprehensively assess the total population and structure of the local population, the inflow population, the number of admissions, the hospitalization rate, and the bed weight corresponding to the service radius.
Sources | the health community
Finishing | four hi