In 2010, the whole country was in the tide of medical reform, and Luoyang, the Shendu capital located in western Henan, was no exception.
At that time, Luoyang had a population of 6.5 million but 114 public hospitals. An industry insider once said that Luoyang's bed occupancy rate is less than 50%, and there is fierce competition between hospitals. [1] Against this background, Luoyang embarked on a vigorous reform of the hospital property rights system - allowing doctors to hold all shares and become the "shareholders" and real "masters" of the hospital.
This indispensable reform, which took only 6 months from proposal to implementation, quietly and quietly, sparked heated discussions among scholars. Some praised, some worried, and some thought it would be an important move to shake up China's health care reform.
In 2017, Luoyang handed over the answer sheet: it was changed to a fully owned hospital, and all of them were changed back. Doctors, who have undergone a change, now often keep silent about the matter.
The eve of the full shareholding system
On February 23, 2010, the Ministry of Health and other five ministries and commissions jointly issued the "Guiding Opinions on the Pilot of Public Hospital Reform", selecting 16 cities as pilot areas for public hospital reform guided by the state, requiring the reform of the public hospital management system and gradually realizing the unified management of public hospitals, Luoyang is one of the 16 cities.
Luoyang is also responding quickly: it is necessary to change, and it is now. On June 12, 2010, Luoyang issued the "Luoyang Public Hospital Reform Pilot Work Implementation Plan", which requires the implementation of the "doubling development" plan for the existing tertiary hospitals, and after 3~5 years of efforts, each tertiary general hospital has between 1000~1500 beds and each tertiary professional hospital has between 800~1000 beds. [1]
In December, the "Luoyang City Implementation Plan for Accelerating the Reform and Restructuring of Public Hospitals" was issued again, stipulating that municipal public hospitals such as infectious disease prevention and control, mental health and other municipal public hospitals should implement operational mechanism reform, in addition to all public hospitals to implement property rights system reform, a total of 14.
Photo: Luoyang Municipal People's Government
Everyone gradually became clear in their hearts that hospitals need property rights. It's just how to change it, it's still unknown.
In August 2010, Mao Wanchun, secretary of the Luoyang Municipal Party Committee, mentioned at the meeting that the pace of reform in hundreds of public institutions in the city is too slow. He shared his reform experience in Xuchang: in 2006, six public hospitals in Xuchang were changed to hospital staff shareholding, and all state-owned capital withdrew. "You can also go to Xuchang to see, after all, hearing is nothing, seeing is believing." For a time, medical practitioners in Luoyang came to Xuchang for field investigations. [1]
Xuchang is about 200 kilometers away from Luoyang, with a population 1/3 less than Luoyang, but the number of public hospitals is only 1/15 of Luoyang, and there was only one tertiary hospital at that time. According to the data, after the restructuring, the development of Xuchang hospitals has made great strides, taking Xuchang People's Hospital as an example, the annual income increased by about 50%, nearly 20 million yuan was invested to purchase medical equipment, and 130 million yuan was raised to start the construction of a 17-story ward building. [2]
Seeing Xu Chang's situation, Luoyang's practitioners are still very worried. "Reform is to peel off the skin, and now the development momentum of the hospital is very good, and the future will be uncertain after the reform." Li Yawei, president of Luoyang Central Hospital, said. [1]
At the same time, some hospitals are gearing up for the restructuring, "The government has not invested much in our hospital, and from 2005 to the present (2010), the operation of Baiba Hospital is very difficult." The president of Luoyang Baima Hospital said. In his eyes, this restructuring may be able to save the hospital's operating situation. [3]
Let doctors be shareholders
On January 4, 2011, the first restructured hospital was unveiled, which was Luoyang Central Hospital, the only third-class hospital in Luoyang and "very good development momentum".
"I didn't expect the central hospital to be restructured, let alone that the government would change us first." In an interview with "President of Chinese Hospital", director Li Yawei said.
The hospital took the initiative to report three restructuring models: one is to attract social capital, the second is that the central hospital and the government each hold a certain proportion of shares, and the third is simply the shareholding of all hospital employees, that is, the same as Xu Chang.
The Luoyang municipal government chose the third one, and in the end, ordinary employees, business backbones and management each accounted for 30% of the equity structure, and the government accounted for 10%. State-owned property rights were transferred to hospital employees for a price of 31.8834 million yuan. Although the hospital has changed from a public hospital to a private sector, it still remains non-profit, the establishment of employees is abolished, there is no dividend for employee shareholding, and there will be no major adjustment of salary.
Of the 50 new graduate students recruited by Central Hospital that year, 23 ended up not working. In this regard, Dean Li Yawei knew in his heart, "Everyone who comes to join the company must first ask about the nature of the hospital." Li Yawei said [3]. A chief physician said that based on the current development of the hospital, he will not leave for the time being, "but the people below the main treatment are more likely to leave," he said. [5]
From the hospital's point of view, the pressure to increase revenue has increased sharply, because after the status change, some funds are gone. For example, in the 2010 national key specialty project selection, the Department of Obstetrics and Gynecology of Luoyang Central Hospital was shortlisted, receiving 5 million yuan of support funds and 5 million yuan of hospital supporting [3]. Originally, the hospital was ready to continue to apply for other departments, but after the restructuring, it was rejected by the Ministry of Health, on the grounds that the selection of key specialties was mainly for public hospitals.
In addition, the Luoyang municipal government stipulates that after the restructuring, the government's investment in hospitals will decrease year by year. The investment remained unchanged for the first three years, reduced to 50% in the fourth year, 30% in the fifth year, and cancelled in the sixth year [4]. Before 2010, Luoyang always attached importance to medical and health investment, with an annual expenditure of more than 1.7 billion yuan, accounting for 12% of all expenditure. [7]
Figure: 2010 Luoyang City Public Financial Expenditure Final Statement
After other hospitals followed the transformation of central hospitals, the problem gradually became prominent. Some hospitals breed corruption, and the president alone owns 85% of the shares; Some hospitals are trying to make small profits due to poor management and illegal leasing of equipment and instruments. [6]
Changed back to public hospitals
In response to this vigorous reform, Zhuang Yiqiang, director of the Management Research Center of Hong Kong Alibi Hospital, said in the early stage of the reform that the reform of Luoyang's public hospitals is eye-catching, although it cannot be asserted whether Luoyang is successful, but at least it is positive.
However, he also believes that China's medical reform lacks a theoretical height, does not carry out the overall principle and system design according to the purpose of reform, and even lacks reasonable reform logic, and eventually crosses the river by feeling the stones.
"Only if you can prove that your restructuring method is ultimately successful will someone think that the reform of public hospitals is correct and will someone learn from your model." Zhuang Yiqiang said. [3]
In "Investigation and Reflection on the Reform Process of Luoyang Public Medical Property Rights System", this system is also analyzed, and believes that it can indeed "concentrate small money to do big things", but it will also lead to problems such as excessive concentration of medical resources, low allocation of public medical resources, and alienation of common property rights. [6]
Reform has gradually gone through 6 years. In July 2017, this medical reform came to an end: hospitals collectively returned from private non-profit hospitals to public hospital attributes, and completely changed back.
Photo: Notice of Luoyang Municipal People's Government on the restoration of public attributes of a hospital
As for why it returned, according to the answer of the Luoyang Municipal Government, "by restoring the public welfare attributes of some restructured hospitals, standardizing the management and operation of hospitals, strengthening the supervision of medical institutions, and improving the level of medical security and health services in the city." [9]
However, the end of this reform was foreshadowed. On the one hand, 2017 is the last year of government subsidies, and on the other hand, the overall direction of the state for public hospitals is also gradually changing. In recent years, the government has repeatedly proposed to expand and deepen the comprehensive reform of public hospitals, so that public hospitals will become the main force for the people to provide basic medical and health services.
After returning to the public attribute for 2 years, the Henan Provincial Health Work Association pointed out that the pace of reform of public hospitals should be accelerated, but not reformed, and those that have been restructured in various cities and counties should be taken back, and those that cannot be recovered should be newly built. And these hospitals in Luoyang just meet the requirements of the work meeting.
By the end of the reform, Luoyang Central Hospital had completed the goal of the original "doubling plan" and had 1,400 beds. In a certain year in the middle of the reform, the central hospital also reached a small peak of 794,000 outpatient emergency visits and a total income of 620 million yuan, twice as much as before the reform. [8]
Today, Luoyang is re-establishing links with public hospitals. Since 2017, China-Japan Friendship Hospital and others have established cooperative hospitals with Luoyang; At the same time, Luoyang City is also establishing medical alliances and establishing cooperation with radiant counties. At present, the number of third-class hospitals in Luoyang has grown to 7, and the reform and exploration of public hospitals is still ongoing.
Curator: yxtlavi|Executive Producer: Gyouza
Source: Visual China
Written by yxtlavi
Resources:
[1] WU Fengqing. President of Chinese Hospital,2011(16):40-44.)
[2]http://www.ngdlysw.gov.cn/?p=227
[3] GAO Wei, WU Fengqing. President of Chinese Hospital,2011(16):46-49.)
[4] Eggenfa. The dilemma and countermeasures faced by the restructuring of hospitals[J].China Health Industry,2011,8(9Z):51-52.)
[5] Wu Fengqing. President of China Hospital,2011(22):34-35+13.)
[6] WANG Jiayu, DENG Yong. Investigation and reflection on the reform process of property rights system of public hospitals in Luoyang[J].President of Chinese Hospital,2022,18(16):66-71.)
[7] LIU Yong. Medical reform Luoyang sample:public hospitals test the water of "diversified medical operation"[J].Hospital Leadership Decision Reference,2011(16):43-44.)
[8] http://www.e-spaces.ca/project/ Luoyang Central Hospital affiliated to Zhengzhou University
[9]https://www.ly.gov.cn/html/1/2/4/5/816069.html