Cao Jian: To improve the marketization of the medical industry, we still need to adhere to the public welfare of the hospital

◎ Cao Jian

Recently, the Wei Zexi incident has continued to ferment. From the perspective of the incident itself, Baidu, the Second Hospital of the Armed Police, and the Putian Department involved in the incident all need to bear relevant responsibilities, but placing this incident in the context of the medical industry, the root cause of the problem actually points to the current distorted medical market.

The occurrence of the Wei Zexi incident and the chaos in the Putian system do not mean that the medical industry cannot be marketized, but it just proves that the marketization of China's current medical industry is still imperfect, that is, the elements of the medical industry have been marketized, but the marketization has not been realized in the personnel system, hospital management, services and commodity pricing, and the fair and benign competition pattern of medical market is far from formed. This also requires that we should fundamentally straighten out the current thinking of medical reform.

Dating back to the late 1990s, China's medical institutions launched market-oriented reforms, began to try "enterprise management, independent operation, self-financing", the government implemented "fixed (fixed) subsidies for hospitals, overexpenditure is not supplemented, balance retention", which makes public hospitals that used to rely heavily on state financial support uncomfortable.

Data show that before 1978, more than 50% of the income of public hospitals came from financial subsidies, and after the 1980s, hospitals gained greater autonomy, but subsidies from the government were also getting less and less. In 1980, government subsidies as a percentage of hospital revenues fell to 30 percent, fell to 19 percent in 1987, and by the end of the 1990s, the share of subsidies had fallen further to 6 percent.

In the context of the reform of state-owned enterprises in the 1990s, the operation of enterprises is generally more difficult, the government financial pressure is relatively large, and various localities cannot come up with so much money to support the development of hospitals, and can only give hospitals some preferential policies to let the hospitals themselves achieve income generation.

In this case, the hospital to seek development at the same time, but also in order to meet the needs of the masses for medical treatment, it is indeed necessary to expand, but this development can only rely on themselves, which has derived some deformed development strategies, in this wrong development path, some public hospitals began to go farther and farther.

Among these deformed development strategies is the "department outsourcing" of public hospitals in the Wei Zexi incident.

In fact, as early as 2000, the Implementation Opinions on the Classified Management of Urban Medical Institutions issued by the Health and Family Planning Commission clearly stipulated that "non-profit medical institutions organized by the government shall not invest in joint ventures with other organizations to establish for-profit 'departments', 'wards' and 'projects' with non-independent legal personality." ”

This kind of "department outsourcing" is an important manifestation of the pursuit of profits by medical institutions. Therefore, in this case, it is particularly important to straighten out the idea of medical reform.

First of all, it is necessary to straighten out the positioning of different medical institutions.

The state has also repeatedly stressed the need to "adhere to the basic positioning of public hospitals for public welfare", so public hospitals should be changed to completely non-profit-oriented, aiming to meet the basic medical needs of the masses and promote fair medical treatment. However, it is unrealistic to let the government run all public hospitals alone, so it must be done to grasp the big and let go of the small.

On the basis of doing a good job in basic medical care, part of the medical market still needs to be liberalized. For example, some high-end medical and special needs medical treatment can provide differentiated medical services according to market-based pricing. Moreover, for these market-oriented forces, it is necessary to strengthen industry self-discipline and carry out strict access restrictions and supervision.

Second, it is necessary to strictly regulate the behavior of medical institutions.

For example, the current advertising behavior of some hospitals should be strictly restricted. At present, the government only has the power to supervise the authenticity of medical advertising, but there is no limit on the specific number of hospital advertisements, especially the advertising volume of non-profit medical institutions, relevant regulations should be formulated to constrain, the experience of developed countries should be learned, and the purpose of the existence of non-profit organizations should be fully considered, requiring that the annual advertising investment of non-profit medical institutions should not exceed 1% to 2% of the total income of the institution in the current year.

(The author is a researcher at the Medical Management Research Center of the School of Economics and Management of Tsinghua University and a researcher at the China Economic Development Research Center of the University of International Business and Economics)