Patients gather in large hospitals: the current situation of Chinese hospitals and the direction of medical reform

Abstract

As doctors, we find it thoughtprovoking to read in the paper, ‘Is it worth being a doctor? Effective altruism and career choice’. It reminds us of the current situation faced by Chinese hospitals and inspires us to think about the direction of future medical reform. At the end of 2020, the Healthcare Report, a wellknown research institution, published a list entitled ‘Ranking of operation volume in general hospitals in China’. According to this list, the hospital with the largest number of operations in China is the First Affiliated Hospital of Zhengzhou University. In 2020, there were 350 000 operations in the hospital, with an average of 1000 operations per day. In recent years, the operation volume in many large hospitals has increased at an alarming rate, which is closely related to the continuous expansion of hospital scale. In addition, large hospitals have also introduced many advanced equipment while expanding their scale. As a result, large hospitals siphoned off a large number of excellent talents from grassroots hospitals, which also led to overconcentration of patients and difficulty in diverting them. However, because the expansion rate of hospitals cannot keep up with the growth rate of patients, doctors in large hospitals are exhausted all day. Nowadays, China’s hospitals and medical system are experiencing a huge test: the demand for medical services is growing rapidly, but the limited medical resources have not been allocated reasonably. To understand these difficulties, we need to know the differences between Chinese and foreign hospitals and medical systems. First of all, China lacks a perfect referral system. Even for the common cold, patients will choose to go to large hospitals, which are considered to have better medical service level, while the number of patients attending primary health institutions is very small. Unfortunately, the gathering of patients has further aggravated the problem of ‘difficulty in seeing a doctor’. In the USA, family doctors usually decide whether patients need to be referred to specialised hospitals for further treatment, which ensures the rational use of medical resources. Second, it is difficult to implement the medical appointment system in China, because the huge number of patients makes doctors in large hospitals overwhelmed, which also increases the risk of medical disputes. Third, in China, people have prejudice against general practice, and general practitioners are even regarded as the group with the lowest medical level in hospitals. In contrast, in UK, general practitioners are the providers of highquality primary healthcare and also the best gatekeepers of residents’ health. Finally, the Chinese government usually only buys ‘disease insurance’ from hospitals, that is, hospitals mainly provide disease treatment services, while disease prevention and management have not received real attention. In developed countries, the government also purchases disease and health management services, and hospitals undertake the dual tasks of treatment and prevention. Considering China’s important role in the global health service system, how to change the status quo of Chinese hospitals and medical systems is worth discussing. First, since most medical resources are concentrated in large hospitals, the Chinese government needs to adjust the allocation of medical resources systematically to promote the balance between supply and demand. Recently, the Ministry of Health proposed to establish a medical service consortium, so that large public hospitals and primary medical institutions can become a community of benefits. The purpose of this initiative is to achieve seamless health management for community residents through twoway referral. Second, the graded diagnosis and treatment system needs to be placed at the top of the medical reform. The government should first optimise the medical service system, focus on improving the basic medical service capacity and improve the basic management and operation mechanism. At the same time, medical administrators should mobilise the enthusiasm and initiative of large hospitals to participate in graded diagnosis and treatment and smooth the twoway referral channel by establishing a continuous service mode of diagnosis–rehabilitation–nursing. Third, policymakers can consider implementing the family doctor contract system in developed areas and supporting the development of nonpublic hospitals, so as to increase medical service resources and improve the medical service system. Fourth, the government should promote the establishment of general practice departments in hospitals and encourage doctors in large hospitals to be leaders in general practice. Besides, it is worth noting that China has fully promoted the resident training system in 2020, which is very important to ensure the homogenisation of doctor training quality. Last but not the least, hospitals and medical managers must realise the importance of disease prevention. At present, the health expenses for chronic diseases in China account for more than 70%, which brings great burden to society. The characteristic of chronic diseases is that the incidence can be reduced by taking intervention measures. Therefore, in the future, large hospitals should pay equal attention to prevention and treatment, rather than simply treating diseases, and change ‘end treatment’ to ‘source treatment’. In short, for the Chinese government and hospitals, medical reform is not a minor repair based on the experience of Europe and America, but a selfinnovation rooted in China. It can be predicted that when China’s large hospitals are no longer overcrowded, China’s medical reform will be on the right path. Given the health needs of onefifth of the world’s population, the future development of China’s medical system and hospitals deserves continuous dialogue and careful scrutiny.