Beijing First Hospital of Integrative Medicine, formerly known as Dongba Hospital, changed its name in 2012. An expert in the field of obstetrics and gynecology told China News Weekly that the obstetrics and gynecology department of Dongba Hospital was once very brilliant, with annual deliveries reaching three to five thousand at one time, and this figure dropped to about 1800 during 2014-2016, but last year it dived to less than 150, shrinking by 90%.
A newborn baby in August 2021 at the Shenzhen Maternal and Child Health Hospital in Guangdong province.
Dongba is not the only one experiencing an "obstetrics crisis". Beijing Henghe Hospital, a second-tier, high-end private hospital, has seen a decline in the number of obstetrics patients in recent years, and is set to be acquired by United Family Hospitals, the leading private obstetrics and gynecology hospital in China. According to people familiar with the matter, the acquisition is now in the stage of "engagement" but not yet "license".
According to data released by the National Bureau of Statistics (NBS) and the National Health Commission (NHC), the number of new births in China from 2016 to 2021 has been declining year after year, with 18.83 million, 17.65 million, 15.23 million, 14.65 million, 12.0 million, and 10.62 million people born, respectively. The Academy of Social Sciences, in its Green Paper on Population and Labor released in January 2019, pointed out that the era of negative population growth in China is approaching. And obstetrics departments in hospitals are the first to feel this change.
Once the peak of births
"October 2016 was the peak of deliveries in our hospital, *** delivering about 300 babies, an average of 10 per day. I remember one night when I basically didn't rest, admitted seven expectant mothers and performed four cesarean sections." Wang Xia, deputy chief physician of Beijing Dongcheng District Maternal and Child Health Hospital, recalled.
It was ten months after the implementation of the "comprehensive two-child" policy, and the demand for the first two children was released. "After the introduction of the policy, many couples felt that they should seize the tail end of the delivery age to have another one," Wang Xia said, "Many couples after 70, close to 40 years old, to have a second child." In 2016, births of two or more children accounted for more than 40% of the country's total births, according to the National Health Planning Commission at the time.
Yu Yabin, director of the Chaoyang District Maternal and Child Health Hospital in Beijing, said in an interview with China News Weekly that in 2016, Beijing, like the whole country, was at the peak of deliveries. The rise in deliveries that year was attributed not only to the birth of second children, but also to the restoration of the demand for births that had been suppressed in the previous year, the Year of the Goat. Many Chinese, influenced by traditional culture, do not like to give birth to a child in the year of the sheep, but prefer to have a "dragon baby", "monkey baby", "pig baby".
At that time, the media reports about the obstetrics department "hard to find a bed" were everywhere: "the floor of the extra beds" "difficult to build a file, the number of traffickers ask for sky-high prices". ...... In order to cope with the rising number of deliveries, Beijing Chaoyang Hospital has transformed seven one-room wards into double rooms, and Beijing Dongcheng District Maternity and Child Health Hospital has added beds in the outdoor courtyard. "I heard that other hospitals have added benches, numbered bench one and bench two ......," Wang Xia said.
At that time, the National Health and Planning Commission to solve the problem of insufficient resources for maternal and child health services, proposed to strengthen the construction of maternal and child health care institutions at the provincial, municipal and county levels, and set up an additional 89,000 obstetrics beds, and strive for the "Thirteenth Five-Year Plan" period to increase the number of obstetricians and midwives by 140,000 people.
Private hospitals have seen the potential market for maternal and child healthcare. Soochow Securities released a special report on the maternal and child industry in October 2016, pointing out that in the past few years, the overcrowding of public hospitals, the year-on-year increase in per capita health care costs, the implementation of the two-child policy, and the use of maternity beds in cities in the eastern part of the country of more than 95% of the situation, are all favorable factors for the development of private maternity hospitals.
There are favorable policies and attractive market prospects, coupled with maternity hospitals require less equipment, low capital threshold, a large number of players to enter the game. Early entrants to the maternity hospitals focus on the high-end market, the target audience for the expatriate and high-income groups in the north and south of Guangzhou, after the entry of the "Putian system" is focused on second-tier cities such as Chengdu, Qingdao, to fill the void. In July of 2015, Hemei Medical, one of the four families of the Lin family, was listed on the Hong Kong stock market.
While public and private hospitals were gearing up for a wave of births, the reality was like a pot of cold water.
The industry's "overcapacity"
2019 is the Year of the Pig, and Yu Yabin realized that the number of deliveries that year had not exceeded that of 2017, the Year of the Rooster. She thus felt that the number of births began to decline. If the decrease in women's willingness to give birth in 2020 was affected by the epidemic, then the fact that obstetrics did not regain its previous vigor in 2021 despite the resumption of work and childbirth indicates that the decline in fertility has become a fait accompli.
There are figures to prove it: Beijing Chaoyang Maternal and Child Health Hospital's annual deliveries in 2016 were close to 5,800, and have been declining year after year since then, falling to just over 2,000 in 2021, more than half of what it was four years ago.
In Hangzhou, Liu Jiangang, deputy chief physician of obstetrics and gynecology at a private tertiary hospital, said his hospital's deliveries were nearly halved relative to a few years ago.Before 2013, he worked at a local public tertiary obstetrics and gynecology hospital. Now, according to him, the hospital's obstetrics wards are now about 20 percent empty. Also according to Liu Jiangang know, Zhejiang Province, Huzhou City, Anji County Maternal and Child Health Hospital obstetrics *** have three layers, and now has removed a layer, Hangzhou City, the second hospital's obstetrics ward is closed half.
In Guantao County, Handan City, Hebei Province, 400 kilometers from Beijing, Zhang Jiewen, director of obstetrics and gynecology at the County People's Hospital and deputy chief physician, said deliveries in his department fell from more than 1,500 in 2016 to 789 last year. "In the first two months of this year, our department gave birth to only more than 50 children, and I don't think this year's figures will be any better. " She said.
"When I went to the countryside for a clinic last year, the secretary of the township health center told me that from the New Year's Eve to the National Day, less than 20 marriages took place in the whole big village." Zhang Jiewen told China News Weekly. She also explained that Tantao County belongs to the economically underdeveloped counties, and the phenomenon of population outflow is more serious, with most local men going out to work and many women marrying abroad.
The number of women giving birth at Wang Xia's Maternal and Child Health Center in Beijing's Dongcheng District has also fallen off a cliff, and there are now only 30 to 40 deliveries per month, just one-fifth of the number in previous years. The reason for this phenomenon, in addition to the willingness to give birth is not strong, but also with the Dongcheng District in recent years, the policy of population deconcentration has a relationship.
Duan Tao, a professor at the Shanghai First Maternity and Infant Health Center, analyzed the impact of declining fertility rates on obstetrics, and the impact on public hospitals at the second level and below is significantly greater than that of tertiary hospitals. Most district-level maternal and child health centers are second-level hospitals, so they are more affected.
Liu Jianguang explained that in the case of the overall decline in deliveries, the previous in the three hospitals can not build a file second to go to the second level of hospitals to build a file of pregnant women, can now go to the three hospitals to give birth to a child, so the tertiary hospitals of the obstetrics outpatient volume in general is still relatively large.
Duan Tao said, in the public tertiary hospitals, maternal and child specialized hospitals are less affected. On the one hand, the reason is that these hospitals "specialize", has formed a competitive advantage and competitive barriers, many people will specialize in tertiary hospitals as the first choice for their children. On the other hand, in the past two years, the impact of the epidemic, general hospitals will be more stringent control of the epidemic, many people will also turn to the maternal and child specialty hospitals to give birth to a child.
Liu Yanhui of the CDC, after monitoring the allocation and utilization of obstetric health resources in the cities of Beijing (Haidian District and Chaoyang District), Chengdu, Wuhan, and Shenzhen from 2014 to 2019, found that, "after 2017, except for the public tertiary level, the utilization rate of obstetric beds in other types of midwifery healthcare institutions and the workload of obstetricians have all decreased significantly! ".
In terms of private hospitals, according to Duan Tao, small single private hospitals have been the most affected, they are small, often over-marketed, and lack a good team of experts. The situation of large high-end private hospitals to be slightly better. Duan Tao believes that the head of these hospitals based on early, first-mover advantage, then catch the wind, so there is a faster development, in addition to the brand advantage, so still survive the impact.
The reduction in workload means a reduction in income. Whether public or private, the salary structure of the doctor is composed of basic salary + performance. Wang Xia said her salary was reduced by about 30% in the years of the obstetrics downturn, and Liu Jiangang gave a similar figure, saying it was sometimes cut in half.
Medical staff prepare to monitor the fetal heart of a pregnant woman in the obstetrics and gynecology department of the Hohhot Maternal and Child Health Hospital in Hohhot, Inner Mongolia, Feb. 23, 2022, China. Photo/Xinhua
Zhang Jiewen said that in 2010, her department was so busy that it was divided into maternity I, maternity II, and maternity III sections, with nearly 30 obstetrics and gynecology medical staff. Now that it's been changed to two sections, there are only about a dozen healthcare workers left. "Some midwives have switched careers. There are some attending doctors and above, went to the Handan City hospitals into gynecology doctor, so that the income will be relatively higher."
Wang Xia's department, will be adjusted according to the gynecology and obstetrics ratios. 2016 around the time of the obstetrics and gynecology, there are seven doctors, accounting for the vast majority of the Department of Obstetrics and Gynecology, and in recent years, with the decline in the number of deliveries, the obstetricians began to gynecological mobility, nearly flat.
The Inside Scroll of Obstetrics
The decline in deliveries has been accompanied by an increase in the average age of pregnant women, with several doctors interviewed saying that it is now rare to see first-time mothers giving birth at the age of twenty-four or twenty-five, and that the majority of first-time mothers are in their thirties. Yu Yabin said that the increasing age of pregnant women at first birth means that the risk of giving birth will increase to a certain extent, and from this point of view, obstetricians are facing increasing challenges. "But according to the requirements, the maternal mortality rate must also be suppressed, which is increasingly demanding for obstetrics and gynecology medical technology."
She also explained, "The maternal mortality rate is an indicator of the government's health capacity and is also ranked globally. Every maternal death needs to be discussed in the city, and all the doctors in the hospital, and all the medical staff who have been in contact with the mothers have to be involved, and every time there is a review, there is a lot of tension."
In order to meet the needs of different levels of maternal demand, Yu Yabin also intends to build special needs wards, that is, hardware facilities comparable to a hotel, a cozy environment, comprehensive services VIP wards.
February 16, 2016, Gansu Provincial Maternal and Child Health Hospital from the first day of the first month to the first eight days of the first day of the first month **** ushered in 352 "monkey baby". Figure / Visual China
In Yabin's view, over the past few decades, public hospitals are mainly to solve the problem of whether pregnant women can live in the hospital to give birth to a child, and now the contradiction has become how to let them give birth to the problem of comfort. "This generation of 90 pregnant women are basically only children, since childhood, one person sleeps in a room, and was raised under the care of their parents, where can stand eight people in a room, privacy." Yu Yabin said.
Tiantao County People's Hospital also said it would create a special needs ward. Professor Wang Shijun, director of the Department of Obstetrics and Gynecology at Xuanwu Hospital in Beijing, told China News Weekly that the hospital for the obstetrics ward for the overall renovation and transformation of the obstetrics department, obstetrics staff, obstetrics beds will be adjusted in a timely manner in accordance with changes in maternity, the hospital is also ready to do not limit the filing of the preparations.
Both public and private hospitals have lengthened their service chains. From prenatal care, to postnatal rehabilitation, each hospital wants to do everything possible. Over the past year, the Maternal and Child Health Hospital of Dongcheng District in Beijing has initiated efforts to integrate preconception care with clinical practice. The hospital is responsible for pre-pregnancy and pre-marriage checkups in the district. "During the physical examination, we will find patients who have a need for consultation, including pre-pregnancy counseling and pre-pregnancy consultation. The healthcare hospital hopes to capture these patients and refer them to the corresponding departments in the hospital to address their needs." According to Wang Xia, "In the past, when there were many patients, our work in this area was not done so carefully, and now that there are fewer patients, we hope to provide a more comprehensive one-stop service."
Beijing Xuanwu Hospital and Hebei Guantao County People's Hospital also intend to carry out post-partum rehabilitation clinics to deal with the problems of pelvic osteoporosis and some complications brought about by the postpartum period.
Beijing Dongcheng District Maternal and Child Health Hospital has also established a medical association with Union Hospital, and obstetricians from Union regularly visit the former hospital. Some critically ill patients would have needed to be referred to Xiehe for surgery, but when the experts from Xiehe Hospital came, the patients didn't have to go there. Under the medical model, the Dongcheng District Maternal and Child Health Hospital can also accept some difficult patients.
Despite the introduction of a number of three-child supporting measures around the world, the willingness of women of childbearing age to give birth is the root cause, and among them, the fear of the unknown of labor pain is one of the obstacles to women's willingness to get pregnant. 2017 Shaanxi Yulin maternal Ma Rouyou jumped off the building is an extreme manifestation of the fear of women of the pain and risk of childbirth. In order to increase women's willingness to give birth, hospitals at all levels are also vigorously promoting labor analgesia technology.
When public hospitals start to build special-needs wards, it will invariably eat into the survival space of private hospitals step by step. Private hospitals have always sold themselves on quality service, but the public hospitals are not inferior to the ward environment, lower prices, coupled with high social credibility and high level of medical team, more pregnant women will be attracted to the past.
Duan Tao believes that health care is a heavy asset investment, on average, a hospital opened 5 to 7 years before it will start to make a profit, and the health care industry is not profiteering, so the private maternity specialty field has entered the era of stock competition, the number of private hospitals in the future will be fewer and fewer.
Private maternity hospitals that are still struggling to survive can either broaden their business or transform directly. Liu Jiangang told China News Weekly that some hospitals are vigorously developing private plastic surgery, postpartum medical beauty and other businesses, and some hospitals will retain a small portion of the obstetrics staff and beds, the focus will shift to the development of stomatology business.
Duan Tao pointed out that private hospitals should also be transformed to the academic, improve technology, which is a long-term work; in addition, the original is an incremental era, and now into the era of stock, private hospitals need to operate well, serve the existing stock of customers. Although many private hospitals used to have a monthly child center, postpartum rehabilitation projects, but not a system, should form a professional team to do these services.
"In the future, the obstetrics departments of public and private hospitals will be more and more like each other, the former began to do service, quality, the latter began to improve the delivery and postpartum technology." Duan Tao analyzed.