How to evaluate the expansion of China's public hospitals

The problem of blind expansion of public hospitals has a long history. Since the launch of the new healthcare reform, some public hospitals, including large public hospitals, have tried their best to build buildings, spend a lot of money on new equipment, or expand their operations by taking over, "accepting as a whole", establishing branch hospitals, or selling hospitals sold in the past few years, which have been transformed into private hospitals and re-purchased for their own. These blind expansions directly impede the goal of balanced distribution of medical resources, and will further divide the market of primary care institutions and private hospitals, strengthen the patient's dependence on large urban hospitals, weaken the patient's trust in private hospitals, and form a "bigger and bigger, smaller and smaller" and "stronger and stronger hospitals" in the city between large hospitals and primary care institutions, and between public hospitals and private hospitals. "and" the strong stronger, the weaker, the weaker" the "Matthew effect".

In addition, public hospitals indulge in "on the scale, on the grade" of the expansion of the impulse can not be extricated, will inevitably fall into the trap of indebtedness, and even into a serious debt crisis. According to the Guangdong Provincial Health Department, deputy director of Liao Xinbo, more than 200 hospitals in the province in recent years, the survey shows that the average hospital liabilities accounted for 23.14% of the total assets, and some even more than 300%. This "high debt for high-speed development" model, and in recent years many universities in the process of large-scale enrollment expansion, a large area of land owed a huge amount of debt in the same way. Some colleges and universities are unable to cope with the heavy burden of debt, had no choice but to sacrifice the "sale of land to pay off the debt" trick, those with debt ratios of more than 300% of the public hospitals, about from the "sale of land to pay off the debt" of the fate is not far away.

The blind expansion of public hospitals to such a point, there are three main reasons. First, some public hospitals inaccurate positioning, target disorder. State-run public hospitals, the most central purpose is to provide basic medical services for the public to meet the public's basic health care needs. The most essential feature of this purpose is public welfare. And some public hospitals "bigger and stronger", mainly to occupy more medical resources, occupy a stronger market position, to earn greater profits, their purpose precisely deviates from the public welfare, can be said to be "blind" of the very same.

Secondly, some people in charge of public hospitals, as well as some officials in charge of local authorities, have incorrect expectations of the new health care reform program to increase investment in public hospitals, that the bigger the plate of public hospitals, the more financial investment can be "extracted", and therefore try to make public hospitals bigger and better. The more the plate is spread, the better.

Thirdly, under the current system, some heads of public hospitals and officials in charge of public hospitals do not need to bear the responsibility for the inefficiency, waste, and high indebtedness in the process of expansion of public hospitals, but may be able to obtain actual benefits from the large-scale infrastructure, equipment purchases, and human resources deployment, and even artificially create some opportunities for rent-seeking and corrupt transactions, so what is the point of not doing it?

The right medicine, first of all, the governments and medical administrative departments at all levels, should be the region, the system of public hospitals for the public welfare of a clear position, from the strategic height of development planning and improve the management of the tactical point of view, to curb the tendency of public hospitals to profit-seeking, to prevent it from departing from the public welfare of the original position. Secondly, the state's investment in public hospitals, must be complete, detailed in the government budget, and receive the supervision of the National People's Congress; audit organs should be rigorous performance audits of these inputs, through the public release of the audit report, to explain to the public public hospitals to spend the money on what, how effective, what problems exist, and so on.

Once again, there is an urgent need to establish a complete incentive and restraint mechanism and strict accountability mechanism. The person in charge of public hospitals need not only in the development and reform of public hospitals to obtain due professional achievements, performance evaluation and professional honor, to achieve personal values and aspirations, but also need for their own decision-making and management behavior to bear due responsibility, including for decision-making errors, management misconduct to bear the party disciplinary and administrative responsibility as well as legal responsibility. The traditional operation mode and management system of "I have a share of the profit, the loss of the country to cover the bottom" and "the achievement is attributed to me, the error of the collective responsibility" can no longer be continued under the conditions of the new health care reform

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