Downtown expansion of large hospitals,

health care resource distribution imbalances alert

Nanjing Daily 

 

    City MCH new building next month, Provincial Hospital South expansion project completed in the second half of next year, the Drum Tower Hospital extension, expansion of the Provincial People's Hospital ... ... 20 tertiary hospitals in Nanjing, more than half completed or are being expanded.

    Extension is to ease the "Medical treatment is difficult," but also makes a more uneven distribution of medical resources.

    Held last month to speed up the work of the forum on the reform of public hospitals, Health Minister Chen Zhu, the expansion of large hospitals eloquently disadvantages. He noted that the concentration of resources to major hospitals, resulting in increasing medical costs, and ultimately exacerbate the medical treatment is difficult and expensive.

    In Nanjing, the provincial and municipal governments have clear requirements: strict control of large hospital expansion plan in the Old City and the District of medical resources between the equilibrium distribution. Health authorities have also been shot, and guide health care resources to invest in Hexi New City and Xianlin, Dongshan, Jiangbei New City and other "one city, three districts."

    Group of newspaper reporters depth reports Charles Jin Zhong Jian Xu Jing

    "Pie", more than half of tertiary hospitals in Nanjing to join the expansion wave

    "Parking is full," from a distance to the brand, Mr. Zhu angry, anxious.

    Son the day before yesterday night fever, 小朱 not neglect, and yesterday morning with his son to the Children's Hospital for treatment. Because live Xianlin, eight in the morning he left home before eleven counting to "get." I did not expect, "Light in Guangzhou on the road to block for an hour!" Even worse, how can not find a parking space. Watching his son's face was burned bright red, Chu furious: "We live in New City, a disease not easy to see!"

    Parking is difficult in patients with sighs, hospital staff also "suffer a lot."

    In order to give priority to patients, First Hospital, City Hospital have provided dental, hospital workers are not allowed to park the vehicle into the hospital, stop looking for a place on the outside; South East Affiliated Hospital of Medical School sophomore, is on the internal staff huh " odd-even rule stop "; Children's Hospital, although hospital staff parking permit, but must be stopped before eight o'clock, after eight to stop, then it is" extremely difficult. "

    "Road is hard, the car difficult to stop because of high-quality medical resources are concentrated in the old town center." Zang director of the city hospital changed to following all said that the Nanjing region is home to 20 tertiary hospitals, the majority concentrated in the Old City, especially Drum area, some places even a six or seven km from large hospitals. For example, Guangzhou Road to the Drum Tower area, the focus of the Provincial People's Hospital, Drum Tower Hospital, Children's Hospital, Brain Hospital, Chest Hospital, City of oral Seven or eight large hospitals and other hospitals; Hanzhong Road area, the "assembly" of the Provincial Hospital Provincial Dental Hospital, the city Maternal and Child Health Hospital, Friendship Hospital, Southern Medical University, Southeast University Eye Hospital. From the Drum to the Hanzhong Road, just a few kilometers away.

    Right now, this concentration intensified. 

    Since 2007, launched a site of major hospitals in Nanjing, "the expansion wave":

    Drum Tower Hospital South expansion project began in 2005, total construction area of the hospital will be expanded three times, nearly double the number of beds;

    Provincial People's Hospital West Expansion Project in December 2009 held a groundbreaking ceremony, the new construction area of 227,200 square meters, of which the area for the Emergency Department will expand 3 times, new beds 1500;

    Provincial Hospital outpatient expansion construction is in full swing, the clinic will nearly double the area of the hospital expansion project is expected late next year the South completed, then the equivalent of a Provincial Hospital of recycling;

    First Hospital Medical Building in March of this year just completed and put into use, began a new round of infrastructure projects, and work is currently being driven "expansion of outpatient and emergency wards transition";

    In addition, the Military General Hospital, Children's Hospital, the city MCH, Brain Hospital, City Dental Hospital, four hundred fifty-four Hospital, Bayi Hospital, Affiliated Zhongda Hospital of Southeast University ... ... According to incomplete statistics, in recent years, have completed or under construction of medical buildings tertiary hospitals, which account for more than half.

    Less government investment, expansion of large hospitals for profit maximization in situ

    For historical reasons, Nanjing high-quality medical resources are mainly concentrated in the old city. The focus in recent years launched a large hospital renovation and expansion project, in addition to the rapid growth of medical needs, there is a background that coincides with the international financial crisis, to catch the "expansion of domestic demand," the wind. Informed sources, the international financial crisis, the city approved a large hospital renovation and expansion project at least seven.

    "Expansion is to maximize profits, if not fame and fortune, survival and development come about?" Person in charge of a large hospital in the provincial interview gave away the key, "government funding accounts for only 5 of the total cost of hospital -8%, bursts of retired workers wages are not enough. "He also added a sentence comment.

    Currently, the main source of income for public hospitals, there are three: First, medical technology fees, laboratory tests is to check the income of the second and third, drug addition. Zang told reporters following a full, long time, in the case of a serious shortage of government investment, public hospitals are relying on self-income living. Hospitals can accommodate more patients, the more revenue. In the interests of the driver, the hospital is difficult to restrain the expansion of impulse. And large hospitals to maintain superiority, exclude competitors, a hospital expansion, the expansion of its competitors must have, and this vicious cycle.

    In addition, the reporter learned that, in the administrative system, and medium-sized public hospitals are always easier to get government support, easier access to relevant project approval project, more financial allocation for greater amount of money, so "bigger is better" public hospitals to become the general interest demands.

    So why not a large new city hospitals new site, but have chosen to place the new expansion?

    "New remote site, the hospital faced a large expansion of economic pressure than in situ." Zang said, following the whole, large hospitals are now "overcrowded", local expansion, it will demand "in situ digestion", the risk is small. But if the Metro expansion, outpatient, hospital bed utilization rate of compliance can quickly produce benefits? Hospital expansion, the new capital mostly to the bank debt, the repayment pressure, natural to choose the most profitable way to achieve the greatest short period of time. 

    "Site of the expansion will also help resource optimization and sharing." Municipal Health Bureau, Deputy Director of Planning and Finance, said Geng Wen Jin, easily tens of millions of large-scale screening equipment, a hospital can not buy two, in-situ expansion of overall arrangement is conducive to the hospital resources.

    Matthew health care market to develop, the patient pays the bill, "urban disease" increase

    High concentration of quality resources, the Matthew effect in health care market to develop worrisome.

    According to statistics, the end of 2007, Nanjing, the largest number of hospital beds per thousand of the Drum area, as 9.50; at least the Jianye District, for 0.32. With the old city after another major hospital expansion project completed, the spatial distribution of high-quality medical resources imbalances. According to latest statistics from the Municipal Health Bureau, in 2009, although the number of beds Jianye District of thousand to 4.08 from 0.32, but the number of the Drum Tower area also soared to 13.26; and ranked next to last in the Jiangning, Pukou, Yuhuatai three areas, two years, respectively, an increase of only 0.49, 0.25 and 1.08.

    Matthew the other side of the medium and small medical institutions "and the poor poorer."

    Tai Kwong Road Community Health Service Centre Cao Songhua that the expansion of large hospitals money, compared to more community health centers at a disadvantage. In 2009, community health centers in Nanjing was only 51.8% of beds in use, only 34.9% of hospitals is far lower than the two above 101% of medical institutions. Cao Songhua said that patients also believe that the prevalence of large mental hospitals, at this stage of the expansion of large hospitals, community health care to a large hospital is not "streaming", but is a large hospital triage of patients to the community, and new medical reform "strong grass-roots" of the mind the opposite direction.

    Blind expansion, large hospital itself will suffer.

    A large municipal hospital, Assistant Dean told reporters that although most of the top three hospitals in Nanjing overcrowding, but most are still losing money. Among these, the "debt 盖楼" overhead can not be ignored. The future, "community first diagnosis" Once the formation of climate, large quantity of hospital outpatient and emergency hospital admissions and the inevitable decline. Now large-scale expansion, perhaps in the future there will be idle and waste of resources.

    The result of an imbalance of medical resources, the patient must pay the bill.

    Hospital under the pressure of the heavy loan repayment, the financial burden will inevitably be passed on to patients, thus further increasing your doctor. In addition, the internal management of hospitals in general are not high, the increasing scale of the hospital has undoubtedly increased the difficulty of management, will make a lot of "doing it" even worse. Such as the decline in medical care quality, increase "nosocomial infection", medical risk and so on. Major hospitals in the densely populated old city create a lot of medical waste, in recent years also increasingly becomes a topic.

    Experts pointed out that the expansion of large hospitals in fact have been far beyond the medical malpractice context, as "urban disease" in an increasingly difficult to ignore the phenomenon.

    In the traffic control department of the city has 10 points in the survey block, University Hospital became the focus area "disaster area", such as "hospital street" Canton Road, among the best in the congested sections of the survey;

    "Many thing to many, many cases will," which is a big police station area of hospital director of the concise summary. He said that the large flow of people in front of a large hospital complex components, focused on social conflicts, there are "street fraud and more electric cars stolen more and more conflicts and disputes, illegal traders and more" of "four more" phenomenon, involves a large number of security police . This reporter learned that most tertiary hospitals in Nanjing, the public security organs have the presence of the police room. 

    Health authorities shot and guide health care resources towards "one city, three areas"

    "Should not be expanded tertiary hospitals, medical resources should be expanded Metro." Zang said, following the whole health sector, large hospitals have already noted that expansion of the evils, and set limits.

    Reporter noted that in October this year, the provincial government issued "to encourage and guide the healthy development of private investment in the implementation of opinions" expressly provides that "strictly control the expansion of the existing public hospitals."

    The Nanjing municipal government last year introduced the "Nanjing Medical Institutions (2009-2015)," also stipulates that "the existing three hospitals, in addition to Children's Hospital and Child Health Hospital, the scale should not be expanded."

    At the same time, planning guidance in the "one city, three-zone" set up large medical institutions, in Hexi New City, Xianlin, Dongshan and Jiangbei New City, a large integrated the new tertiary hospital: Jiangning Tongren Hospital, the hospital has been opened west BenQ , Drum Tower Hospital Xianlin Xianlin International Hospital is under construction, and Jiangbei will enhance an existing two hospitals. 


    In addition, the plan also encourages the major hospitals in urban areas through participation in management, technical cooperation, to strengthen Xin Cheng Xing specialist shortage, especially pediatric, obstetrics and gynecology power. It is reported that the Provincial People's Hospital have all gynecological and pediatric inpatient wards moved to the west branch; Pukou First Hospital and Central Hospital to reach a comprehensive agreement, sending Obstetrics and Gynecology, big surgery, ENT and the chief physician to the nursing Zuozhen, and participate in management.

    The reporters also learned to adapt to the rapid development of new city, the city health department is preparing a new round of development of new district health programs, will be in the Hexi New City, South Park, Kirin Metro, North Metro and other new construction of four major Metro City Medical Center.