How can the township hospitals here "reversely suck" the patients and doctors in the city
Liuyang, Hunan: Investigation on the Phenomenon of "Super Township Hospitals" in Xiangxi and Jiangxi
▲At 9:30 in the morning, the waiting hall of Shegang Hospital was already full of people.
Photo by our reporter Zhang Dianbiao
Our reporter Xiang Qingkai, Zhang Dianbiao, Su Xiaozhou, Liu Liangheng, Shuai Cai
With different accents, carrying CT films and X-ray bags from various hospitals... There was a long line in the hospital, and the crowd was humming and talking.
Outside the hospital, cars with license plates from Hunan, Jiangxi and even further provinces blocked for almost 1 km.
The rapid horn sounded one after another, seeming to urge the doctor to see the doctor quickly.
Feng Xia, a 45-year-old medical guidance nurse, glanced at the clock. It was less than 9 o'clock. The electronic caller on the wall indicated that more than 500 patients had been registered.
Experience tells her that the streets of the town have to be blocked for more than an hour, and the same number of patients will flood in the afternoon.
The Orthopedics Hospital of Liuyang City, Hunan Province where Feng Xia is located (also Shegang Town Health Center, referred to as Shegang Hospital) is a remote township hospital located in Luoxiao Mountain in eastern Hunan, surrounded by quiet mountain villages and small market towns.
For the guiding nurse, this kind of crowded scenes that can only be seen in big hospitals in the city is already commonplace.
After being here for 13 years, she met patients from all over the country, and even foreigners in Southeast Asia and Africa.
Understanding the "hometown accent" from all over the world is an essential skill in her work.
Liuyang City is located on the border of Hunan and Jiangxi, east of Jiangxi Tonggu, Wanzai, and Yichun, and south of Jiangxi Pingxiang.
There are several super township hospitals like Shegang Hospital in Liuyang, a county-level city.
Busy as during the Spring Festival, appear in these hospitals every day.
Famous doctors from major hospitals came to "investigate" unannounced visits
For a long time, the "siphon effect" of large urban hospitals has sucked away patients and good doctors like a water pump.
The Shegang Hospital can be called "reverse suction"-"robbing" patients and doctors from large urban hospitals...
According to Changjiang Lin, the Honorary Hospital of Shegang Hospital, the hospital has more than 400 employees. In 2019, its business income was 320 million yuan and the annual outpatient volume exceeded 370,000.
Only 10% of the patients are from Liuyang, and 90% are from other places, focusing on the border areas of Hunan and Jiangxi.
Luo Dingkun, the mayor of Shegang Town, gave a set of comparative figures: The town’s registered population is less than 50,000, and Shegang Hospital brings nearly one million floating population every year.
"A township hospital brings a township to life" has become a consensus in Shegang.
Luo Dingkun said: “The town has formed a supporting industrial chain around Shegang Hospital, including accommodation, catering, transportation, Chinese herbal medicine planting, and nursing. Take the escort as an example, nursing workers can earn 200 yuan a day, more than many young people who go out to work.”
Without exception, the patients came for the "Jiang's Osteopathy".
More than 90% of the patients in Shegang Hospital are treated by this traditional bone reduction method, and the operation rate is less than 8%, while the orthopedic operation rate in general hospitals is about 80%.
Even so, the more than 500 beds in Shegang Hospital are still stretched, and patients are queuing for beds every day.
The head nurse of Shegang Hospital, Yu Ganxiang, told reporters that 270 people are discharged from the hospital every month, and the mobility of inpatients is high. On average, they are discharged every 7 to 10 days to make room for more serious patients.
Chen Hao, who departed from Yichun, Jiangxi early in the morning, took a three-hour car ride to see a doctor. He said that after a local hospital examined his bone injury, it was estimated that it would cost tens of thousands of yuan to heal him. Two thousand yuan.
Jiang Yongge, director of the Orthopedics Office of Shegang Hospital, said that because most of the patients are farmers in Hunan and Jiangxi, in order to save money for the patients, the hospital insists that “ones who can restore their bones will not undergo surgery; those who can go home to recuperate will not be hospitalized.
Many patients treated at Shegang Hospital can go home on the same day of treatment.
The hospital stated that in 2019, they used traditional techniques to reduce the cost of treatment for patients by more than 100 million yuan.
"Word-of-mouth drainage" formed by the high volume of outpatient visits, coupled with relatively low operation rate, hospitalization rate and diagnosis and treatment fees, has attracted patients from all over the country, and even constituted a "reverse suction" for large hospitals.
A doctor at a large hospital in Changsha City saw his patients continue to run to the Hong Kong Hospital, and he suspected that the township hospital had hired a "medical trust" to dig out patients.
For this reason, he made a special drive to the community to make unannounced visits, which dispelled suspicion.
Shegang Hospital doctor Liu Yukun said frankly that out of suspicion or curiosity, many famous doctors in major hospitals have privately "investigated" Shegang Hospital.
The patient population spreads from word to mouth, so that the reputation of the community hospital has spread farther and farther.
Last year, Mao Xianguang, deputy dean of the Stanford University Medical Center, director of orthopedics, and joint replacement expert, and Professor Xin Zhenkai of the Bone and Joint Orthopedics Center of Hong Kong Queen Mary Hospital also came here.
In Liuyang, Jili Hospital is also an impressive super township hospital.
As the only township hospital in Hunan Province that has an intensive care unit and can perform craniotomy, in March this year, Jili Hospital ranked among the "Top 300 Comprehensive Stroke Prevention Centers in China" issued by the National Health Commission.
According to Chen Xiaoling, Dean of Jili Hospital, the hospital features neurology, ophthalmology and pain departments. 30% of patients come from outside Liuyang, covering the vast areas of Hunan, Jiangxi, Hubei.
Last year, Jili Hospital received nearly 500,000 outpatient visits, with revenue of 368 million yuan, 98.51% of inpatient satisfaction, and 97.7% of outpatient satisfaction...
Shegang Hospital and Jili Hospital not only attracted patients but also doctors.
Take the Shegang Hospital as an example. Among the more than 160 doctors at present, 20 have voluntarily moved over from county-level hospitals in other places.
At the moment when most of the township hospitals are “marginal” and “cold out”, Shegang Hospital and Jili Hospital are just like those super hospitals with large scale and many patients in big cities, and their “reverse suction” effect is breathtaking.
"It's not expensive to be optimistic about the disease, of course we choose us"
Super township hospitals are not built in a day.
Bei Yuzhang, the 52-year-old director of the Department of Neurology of Jili Hospital, came here in 1995 when the township hospital was tossed with anemia.
At that time, the Jili Hospital had less than 30 employees, 30 to 40 outpatient visits per day, and only a few patients on observation and almost no inpatients.
As in the situation of many township hospitals, local patients would rather go to the large hospitals in the city to wait in long lines and spend high prices than to go to the Jili Hospital for treatment.
Unable to retain doctors, unable to recruit new people, Jili Hospital is caught in a vicious circle of "lack of doctors-no patients-unable to retain doctors-unable to attract patients...".
Jili Hospital is located in the suburbs of Liuyang City. There is a village clinic below and a county hospital above. You must find a living space in the cracks.
In 1995, Jili Hospital established a stroke specialist.
Prior to this, the Jili Hospital did research and found that stroke, cataract and chronic pain are the most common diseases in Liuyang.
But until Chen Xiaoling took over as the dean in 2005, there were still only 30 or 40 patients in the stroke department of Jili Hospital, which was already "ten years old".
Self-rescue starts with "blood transfusion".
In 2005, Jili Hospital hired Qi Haobo, a neurology expert and deputy chief physician, from the Fourth People's Hospital of Hebei Province.
This is the first case of Liuyang introducing foreign talents into a local hospital.
The conditions offered at that time were an annual salary of 100,000 yuan and an additional house of 168 square meters. Qi Haobo's wife's work was also arranged.
This recruitment became a sensational news in Liuyang that year.
You know, the annual income of employees of Jili Hospital was only 10,000 to 20,000 yuan.
Qi Haobo soon became the leader of the neurology department and began to train the talent team of Jili Hospital.
From 2005 to 2020, Jili Hospital has introduced 66 mature talents.
Chen Xiaoling said that cultivating a mature doctor will not work in less than 8 to 10 years, and the hospital has completed the "blood transfusion" quickly through the introduction of talents.
At the same time, Jili Hospital is also actively self-made blood.
Bei Yuzhang recalled that since 2006, Jili Hospital began to send people to major hospitals to study. Wherever there are good resources, Jili Hospital will do everything possible to "cram" doctors there.
Intravenous thrombolytic therapy is an important treatment measure in the acute stage of ischemic stroke. After hearing that Tianjin Huanhu Hospital has done a good job of thrombolysis, Jili Hospital sent the backbone of the stroke department to "get the experience."
After studying, Jili Hospital successfully opened thrombolytic business.
In fact, many large hospitals tend to ignore the doctors sent by township hospitals for further training.
The management of Jili Hospital was able to send their doctors into the "class" one by one with a smile, a soft and hard bubble, and asking for help.
Huang Pujia, 38, is a doctor in the intensive care unit of the hospital and the doctor who performed the craniotomy in the hospital. He has a deep understanding of Jili Hospital's determination to send the doctor out.
"When some critically ill patients are sent to the hospital, they must have their craniotomy immediately before they can be saved. Ten years ago, no one in our hospital would have this operation and could only be referred." In order to win precious life-saving time for the patients, Huang Pujia has three times. I went to Xiangya Hospital and China-Japan Friendship Hospital to study. It took one year and three months to master craniotomy.
As of the end of September, Jili Hospital has completed 95 craniotomy operations this year.
"During the study period, the salary performance of medical staff remains unchanged, so that everyone has no worries." Huang Pujia said, "The hospital will give full support to doctors in any aspect of technology they want to learn."
Bei Yuzhang said that 30 to 40 people go out to study in the hospital every year. The hospital currently has 751 employees, including 281 with intermediate and senior titles and 26 graduate students.
Among stroke patients in Jili Hospital, rural patients account for 90%.
In order to reduce the burden on patients, the hospital carefully planned and strictly controlled the procurement cost of medical consumables.
For the same purchase of a bracket, some large hospitals cost 20,000 yuan, but Jili Hospital just cut it down to 15,000 yuan... Some consumable suppliers felt that they were earning less and would rather not do business in Jili Hospital.
Chen Xiaoling told reporters: "Jili Hospital is applying for tertiary hospitals, but the fees have been maintained at the level of township hospitals. Even for a more expensive craniotomy, it only costs 20,000 to 30,000 yuan, which is only about half of that of the provincial tertiary hospitals. ."
"It's not expensive to be optimistic about the disease. Of course the patients choose us." Chen Xiaoling said that this is the secret of Jili Hospital's solution to the development dilemma of primary hospitals.
A similar scene also happened in Shegang Hospital.
"I can't see so many patients alone, and the key is to rely on the hospital's talent team." Talking about how to retain talents, Jiang Lin said that social hospitals retain people through treatment, career, and emotion.
In terms of remuneration, the annual income of doctors in social and Hong Kong hospitals ranges from 100,000 to 200,000 yuan, not lost to county hospitals.
During the interview, many doctors from the Social Hong Kong Hospital admitted that there is no need to worry about survival, let alone making money from patients.
You only need to work hard and work hard to do something professionally, and you and your family can live a decent life.
In terms of career, Shegang Hospital gives doctors a faster growth opportunity.
Liu Yukun, who came over from Hunan Pingjiang County Hospital of Traditional Chinese Medicine, said: “It usually takes 10 to 15 years or even longer to train a surgeon who can be on his own. The surgeons in the social port hospitals have a lot of contact with patients, often less than 10 years. Can mature."
Jiang Lin believes that this is one of the reasons why many hospitals tried to recruit doctors from Hong Kong hospitals but failed.
Behind the super township hospital group
It is not easy for a county-level city to have a super township hospital. Now a group of super township hospitals have emerged, which has to be amazing.
Xiao Bo, deputy director of Liuyang Municipal Health Bureau, introduced that there were 35 township hospitals in Liuyang. Last year’s medical business income was nearly 1.2 billion yuan, with the largest one exceeding 300 million yuan, and 10 township hospitals with an annual income of more than 50 million yuan. .
When most of the township hospitals were still unable to retain local patients, the medical consultation rate in Liuyang City had reached 96%.
“The prerequisite for retaining patients is to retain good doctors, and to retain good doctors, there must be an incentive mechanism.” Wang Keming, Chief of the System Reform Section of Liuyang Health Bureau, believes that “a reasonable incentive mechanism is the way that Liuyang township hospitals can The key to growing against the trend."
Liuyang allowed to break through the total performance salary limit of public welfare institutions, and the hospital used 60% of the balance of income and expenditure for the total performance salary of medical staff.
Doctors’ income is decoupled from drugs and linked to workload.
In addition, Liuyang implements a standardized treatment plan. For the same disease, which hospital sees it, the process and cost are the same.
At the same time, Liuyang City Health Bureau requested that income distribution be tilted toward the clinical frontline.
The performance distribution plan of each hospital is determined by the hospital itself, but it needs to be reviewed by the Health Bureau and filed with the Human Resources and Social Security Bureau and the Finance Bureau.
"In our Liuyang hospital, the highest salary is not the dean, but the academic leaders and first-line experts." Wang Keming said, "Some doctors earn five or six times that of the dean."
In addition to performance reforms, Liuyang also has “two brushes” of “empowering township hospitals” and “creating specialty specialties”.
Wang Keming said that performance reform solves the problem of willingness to do it, and empowering township hospitals solves the problem of whether or not they can do it, and the problem of what can be done to create a special specialty.
"Empowering township hospitals", in addition to empowering talents through "inviting in and going out", it also empowers the hospital as a whole through the "medical consortium" mechanism.
The Longfu Town Health Center in Liuyang relied on the medical consortium to “resurrect the dead”.
In 2008, Longfu Town Health Center and Jili Hospital formed a medical consortium.
Dean Liu Xiangqian introduced that before 2008, the Longfu Town Health Center had fewer than 3,000 outpatient visits a year, less than 400 hospitalizations, and an annual business income of only 900,000 yuan.
"Jili Hospital's assistance to Longfu Town Health Center is divided into three steps, namely, getting up, walking with you, and letting go." In Liu Xiangqian's view, this is similar to targeted poverty alleviation.
From 2008 to 2013, during the "supporting" phase, Jili Hospital sent key personnel to invest in medical equipment to "charge" the Longfu Town Health Center. A dozen key personnel stayed for three years.
From 2013 to 2016, in the “accompaniment” phase, only the deputy dean who managed the business was left, and medical experts were sent to conduct regular rounds, training and lectures every month, focusing on cultivating the talent team of the Longfu Town Health Center.
Since 2016, let the Longfu Town Health Center manage and operate it by itself.
In 2019, the total income of Longfu Town Health Center reached 16.85 million yuan, the number of outpatient visits exceeded 30,000, and the number of hospitalizations reached 4462.
Liu Xiangqian said: "Not only did the patients who had originally been outflow returned to the health center, 20% of the inpatients came from other places."
The so-called 20% of the inpatients in the Longfu Town Health Center are mostly from Shegang Town.
The local officials said that the super township hospitals in Liuyang are not competing for homogeneity, but for differentiated and misplaced development, creating specialties with regional characteristics.
The specialty of Shegang Hospital is Orthopedics of Traditional Chinese Medicine, while the specialty of Longfu Town Health Center is chronic diseases.
In addition, there are the Department of Neurology, Ophthalmology, Pain in Jili Hospital, the Department of Hyperthyroidism in the Jichong Town Health Center, the Department of Traditional Chinese Medicine in the Gugang Town Central Health Center, and the Pain Rehabilitation Department in the Dayao Town Central Health Center...
In order to ensure the development of specialty businesses, and to implement the national essential drug system and medical reform policies, Liuyang divested specialty businesses, such as the establishment of Shegang Town Health Center and Orthopedics Hospital, Jili Sub-district Community Health Service Center and Jili Hospital.
Community health service centers and health centers implement grassroots medical reform policies, implement basic medical care and public health, and specialty hospitals implement public hospital reform policies.
Two institutions, two sets of management systems, the same legal representative, large-scale equipment resources are shared, basic medical services are implemented in health centers, and specialized medical services are in specialized hospitals.
Performance reform, empowering township hospitals and cultivating key specialties-Thanks to the "three brushes" of Liuyang's grassroots medical reform, Liuyang super township hospitals have gathered and gradually become a medical center in the border region of Hunan and Jiangxi.