Worries and Thoughts on China’s Medical Reform in 2016

　　In 2016, China's medical reform will officially enter a critical stage of public hospital reform. Due to the large size of public hospitals and the wide range of services, they are the most important step in determining whether China's medical reform can truly succeed, truly satisfy the people, and truly promote the healthy development of medical and health care.

　　2016 can be said to be a tough, critical and deep-water year for China’s medical reform. Looking forward to China's medical reform in the new year, I have a few concerns that I feel are worth mentioning and discussing with those who are concerned about China's medical reform:

　　The first concern is whether eliminating the need for drugs to support medical care will make medical treatment cheaper and more satisfactory for the masses.

　　Jiangsu Province, now a national pilot for medical reform, took the lead in achieving zero margin for drugs in public hospitals in October 2015. However, this decisive step in the reform did not allow the public to experience obvious benefits of medical treatment! Because the inflated and expensive drug prices did not arise from the 15% hospital markup. Moreover, the cancellation of drug markups in public hospitals, a seemingly normal and ordinary medical service market behavior, has a serious impact on the survival of public hospitals that far exceeds the expectations of leaders and experts. With the government's special subsidy increased by 30% and the price increase of medical services reduced by 60%, the vast majority of public hospitals will likely experience comprehensive scarcity and losses. On the one hand, canceling the use of medicines to support medical care has not made medical treatment cheaper and more satisfying for the masses; on the other hand, canceling the use of medicines to support medical care may make public hospitals unable to survive. This is a cruel fact that deserves great attention from China's medical reform policymakers.

　　The second worry is that the reform of the three medical institutions is not coordinated, and public hospitals are swimming blindly in the deep end.

　　The office of China's medical reform is located in the health administration department, which has leadership and command authority over public hospitals. The Medical Insurance Bureau, which is located in the Ministry of Human Resources and Social Security, has no command and decision-making power. It also has little decisive effect on the circulation and pricing of medicines. Therefore, the simultaneous promotion of medical, medical insurance, and pharmaceutical reforms is only a theoretical possibility. The reality is that medical insurance still determines its own reimbursement policies based on its own funding situation, regardless of whether public hospitals are reformed or changed. There are many cases where medical insurance policies and medical reform policies in various places run in opposite directions. There are many phenomena that encourage large-scale care for minor illnesses, encourage concentration in large hospitals, and cause public hospitals to generate a large amount of bad debts. The pharmaceutical industry itself is still inflated, unwilling to cut prices, and unwilling to release meager dividends to hospitals that sell 80-90% of the domestic pharmaceutical market. This is also a key factor. In fact, if public hospitals cannot survive, it can be said that the pharmaceutical industry will not survive either.

　　The third worry is that public hospitals have no autonomy and the treatment of medical staff has declined.

　　The modern hospital management system cannot just stay on words and paper. Hospitals should be given appropriate autonomy in regular management. In the current medical reform, the independent operation and management rights of hospitals are not guaranteed, but have gone backwards. The hospital has almost lost its management rights, personnel rights, decision-making rights, and rewards and punishment rights. Medicines cannot be chosen and negotiated by oneself, and equipment cannot be purchased independently. The superior departments are happy to manage these hospital management matters that are not their responsibility, and they are not proficient and professional. Still happy with it, unwilling to delegate power to the hospital. The hospital also has no autonomy in recruiting talents. The introduction of high-end and urgently needed talents also requires complicated procedures for public recruitment of civil servants, which has resulted in the loss of many professional talents urgently needed by hospitals and has become a shortage. Internationally, the characteristics of medical personnel such as late maturity, high risk, and continuity of work determine that their remuneration is much higher than that of many social industries such as civil servants and teachers. However, if the remuneration of Chinese medical staff is not implemented in the medical reform, or if it declines instead, it will ultimately be the interests of patients and social functions that are damaged and affected.

　　The fourth worry is that China's medical reform lacks top-level design and sufficient investigation and research.

　　There are now many documents on medical reform in various places, and one province or city can issue ten or twenty supporting documents in one year. It makes public hospitals feel very messy, with a hammer in one place and a stick in the other. China's medical reform should be fully investigated and researched and top-level design should be strengthened. Develop a practical three-year plan and goals. Several goals every year, continuous reform, continuous improvement, continuous matching, and continuous advancement. China's medical reform must adopt practical measures and focus on practical results. Only in this way can China's medical reform be grounded, have positive energy, and satisfy society, the people, and hospitals. Jiangsu has begun to explore, and we hope that China’s medical reform and Jiangsu’s medical reform will see spring in 2016!