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The scale and growth of China's rehabilitation medical market in 2013-2015 (data from: China Market Research Network) 
There are several top three hospitals near the exhibition road hospital 
Changes in business data after the transformation of rehabilitation hospitals in Exhibition Road Hospital
How do secondary hospitals that survive in the cracks of large hospitals counterattack?
At present, the second-level public hospitals in many places are gradually transforming into rehabilitation hospitals. How do they seek to survive in the cracks? How are these transitional secondary hospitals going? What are their implications?
Recently, Wang Xuesong, dean of the Exhibition Road Hospital of Xicheng District, Beijing, gave an answer at the “Medical and Reconstruction Capacity Building Seminar†organized by the Center for Capacity Building and Continuing Education of the National Health Planning Commission. The secondary hospital should be accurately positioned and Specialized rehabilitation medical institutions.
In the process of transformation, Exhibition Road Hospital has formed its own service characteristics, and has deepened and cultivated many rehabilitation sub-specialties such as orthopedics, heart, gynecology and neurological diseases.
Moreover, with the development of rehabilitation technology, the proportion of hospital drugs decreased from 55.08% in 2010 to 36.06% in 2016. The use rate of antibiotics also dropped significantly, from 75.82% in 2010 to 40.63%. The hospital not only attracted the elderly who need rehabilitation, but also attracted a group of young patients.
Rehabilitation medical services are far from meeting market demand
In Wang Xuesong's view, the transformation of secondary public medical institutions into rehabilitation is both market-driven and necessary for the situation.
As China enters an aging society, China's rehabilitation medical market is in strong demand and is showing a “spurt†growth. According to statistics from the White Paper on China's Pension Industry Development, in 2016, China's population aged 60 and over exceeded 230 million, accounting for 16.7% of the total population, and the number of elderly people over 60 years old is growing at an annual rate of 10 million. Six to seventy percent of people need rehabilitation services. In addition, the number of disabled people exceeds 85 million, the proportion of the population is about 6.21%; the number of chronically ill patients is as high as 260 million. These two large groups are also the main target of rehabilitation medical care.
Compared with the rapidly growing demand, the medical resources for rehabilitation are far from meeting the rehabilitation needs of people, and the rehabilitation medical institutions and beds are still in short supply.
According to the "2014-2018 China Rehabilitation Medical Industry Development Trends and Development Strategy Research and Analysis Report" data shows that there are about 3,000 general hospitals in China with rehabilitation medicine departments, accounting for only 24.6% of the total number of national comprehensive hospitals, of which only half are There are rehabilitation wards; 338 various types of rehabilitation hospitals, rehabilitation beds only accounted for 1.18% of the total number of beds in the national health institutions. In Shanghai, for example, only one out of every 60 patients who need rehabilitation can be hospitalized for rehabilitation.
The situation that the supply of rehabilitation medical resources is in short supply is also reflected in the market scale.
According to the data from the China Market Research Network, the size of China's rehabilitation medical market in 2016 was 50 billion yuan, and the average per capita was about 38 yuan. At present, the size of the rehabilitation medical market (including long-term care) in the United States has exceeded 200 billion US dollars, and the average per capita is about 800 US dollars. According to the market size, China's rehabilitation medical market is still less than a quarter of the US, while China's per capita rehabilitation medical expenses are less than 5% of the US.
In order to encourage and support the development of rehabilitation medical care, the Chinese government introduced a series of policies during the 13th Five-Year Plan period. Among them, the Ministry of Human Resources and Social Security, the Ministry of Civil Affairs of the National Health and Family Planning Commission, the Ministry of Finance, and the China Disabled Persons' Federation jointly issued the "Notice on the New Medical Rehabilitation Projects to Be Covered in the Payment of Basic Medical Insurance," which mentioned that the State has increased rehabilitation. 20 rehabilitation projects such as assessment were included in the scope of medical insurance payment.
In this regard, Wang Xuesong believes that "the settlement of the payment problem will certainly promote the popularity of rehabilitation medical care."
However, the actual social environment is not optimistic about the development of the rehabilitation medical market.
Apart from the two problems of imperfect rehabilitation medical service system and insufficient total rehabilitation institutions, the other two problems that need to be urgently solved in the development of the rehabilitation medical market are: lack of rehabilitation professionals and weak ability of rehabilitation medical services.
In terms of professional talents, according to the 2012 report of the National Health and Family Planning Commission, China needs 114,700 rehabilitation therapists at this stage, with a gap of 100,000. In terms of rehabilitation medical service capabilities, China's Rehabilitation Medicine currently only meets 20% of rehabilitation services, and rehabilitation medical expenses only account for 1% of expenditure.
The secondary hospital is the main battlefield of rehabilitation
For the existing public medical institutions, the two best-developed hospitals are tertiary hospitals and primary-level hospitals, and the secondary hospitals sandwiched between them are in crisis. How to transform the secondary hospital is also an urgent concern in the industry.
At present, some provinces and cities in China have gradually transformed some public hospitals into rehabilitation hospitals, mainly in primary hospitals and secondary hospitals. Shanghai and Beijing are doing this.
Taking Beijing as an example, in 2016, Beijing Municipality first identified Xicheng District Exhibition Road Hospital, Chaoyang District Nanjianfang Community Health Service Center, Sun Palace Community Health Service Center, Daxing District Red Star Hospital, Changping District Nankou Railway Hospital, Pinggu District Jinhai Six institutions including the Huzhen Community Health Service Center have been transformed into rehabilitation hospitals and communities.
In 2017, Beijing also identified 6 institutions including Xicheng District Guangwai Hospital, Haidian District Yangfangdian Hospital, Fengtai District Tieying Hospital, Tongzhou District Second Hospital, Huairou District Tanghekou and Fangshan District Hancunhe Community Health Service Center. Transformation.
Wang Xuesong shared that it is closer to residents, and the first- and second-tier hospitals in the urban area have geographical advantages in the process of transition to rehabilitation.
Why do you say that? As far as the rehabilitation hospitals that have begun to take shape in Beijing, the public Xiaotangshan Rehabilitation Hospital, the Beijing Rehabilitation Hospital affiliated to the Capital Medical University, the Affiliated Rehabilitation Hospital of the National Rehabilitation Deputy Research Center, and the Peking University Rehabilitation Hospital for social capital investment, and Home rehabilitation hospitals, Yuhe Rehabilitation Hospitals, most of these rehabilitation hospitals are located around the city, with long distances and tight beds. The rehabilitation hospital in the city center is only one of Beijing Boai Hospital.
“Obviously, rehabilitation medical institutions in the urban areas that are closer to residents are still a blank point in the market and a development opportunity for rehabilitation medical institutions,†said Wang Xuesong.
However, the process of transitioning these primary or secondary hospitals to rehabilitation institutions is not easy. Wang Xuesong summed up some of the difficulties in front of him and proposed some solutions. The main points are as follows:
First of all, the medical resources of the secondary general hospital are worse than the top three hospitals. For example, the overall strength is weak, the medical characteristics are not obvious, the medical technology is low, the medical staff is unreasonable, the education level is low, and there is no reserve talent.
Second, the graded diagnosis and treatment system has not yet been formed. At present, two-way referral based on hospital level has not been established; referral with tertiary hospitals is based on the loose relationship at the department level. There is still a lot of work to be done to put the "two-way referral system" into practice. The function setting of medical institutions at all levels has not been defined. The level of rehabilitation work carried out at different stages of the disease is not uniform. The corresponding relationship of medical institutions at all levels should be clarified, and unified management of the industry should be implemented.
Third, the service price system is not sound. At this stage, although the new medical reform has adjusted the price of some medical services, rehabilitation medical care still implements low labor cost charges. Rehabilitation service charges are narrow in scope, low in coverage, and low in price, and cannot reflect the labor value of medical personnel.
Fourth, the industry supporting policies are not perfect. At present, the development of rehabilitation medical care in China is still at a preliminary stage, and relevant supporting policies are still not perfect. The government has no special compensation policy for rehabilitation hospitals, medical insurance coverage is small, and reimbursement levels are low.
Wang Xuesong suggested that it should gradually explore the establishment of a classification guarantee system, play a policy guiding and regulating role, and use economic means to regulate the supply and utilization of rehabilitation medical services with different payment ratios.
Finally, the rehabilitation concept of medical institutions and medical staff needs to be changed. Hospitals and medical staff "health care, light recovery." The foreign rehabilitation medicine service target has accounted for 70% of the total number of sub-health groups in society, while China's rehabilitation service concept and technical level are relatively lagging behind. Due to various factors such as economy, ideological understanding, and social medical rehabilitation ability, most patients did not receive timely and systematic rehabilitation treatment and guidance, which delayed the optimal rehabilitation treatment time.
Avoid the tertiary hospital and find your own special project
In Beijing, the Xicheng District Exhibition Road Hospital, established in 1960, is a typical case of transformation to a rehabilitation institution.
According to the Beijing Municipal Health Bureau's "Beijing Rehabilitation Medical Service System Pilot Work Arrangement", in 2010, Beijing Xicheng District Exhibition Road Hospital accepted the task as a pilot unit for the rehabilitation service system construction in Beijing and Xicheng District.
As of December 2016, Xicheng District Exhibition Road Hospital has treated a total of 14,427 outpatients and 4,977 inpatients, and accumulated rehabilitation treatment for seven hospitals including Peking Union Medical College Hospital, Peking University People's Hospital, Beijing Jishuitan Hospital and Beijing Third Hospital. More than 200,000 people.
However, in Wang Xuesong's view, the transformation from a rehabilitation institution to a hospital is not limited to the growth of the number of patients served, but more importantly, it has identified its own positioning and characteristics.
Exhibition Road Hospital is located in Xizhimen area, Xicheng District, Beijing. “We have three or four large well-known top three hospitals within two kilometers of our hospital. Even Peking University People’s Hospital is less than 400 meters away from us.†Wang Xuesong felt that Surrounded by several large top three hospitals, the development of Exhibition Road Hospital has almost no advantages.
"As a secondary hospital, the comprehensive strength is relatively weak, and what professional disciplines are developed is related to the future development of the hospital." Wang Xuesong mentioned that if the hospital wants to develop, it must not only differentiate itself from the big hospital, but also find a way to find out. Features. "As a public secondary general hospital with unclear positioning, unclear characteristics and serious brain drain, it is very feasible to carry out rehabilitation transformation."
In this regard, the Director of the Elderly and Maternal and Child Health Service Department of the Beijing Municipal Health and Family Planning Commission, Yan Shuyan, also believed that in the process of transitioning from public hospitals to rehabilitation, secondary medical institutions must have their own rehabilitation characteristics and advantages and be accurately positioned.
Under such a background, Exhibition Road Hospital has established its own development path of “specialist, small comprehensive, innovative rehabilitation discipline constructionâ€.
Among them, "college" is to aim at the market and develop departments with the characteristics of the hospital. "Strong integration" is to strengthen the integration of the original department size and reconfigure medical resources. Wang Xuesong said, "The two complement each other, they are indispensable, there is no comprehensive support, and the specialists have no developmental stamina; and only through the development of "specialties" can the hospital develop comprehensively."
The expansion route of the exhibition road hospital rehabilitation area:
In February 2011, the comprehensive rehabilitation clinic featuring rehabilitation of orthopedic diseases was officially opened at Exhibition Road Hospital;
In May 2011, the rehabilitation area of ​​the Exhibition Road Hospital officially received patients;
In October 2011, Exhibition Road Hospital set up a 100-square-meter rehabilitation treatment area from the administrative office area;
In March 2013, the Second Hospital District of Exhibition Road Hospital officially received patients;
In September 2015, a rehabilitation area of ​​800 square meters on the fifth floor of Exhibition Road Hospital was completed;
In 2016, Exhibition Road Hospital and Fuwai Hospital established a cardiopulmonary rehabilitation medical association;
In November 2016, the exhibition road hospital cardiopulmonary rehabilitation joint clinic opened.
So far, the hospital has formed a number of rehabilitation sub-specialties such as orthopedic diseases, heart diseases, gynecological diseases, and neurological diseases.
As can be seen from the above table, with the development of rehabilitation technology, the proportion of hospital drugs decreased from 55.08% in 2010 to 36.06% in 2016. The use rate of antibiotics also dropped significantly, from 75.82% in 2010 to 40.63%.
Wang Xuesong said, "The development of the rehabilitation department has changed the sub-average cost caused by the single inpatient disease, adjusted the income structure of the hospital, and improved the use efficiency of hospital resources. The development of the rehabilitation department not only optimizes the resource allocation of the hospital. Improve the overall service capacity of the hospital, and broaden the service leadership, creating a good social and economic benefits."
In addition, Exhibition Road Hospital is exploring a grading clinic and a medical institution's division of labor coordination mechanism. In this collaborative mechanism, the tertiary hospital performs surgery and goes through the acute phase. The secondary hospital conducts assessment and evaluation of rehabilitation access criteria, implements systematic, professional, standardized and effective rehabilitation treatment and training, and community health center. Carry out daily outpatient rehabilitation or family rehabilitation training.
At present, in addition to establishing medical associations with Fuwai Hospital, the Exhibition Road Hospital is also connected to 15 community health service centers in Xicheng District. The hospitals are trained and taught by the community under the rehabilitation of the hospital, and the community rehabilitation teachers are treated and inspected. Household renovation.
"This kind of collaboration mechanism has several advantages: First, the average hospitalization day of the tertiary hospital is shortened, and the average number of hospitalization days per person is 6.2 days, which improves the bed turnover rate and solves the patient's export problem for the tertiary hospital. It is an improvement in the overall utilization efficiency of medical resources, and a clear pattern of medical services with clear division of labor. The third is to significantly reduce the overall hospitalization costs of patients." Wang Xuesong said.
How to solve the problem of talents while improving the rehabilitation medical service system?
Wang Xuesong mentioned that at present, the exhibition road hospital has developed from a group of 20 people in the early days of Jianke to a professional rehabilitation team with 52 people, including 10 rehabilitation doctors (including three senior titles), 23 rehabilitation technicians and 19 nurses. Behind this, the "three steps of talent training" strategy is indispensable.
"We believe that to train talents, we must use the existing talents of the hospital, transfer the doctors and nurses, and send them out in batches for professional training and further study. Second, we must introduce and train professional rehabilitation therapists. Our hospitals must be Introduced 2-3 rehabilitation therapists, and at least 2 therapists will go to Hong Kong for medium and long-term training. The third is to strengthen the intensive training of key personnel in the discipline." Wang Xuesong said.