| Objective:Establishing branches of large comprehensive public hospital in suburban areas and introducing mature medical technologies and management methods is the best way to rapidly improve suburban health care system and achieve better availability of high-quality medical resources, and it is a very important measure to improve the allocation of health resources. Newly established in the suburban areas of Shanghai, Shanghai Renji, Shanghai No.6 People's Hospital, Huashan and Ruijin Hospital are guided by above-mentioned policy. Up to now, the four new hospitals have been operating for two years. This study intends to make periodic evaluation on its operating results, makes analysis from construction background, policy implementation, resource allocation and operational situation, and summarizes the achievements and problems, so as to provide reference for the further deepening of the reform.Methods: Relevant background information of the four new hospitals are collected from government reports, official website data, CNKI and other databases, literature method is adopted for systematic retrieval, analysis and summary. Operating information is collected from the real-time data provided by medical alliance platform of Shen Kang Health Development Centre, variously data of the 4 new hospitals from the first quarter of 2013 to the first quarter of 2014 are collected, Excel 2010 software is adopted for data entry and sorting, descriptive methods are adopted for the statistical analysis and processing of various indicators; patient satisfaction data are collected from questionnaires covering thousands of patients in Shen Kang Center.Results: it is necessary to build new hospitals for 4 large hospitals in the suburbs of Shanghai, because of development of social economy, policy environment and their own development. They have clear public welfare objectives and appropriate scales,and do a systematic and innovative job in structure optimization, reform of the relevant systems and mechanisms and, implement the reform well. In the 4 new hospitals, human resources and medical facility are ready to be put into use efficiently.But they suffer from losses, either. The residents have a higher degree of satisfaction,and the operation is in line with the original intention of construction.Specifically speaking:(1)In 2014, in the 4 new hospitals, in total, there were 1,524 beds in use, 2,470 employees. Out of them, there were 745 doctors, 1,138 nurses. The doctor-nurse ratio was 1:1.53, and the bed-nurse ratio was 1:0.75. Almost all the hospital staffs were available to work.(2)In 2014, in the 4 new hospitals, in total, there were 2,104,685 outpatient visits, a year-on-year increase of 41.71%, which increased significantly; there were 56, 656 persons leaving the hospital, a year-on-year increase of 46.5%; in terms of operations,there were 2,7395 operations, a year-on-year increase of 50.99%. And the three or 4level operation accounted for an average of 38.69%.(3)In 2014, in the 4 new hospitals, the average costs for an emergency treatment were 275.19 Yuan, a year-on-year increase of 4.58%, 15.93% lower than that of the parent hospitals in the same period; the average hospital discharge costs were14,388.92 Yuan, a year-on-year increase of 5.14%, 21.8% lower than that of the parent hospitals; in drug proportion, the average drug proportion was 42.64%.(4)In 2014, in the 4 new hospitals, the average number of daily out-hospital patients was 2,096, a year-on-year increase of 41.71%. In terms of per clinic doctor daily burden of outpatients, in addition to the Municipal Sixth People ' s Hospital East Clinic, the other three new hospitals all had an average of 60 patients. In the 4 new hospitals, the average length of stay was 8.37 days, a year-on-year decrease of 0.4%.In terms of the bed occupancy rate, the average value of the 4 new hospitals was93.34%, a year-on-year increase of 11.46%.(5) Amount-expenses analysis results: from the perspective of the amount of services,in 2014, the emergency treatment and hospitalization volume of Huashan Hospital North Clinic, Ruijin Hospital North Clinic and Renji Hospital South Clinic increased significantly, while the emergency treatment and hospitalization volume of Municipal Sixth People ' s Hospital East Clinic lagged far behind the other 3 newly built state-owned hospitals and it mainly depended on the increases in the medical and health services. Out of them, the Huashan Hospital North Clinic had a particularly good performance. The expenses of medical and health of the Municipal Six People's Hospital East Clinic witnessed a weak growth.(6) Disease category analysis results: the high-quality medical resources of parent hospitals did not completely sink to the suburbs. The follow-up policies should continue to encourage and guide the high-quality medical resources to flow from the parent hospitals to the new hospitals, so as to make the regional health planning more fair and the high-quality health resources more available.(7) Economic operation: as a whole, the 4 new hospitals could not make both ends meet. Medical income can only make up about 73%(68.2%~77.1%) of the medical costs. Plus basic financial subsidies and they can only make up about 94%(91.1%~95.9%) of the medical costs. The 4 new hospitals totally lost l-71,250,000 Yuan throughout the year.(8) Patients gave an average satisfaction score of 98.45, 1.93 scores higher than the average score of 24 hospitals at municipal levels.Discussions and Suggestions: The further reform, optimization and development of the large state-owned hospitals suburbs new hospitals should proceed from the following aspects: try to solve the problem of insufficient human resources for the 4new hospitals; attach great importance to mobilize the enthusiasm of the medical staffs; further improve the management system; establish and improve the supervision and evaluation system as soon as possible; consider deliberately the promotion of canceling drug price addition; perfect the compensation mechanism as soon as possible; improve the treatment transfer system, and gradually build a reasonable treatment order; deepen “ Joint Reformation for Public Health Services, Medical Insurance, and Medical Production-Circulation”, and make the management more scientific; optimize internal paths in the 4 new suburban hospitals. |
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