Shot in the arm for Beijing’s public hospitals

Public hospitals have for many years faced a host of problems. Things have, however, improved since the setting up of the Beijing Municipal Administration of Hospitals last July.

THE management of public hospitals in Beijing has been out of hand for many years.

The problems include the sales of medicine becoming the main revenue; the establishment of elite VIP medical centres for the rich which takes away medical resources; lackadaisical attitude of doctors and medical staff; and the long wait by patients.

To address these issues, the city set up the Beijing Municipal Administration of Hospitals (BMAH) last July as part of the healthcare reform the Chinese central government had been pressing for the past three years.

The BMAH oversees the operations and administration of 22 public hospitals and its role is more like a referee which blows the whistle on hospitals that sidetrack from their real objective as non-profit establishments.

Six months after the BMAH took charge, the city's public healthcare sector has seen a decrease in outpatient treatment expenses, hospitalisation fees, medicine expenses and the ratio of medicine expenses against the total medical expenses, the first in a decade.

Last year, expenses for outpatient services and hospitalisation fees reduced by 0.8% and 4.2% respectively.

The outpatient medicine prescription was down by 3.1% and the ratio of outpatient expenses for medicine against the total expenses down by 1.4%.

As for hospitalised patients, their expenses for medicine declined 11.6%. Doctors also cut down on the prescription of antibiotics from 15.7% to 13.4%.

"Based on our statistics, the decrease in expenses for medicine and treatment and use of antibiotics has saved the patients over 540mil yuan (RM259mil)," said BMAH director Pan Suyan in a recent interview.

"I think the reduction in expenses can be attributed to various factors. Firstly, the Beijing municipal health bureau did collective procurement of medicines last year, and through an open tender practice, the drug prices were reduced significantly."

She said better management and promotion of good ethics and practices among the medical staff had helped eliminate the phenomenon of doctors profiteering from drug prescriptions.

The other contributing factor was the introduction of pre-paid service for medical expenses and categorisation of payments according to diseases by the city's labour and welfare protection department, she added.

Beijing Friendship Hospital vice-president Zhang Jian said the hospital's revenue came mainly from government allocation, medical service fees and the sale of medicine.

"Last year, the sale of medicine accounted for 14% to 15% of our total revenue, as directed by the government. The practice of hospitals generating their income from the sales of medicine to compensate for the lack of funding by the government was a result of the previous reforms.

"It suited the country's healthcare development at that time. As the hospital operator, we depend very much on the government's policies. Of course, we hope that after the reduction of drug sales we will be fairly compensated by the government for us to run our hospital well," he said.

Last year, the government funded the city's hospitals to a tune of about 3.4bil yuan (RM1.63bil), which was a 51% increase from 2010.

Chinese Medical Association vice-president Wu Mingjiang said the past policy of sale of medicine was outdated and would not rightly reflect the medical staff's capability and values.

"We have recognised that this policy would not be good for the development of the industry. What is important now is to come out with a huge compensation for the hospitals.

"Of course, the government will have to increase its funding. We are also exploring ways of paying medical expenses through the patients' social insurance scheme. It will be interesting to see how some 300 county-level hospitals change to the new system this year," he said.

Throughout the years of reform, about 95% of rural and urban residents were covered with basic health insurance. But, many people still complain of high medicine costs and sub-standard medical services.

Chinese Academy of Medical Science party secretary Li Liming said China had achieved much success as the contribution ratio for health insurance is now 28.5% from the government, 35.9% from society and 35.5% from individuals, compared with the individual contribution of 60% in 2001.

Early this month, Chinese Premier Wen Jiabao revealed in a report that privately-funded hospitals and clinics would become the country's cornerstone in developing the healthcare sector.

Beijing Chaoyang District Diabetes Hospital president Wang Zhili expected the government to come up with more detailed guidelines this year on how to set up private clinics.

He said the competition from the private sector would only prompt public hospitals to be on their feet and to improve their services.

Pan said the BMAH would rather focus on efforts to raise the hospitals' bar than look into their books.

"Whether the healthcare reform will be a success or not depends on the concerted effort of medical workers to provide excellent services. The government funding is just a part of it," she said.

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