Medical reform aims to shift elite services from public hospitals(2)

The interior of the newly opened Shanghai International Medical Center. Photo: Ni Dandan/GT

Shanghai's health department has stated that public hospital doctors who wish to work at multiple facilities can only do so at grass-roots medical facilities and the two medical centers, namely the SIMC and Shanghai New Hongqiao International Medical Center.

The new model, however, is facing challenges. The biggest obstacles, according to Huang, are the public hospitals that are unwilling to share their elite resources. "What would happen to the public hospitals if their best doctors were accessible at other medical facilities? I made it clear that I would never bring my patients at Renji Hospital to the SIMC. This is considered indecent and the management teams of public hospitals are strongly against it."

When asked whether this practice would affect the accessibility of quality medical services at public hospitals, Huang said he had half a day every week seeing outpatients at Renji Hospital, which would remain unchanged in the future. "Above all, my major task at present is training young doctors."

While some public hospital doctors will work at multiple hospitals, a few others chose to leave the system and join the center full time. Pei Bin, the chief infection control officer at the SIMC, used to work at the Putuo District Center Hospital. Additionally, his two previous employers were both public hospitals in Shanghai. The decision to quit the stable job at the public facility received strong opposition from his family members. But Pei told the Global Times that the high level of professional risk at public hospitals helped him make up his mind.

"My record at a public hospital was seeing 86 patients in a morning. It's not that I don't want to take any responsibilities. But spending an average of two to three minutes on a patient, I could not be sure if every diagnosis was totally accurate." Pei said he spent 45 minutes talking with the last patient he saw at the SIMC.

The compulsory scientific research tasks are another reason for Pei's decision to leave the system. "I don't think a good doctor has to be a scientist," he said.

VIP reform

With a reinforced team of quality doctors, the SIMC shoulders another mission (which is also part of Shanghai's new medical reform) -taking over the controversial paid VIP services available at public hospitals, which came into existence in 1997.

In 2010, the then Ministry of Health proposed that paid VIP services at the country's public hospitals should not exceed 10 percent of a hospital's entire services.

In May 2011, Shanghai's health department pointed out in its new medical reform plans that VIP services should be gradually withdrawn from public hospitals. While tough controls are imposed on the existing VIP wards, newly-established public hospitals are not allowed to be equipped with such services any more.

"VIP services do exist in some foreign public hospitals as well. People who choose the more expensive services can enjoy a better environment. But it is wrong if VIP services guarantee a more professional doctor is in charge or hospitals make room for VIP wards by reducing the number of ordinary wards. To some extent, in China, VIP services mean priority access to better quality medical resources in a public hospital," said Zhang Chengyu.

Cai Jiangnan, director of the Centre for Health Care Management at the China Europe International Business School, said VIP services in public hospitals had meant that a small group of people could use up a large amount of medical resources, which has resulted in the unfair distribution of these resources.

"Financially, a public hospital relies heavily (90 percent) on its patients. VIP services have been a major source of income for public hospitals. Without a new mechanism channeling proper government subsidies into public hospitals, it will be very difficult to withdraw all VIP services from these institutions," said a department director with a tier-three city hospital, who insisted on anonymity.