Medical Service Fees – A Key Step Forward
The comprehensive reform of medical separation initiated by the Beijing municipal government on April 8, 2017, marked a significant milestone in the healthcare system of China. This reform, implemented across more than 3600 public and private hospitals in Beijing, aimed to address several critical issues in the healthcare sector. The reform encompassed the cancellation of medicine markups, the introduction of medical service fees (MSF), and the adjustment of prices for 435 basic medical service items. The primary goals of this reform were to improve the quality of medical services, promote the efficient use of limited resources, and remodel the income structure of hospitals within the constraints of the global budget.
One of the key components of this reform was the introduction of the MSF, which played a pivotal role in reshaping the healthcare landscape. The MSF was designed to increase the prices of medical services that reflect the value of medical staff while decreasing the prices of services that reflect the value of equipment and drugs. This shift aimed to ensure that hospitals could maintain their financial stability while focusing on the quality of care provided by healthcare professionals.
The implementation of the MSF had several notable impacts on the healthcare system. First, it facilitated an orderly flow of patients and remodeled the patient distribution configuration among different levels of hospitals. For many years, efforts had been made to increase financial and personnel support to community health service centers (CHSCs). However, the “inverted pyramid” distribution of patients, where a large number of patients sought care at tertiary hospitals rather than primary hospitals or CHSCs, persisted. The introduction of the MSF helped to address this issue by increasing the out-of-pocket cost for attending physicians at tertiary hospitals while reducing or even eliminating these costs at primary hospitals and CHSCs. In contrast, the costs for deputy chief physicians (DCPs), chief physicians (CPs), or honor specialist physicians (HSPs) remained the same across all levels of hospitals.
As a result of these changes, patients with severe clinical conditions were more likely to visit tertiary hospitals, where they could receive specialized care for the same cost. On the other hand, patients with chronic conditions, particularly older adults, were more inclined to seek care at primary hospitals or CHSCs, where the costs were lower or free. Additionally, a regulation was implemented that allowed the largest dose of medications (no more than 2 months’ worth) to be prescribed in a single prescription at primary hospitals or CHSCs for elderly patients with chronic diseases. These changes led to a significant shift in patient distribution, with the average number of patients decreasing by 11.9% at tertiary hospitals and increasing by 16.1% to 30% at primary hospitals and CHSCs one year after the comprehensive reform.
Second, the introduction of the MSF gradually changed the income structure of hospitals and increased their profit margins. Prior to the reform, many hospital managers were concerned about whether the increased income from the MSF would be sufficient to offset the loss of income from the cancellation of medicine markups. However, the implementation of the MSF and other price-related policies significantly altered the hospital income structure. Even hospitals that had relied heavily on drug income experienced a greater profit margin after the reform. This shift allowed hospitals to focus more on providing high-quality medical services rather than relying on the sale of drugs to generate revenue.
Third, the implementation of the MSF dramatically constrained patients’ demand for access to specialists. After the reform, data showed that visits to DCPs and CPs decreased by 9.7% and 22.5%, respectively. This reduction in demand for specialist care was a result of the increased costs associated with seeing specialists at tertiary hospitals. Hospital administrators began to take notice of this new phenomenon and employed various strategies to address the decreasing volume of outpatients. However, these efforts had little effect on reversing the trend. From the government’s perspective, this reduction in demand for specialist care was a positive outcome, as it allowed HSPs to focus on treating more complex and critically ill patients, thereby improving the efficient use of medical resources.
The comprehensive reform of medical separation, particularly the introduction of the MSF, had a profound impact on the healthcare system in Beijing. It successfully addressed several longstanding issues, including the uneven distribution of patients across different levels of hospitals, the over-reliance on drug income, and the excessive demand for specialist care. By increasing the cost of attending physicians at tertiary hospitals and reducing or eliminating these costs at primary hospitals and CHSCs, the reform encouraged patients to seek care at the most appropriate level of the healthcare system. This shift not only improved the quality of care for patients with severe conditions but also made healthcare more accessible and affordable for those with chronic diseases.
The reform also highlighted the importance of valuing the contributions of medical staff in the healthcare system. By increasing the prices of medical services that reflect the value of medical staff, the MSF ensured that healthcare professionals were adequately compensated for their expertise and efforts. This change not only improved the financial stability of hospitals but also motivated medical staff to provide high-quality care to their patients.
In conclusion, the comprehensive reform of medical separation, with the introduction of the MSF as a key component, represented a significant step forward in the evolution of the healthcare system in Beijing. The reform successfully addressed several critical issues, including the uneven distribution of patients, the over-reliance on drug income, and the excessive demand for specialist care. By increasing the cost of attending physicians at tertiary hospitals and reducing or eliminating these costs at primary hospitals and CHSCs, the reform encouraged patients to seek care at the most appropriate level of the healthcare system. This shift not only improved the quality of care for patients with severe conditions but also made healthcare more accessible and affordable for those with chronic diseases. The reform also highlighted the importance of valuing the contributions of medical staff in the healthcare system, ensuring that healthcare professionals were adequately compensated for their expertise and efforts. Overall, the implementation of the MSF and the comprehensive reform of medical separation have had a profound and positive impact on the healthcare system in Beijing, setting a precedent for future reforms in other regions of China.
doi.org/10.1097/CM9.0000000000000363
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