With the formation of a national network of national regional medical centers in 2022, the issue of expansion of high-quality medical resources and regional balance has basically been initially resolved.
The question is, how will these regional medical centers be positioned, how will they fulfill their missions, and how will they play a better role? Undoubtedly, this has aroused widespread concern within and outside the industry.
The National Regional Medical Center construction roadmap is basically clear. 28 July, the National Development and Reform Commission, the National Health and Health Commission, the State Bureau of Traditional Chinese Medicine jointly issued the "new national regional medical center construction output hospital list", outlining the top-level design ideas to accelerate the expansion of high-quality medical resources and regional balanced layout, basically clear national regional medical center roadmap for each batch of construction and time points.In October 2019, with the consent of the State Council, four departments, including the National Development and Reform Commission and the National Health and Wellness Commission, jointly issued the Pilot Program for the Construction of Regional Medical Centers (hereinafter referred to as the Work Program), marking the official launch of the construction of national regional medical centers.In addition, the State Council clearly, next year will continue to expand the scope of the pilot to achieve coverage of all provinces, to complete the national planning layout, and strive for the end of the "14th Five-Year Plan", the national regional medical center construction task is basically completed.Three Speculations of National Regional Medical Center
After more than a year of operation, the construction of the national regional medical center has made positive progress and phased results in the pilot project. Based on the experience of this construction for more than a year, the following three major conjectures about the regional medical center are proposed.Guess one: the construction of a national regional medical center or will trigger a new infrastructure boom
Since the 2018 Central Economic Work Conference proposed "new infrastructure construction" (hereinafter referred to as "new infrastructure"), various industries have been accelerating the process of digitalization and intelligence, and new infrastructure has become a new engine to drive the development of people's livelihood. The "Health China 2030" planning outline has clearly put forward the development of health industry as one of the five major tasks of "Health China" construction, and put forward the strategic goal of developing the health industry as a pillar industry of the national economy.Currently, there is strong support at the national level to support the construction of regional medical centers. As an important part of the new infrastructure, will the national regional medical center generate a large demand in terms of hospital instruments and equipment, high-value consumables, in addition to basic buildings?What is clear is that during the new crown epidemic in 2020, Wuhan Caidian Vulcan Mountain Hospital and Jiangxia Lei Shen Mountain Hospital took only ten days to be built and put into operation. While showing "China's speed", it has also become a successful example of China's new infrastructure.It is reported that during the construction of Vulcan Mountain Hospital and Thunder Mountain Hospital, more than 2,500 large equipment and transportation vehicles, more than 4,900 box-type cubicles, 200,000 square meters of impermeable membranes, and a large number of cables and wires, distribution cabinets, sanitary ware and other materials were put into use, and 1,608 suppliers and 952 subcontractors from all over the country actively participated in the construction of the hospital, providing strong support for the overall speed of hospital construction.This shows that the construction of a national regional medical center may trigger a new infrastructure boom!Conjecture 2: Output hospitals and pilot hospitals to face the "homogenization management" problemAlong with the continuous expansion of China's public hospitals, many hospitals, especially tertiary hospitals, have developed the development form of "one hospital with multiple districts", and the operation mode of "one hospital with multiple districts" cannot be separated from homogeneous management. As the first unit to be inaugurated in the first 10 pilot regional medical centers, Xiamen Hospital of Zhongshan, Fudan University has explored a unique model of homogeneous management.Wang Hesheng, deputy director of the National Health Commission and director of the National Bureau of Disease Control and Prevention, pointed out during his research at Xiamen Hospital of Fudan University that the construction of a national regional medical center is not only the export of medical resources or a simple "copy", but also the advantages of the new hospital should be given full play, and the advanced infrastructure and management models of the exporting hospital that cannot be implemented in time due to system and land constraints should be implemented in the new hospital. The advanced infrastructure and management model of the exported hospitals, which cannot be implemented in time due to the constraints of system, land and other objective factors, should be implemented in the new hospital area first.According to the introduction, Zhongshan Hospital of Fudan University innovated the "homogenization" management model, exporting talents, technology and management to Fudan Zhongshan Xiamen Hospital, forming a unique regional medical center construction "Fudan Zhongshan Xiamen" model.
In terms of "homogenization of talents", more than 120 senior experts and backbones from Zhongshan Hospital of Fudan University in Shanghai are sent to Xiamen Hospital; the directors of various disciplines and members of the famous doctors' studio will also take turns to visit Xiamen every week for consultation, surgery, teaching and ward inspection; and a medical team of senior attending doctors will be formed to participate in discipline construction in batches.
At the same time, the two hospitals have also implemented the "double director" system of clinical and administrative "vertical management", i.e. the directors of departments in Shanghai headquarters are also the directors of clinical and medical-technical departments in Xiamen Hospital, and the heads of administrative departments in headquarters are the first heads of corresponding departments in Xiamen Hospital. The head of the administrative department of the headquarters is the first person in charge of the corresponding department of Xiamen Hospital. Whether it is medical level, treatment standard, workflow, emergency plan and other hospital core management, all ensure the "Fudan Zhongshan standard".
Now, the advanced and mature multidisciplinary treatment (MDT) model of Shanghai headquarters has been transferred to Xiamen Hospital of Fudan University, which can provide individualized, multidisciplinary and comprehensive "one-stop" precise treatment for patients. With the "homogenization" management as the grip, the high level of treatment technology and management capability of the exporting hospitals will be synchronized to provinces and regions with shortage of quality medical resources, truly realizing the balanced layout of quality resources advocated by the state.
Conjecture three: the national regional medical center construction pilot calls for "new policies"
National Regional Medical Center this year's construction goals are: to further improve the orderly expansion of the national regional medical center construction work program, guidance to the new 12 provinces and Xinjiang Production and Construction Corps to carry out preliminary work to ensure that each region this year to start at least 1 project construction.With the formation of a national network of national regional medical centers in 2022, the issue of expansion of high-quality medical resources and regional balance has basically been initially resolved. The question is, how will these regional medical centers be positioned, how will they fulfill their missions, and how will they play a better role? Undoubtedly, this has aroused widespread concern within and outside the industry.Looking into the future, the construction of regional medical centers is never as simple as mere hardware. At a time when it is being vigorously pursued at the national level, whether relevant policy documents will be issued to encourage the landing of regional medical centers with substantial concessions as well as supporting measures to ensure their sustainable and healthy development, which carries too much expectation.Ten years of history: changes and changes in the construction of a national regional medical center
As early as 2009, the former Ministry of Health had issued the "Principles of Regional Medical Center Settings (Trial) (Draft for Comments)", proposing that national medical centers be set up in accordance with seven regions, with 1-3 national medical centers set up in each region and 1-3 national specialized medical centers set up in relevant specialties. This also marks the regional medical center in a new round of health care reform launched in the context of the agenda.In January 2017, the former National Health and Family Planning Commission issued a notice on the "13th Five-Year Plan for the Establishment of National Medical Centers and National Regional Medical Centers", which requires the selection of comprehensive hospitals with leading levels in medicine, education, research, prevention and management in each province to set up and build a national regional medical center in a comprehensive category. According to the coverage area and population distribution, six regions in North China, Northeast China, East China, South China, Southwest China, Northwest China, each region selected leading hospitals, according to children, oncology, cardiovascular, obstetrics and gynecology, infectious diseases, dentistry, psychiatric and other specialty categories to set up national regional medical centers.After many years, the construction of the national regional medical center finally started in 2019, however, the roadmap for the construction as well as the layout planning is very different from the past.Pilot areas were first selected in eight provinces with a shortage of quality medical resources, and then deployed this year to include 12 provinces in the construction of the national regional medical center, basically covering the provinces with large patient output and and relatively weak medical resources provinces, by next year, to achieve full coverage of all provinces, to complete the national planning layout.This is not consistent with the 2009 "principle of setting up in accordance with the seven regional divisions", but actually turned to the principle of "allocation according to need", giving priority to provinces with a shortage of quality medical resources, and then gradually expanded to the whole country. Since 2009, the former Ministry of Health issued the "principles of setting up regional medical centers" to the official launch of the construction of national regional medical centers in 2019, 10 years, the construction of national regional medical centers is not a straight path, the reasons for which are unknown.However, the renewed effort to start the construction of a regional medical center is undoubtedly an important step in implementing the 14th Five-Year Plan and the outline of the 2035 Vision.Based on the new development stage, implementing the new development concept and building a new development pattern, the mission of the regional medical center to carry the expansion of high-quality medical resources and the balanced layout of the region has never changed. 
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