Liu Guoen: Reflection on Chinas public health and medical system under the current epidemic

 Liu Guoen: Reflection on Chinas public health and medical system under the current epidemic

Liu Guoen (distinguished professor of Changjiang Scholar, National Development Institute, Peking University, director of China Health Economic Research Center, Peking University, member of national new coronavirus expert group of national health and Health Commission)

It is very important to define the responsibility and right of direct report system

Since 2003, China has established a top-down direct reporting system through huge investment in technology, capital and staffing. In any case, it is difficult to make a major judgment on the technical level of the direct reporting system. In other words, because the epidemic itself is very sudden and the new coronavirus is a new thing, it is understandable that the direct reporting technology system is far from the level of intelligence to replace human decision-making. The direct reporting system collects the relevant information of the epidemic situation from the technical level, but from the decision-making level, whether the information can be used in a timely and comprehensive manner, so as to help the government and society to take the most effective action in the first time, which is not a work that a pure technical system can complete.

In order to make better use of the information of the direct report system, we need to further explore the issue of authorization. From the observation of this anti epidemic, the relevant authorization policies or institutional arrangements are relatively lagging behind. If we can improve the use specifications and authorization definitions at all levels that are more suitable for the direct reporting system, the system may play a better role. From the perspective of system optimization, how to play the efficiency of direct reporting system is an extremely complex system engineering, which needs system design. As it involves the responsibility and power positioning of relevant departments at all levels, the system engineering is much more complex than the construction of technical platform.

In recent months, the role of National Centers for Disease Control and prevention in the process of epidemic prevention and control has been widely discussed. However, there is little consideration on how to define the responsibilities and rights of local disease control departments at all levels. In addition, what is the relationship between the health care commission system and the CDC? What is the relationship between the Central State Council, local municipal government, provincial government and CDC? How to establish a mechanism that can not only centralize and unify, but also give full play to the efficient role of administrative subject in every link? The solution of the above problems requires us to reform and improve its long-term mechanism. The direct reporting technology system and the responsibility and power decision-making system are indispensable. Only when they operate simultaneously can we make better and effective response and timely action to public health emergencies.

Strengthen the construction of basic health service system after epidemic

Under normal circumstances, the main responsibility of a hospital is to provide citizens with specialized, emergency and inpatient medical services needed at the individual level. Of course, in the event of a major public health event, the medical service institutions, including hospitals, have the responsibility to participate in the first aid process. In response to the new crown epidemic, more than 40000 medical staff from all over Wuhan gathered from major hospitals across the country. This is not only the general response of medical systems in various countries, but also the characteristics of Chinas highly centralized mobilization of resources. Of course, after the anti epidemic, the normal central task of the hospital has to return to the normal diagnosis and treatment services, and there will be no essential change in response to emergencies.

What we can see is that there are many places that hospitals can do better and more effectively in the process of participating in the new crown epidemic. For example, if a large hospital and a community clinic can better combine or cooperate, it may significantly reduce the degree of light patients taking up too much valuable resources of the hospital. At this point, there are many experiences that can be used for reference in other countries, such as Japan, South Korea, Singapore and other countries. The role of the separation and cooperation mechanism between hospitals and community clinics is very effective, most of which are social forces and highly flexible. Because the community clinic manages a large number of light patients, it not only creates conditions for the hospital to better protect the severe patients, but also reduces the risk of further cross infection and other secondary disasters, and also reduces the total cost of medical treatment, so it should be a more sustainable mode of saving response. Fortunately for China, the epidemic is mainly concentrated in Wuhan, Hubei Province. Imagine that if other cities erupt at the same time, the number of people infected by the epidemic will not be 80000. At that time, if the hospital is still the core platform to deal with the epidemic, the run result and huge cost caused by overburden may be a high probability event.

The construction of School of public health should be adapted to local conditions

It is necessary to point out that public health and clinical medicine are highly related, but each has its own emphasis. In China, the school of public health and the medical college belong to the same department of medicine. The advantages of such a setting are obvious, including the sharing and technical support of clinical bases and basic medical platforms. At the same time, a long-term problem is how to better allocate resources between clinical and public health. Generally speaking, because the public demand for clinical services is larger and more realistic, the degree of public health attention and resource allocation is relatively weak. In the long run, from enrollment, training to employment, Chinas public health is facing the challenge of increasing gap with clinical medicine.

Looking forward to the future, how to better promote the coordinated development of public health and clinical medicine? China has a large number of entrances, and there are great differences between different regions. It is the basic policy to run schools according to local conditions. The state should encourage and support all localities to explore the most suitable mode of running schools for local conditions and comparative advantages according to the different situations of social economy, medical market and health resources, try to avoid the one size fits all administrative intervention of relevant government departments, and leave space for all localities to fully explore the development of innovative mode.

The fundamental solution to the problem of uneven distribution of resources in public health is to change consciousness

This article is the exclusive contribution of Netease Research Bureau and does not constitute an investment decision.

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