Summary of Key Points
The State Council's "15th Five-Year Plan for National Health" has introduced the most detailed measures in history to control the expansion of public hospitals. These measures include using a dual indicator system of "assets and operations" to limit new bed additions, refining targets for beds in different types of healthcare institutions, and guiding the allocation of beds towards less competitive specialties. Additionally, there is a focus on ensuring that primary care facilities can accommodate patients who are diverted from larger hospitals. This policy is no longer just empty rhetoric; it comes with clear quantitative targets, and local authorities have already begun to implement them (for example, the First Affiliated Hospital of Zhengzhou University has reduced its number of beds). With healthcare insurance reforms, hospitals no longer have the incentive to expand, marking a shift from an era of scale expansion to one focused on quality and efficiency.
Hospitals Subject to Expansion Restrictions
The plan sets clear boundaries for two types of hospitals:
1. Hospitals with high debt levels: Those with a debt-to-asset ratio exceeding 80% (in other words, the hospital owes more than 80% of its total assets, making it even harder to repay debts if they continue to expand).
2. Hospitals with low efficiency: Hospitals with a bed utilization rate of less than 75% and an average length of stay exceeding 9 days (indicating potential issues with patient flow and treatment processes).
In principle, these hospitals are not allowed to add new beds. Experts estimate that approximately 15%-20% of public hospitals nationwide will fall into these categories, with secondary hospitals being particularly affected (both by the competition from top-tier hospitals and the diversion of patients to primary care facilities). Some city-level hospitals in central and western regions that have borrowed money to build branch campuses are also at risk.
The Purpose of Controlling Expansion
The real goal of the plan is not simply to reduce the number of beds but to re allocate them more efficiently:
- What to reduce: The growth of beds for routine treatments and inpatient care.
- What to increase: The allocation of beds towards areas with higher demand, such as chronic diseases, critical illnesses, mental health, rehabilitation, and nursing services. For example, primary care facilities should increase the number of rehabilitation and home care beds, while larger hospitals can establish beds for clinical research.
Notably, "continuity of care" beds (needed after patients are discharged) have been highlighted for the first time, with a much higher growth rate than overall bed numbers. This indicates a shift from a model where large hospitals compete by increasing their capacity to one where they focus on improving quality and efficiency.
Is this Control Effort Successful?
Past attempts to control hospital expansion have had limited success (for instance, the First Affiliated Hospital of Zhengzhou University once expanded to 13,000 beds). However, this time things are different:
- More specific policies: There are clear numerical targets (such as a maximum of three branch campuses and a limit of 1,500 beds per hospital), and these targets are linked to local performance evaluations.
- Local action: Shanghai has already restricted the number of new branch campuses, and the First Affiliated Hospital of Zhengzhou University has reduced its bed count from 13,000 to 7,500. For the first time, the total number of hospital beds nationwide is expected to decrease by 190,000 by 2025.
- Hospitals' own motivation: With healthcare insurance reforms, beds are no longer seen as a profit-making tool but as a cost burden; therefore, hospitals are more willing to reduce their capacity.
With both internal and external pressures driving this change, the chances of success are higher than in the past.
Where Will Patients Go After Large Hospitals Reduce Their Capacity?
To prevent a surge in patient numbers, the plan emphasizes strengthening primary care facilities:
- Service coverage: Ensuring that patients can find a primary care facility within 15 minutes (with over 95% of township health centers and community health centers meeting standards).
- Capacity enhancement: Supporting secondary and county-level hospitals to develop services in rehabilitation, nursing, and pediatrics, and promoting the transfer of expertise from larger hospitals.
- Incentives for primary care staff: Improving salaries and career development opportunities, as well as using healthcare insurance reimbursement rates to encourage patients to use primary care facilities.
Only if primary care facilities can effectively accommodate these increased demands will the control measures be successful. Experts estimate that it will take 3-5 years to see significant changes, but the direction of the policy is clear.
In Conclusion
This effort to control hospital expansion is not about preventing hospitals from developing; rather, it aims to shift the focus from competing on bed numbers to competing on quality and efficiency. The drive behind this change comes from pressures related to healthcare insurance and population aging, as well as the need for a transition in the medical system from quantity-focused to quality-oriented services. The key lies in whether primary care facilities can truly improve their capabilities and if the supporting reforms can be effectively implemented.