What are the difficulties of China’s medical reform?

　　It is said that China's medical reform is difficult! What is the difficulty? On the surface, China's medical reform is difficult because of the large scale of the reform and its wide coverage, especially the life, old age, illness, death and vital interests of the people. Therefore, it is of great importance and affects the whole body!

　　China's medical reform is difficult! From a management perspective, the root cause of the difficulty is not limited to this. What's more important is that China's medical reform has insufficient motivation and investment. In particular, the interest game and mutual restraint between government departments have made China's medical reform policies unmatched, investment funds insufficient, medical insurance not linked, price adjustments insufficient, and the legitimate treatment of medical staff incompletely implemented. These are the fundamental causes of difficulty! Although it is cruel, it is also very realistic!

　　China's medical reform cannot all let China's public hospitals assume the tasks and responsibilities of medical reform! The public welfare of medical reform should be maintained through government and financial investment! Without financial investment, hospitals cannot maintain the public welfare by themselves. The final price of drugs is formed through many links such as production, circulation, sales, and hospital pharmaceutical services. Why is it that only hospital pharmacy services have zero margin? How the state subsidizes the normal consumption of hospital pharmaceuticals is also a motivation for reform.

　　The focus of China's medical reform may be the reform of public hospitals! On the one hand, public hospitals are large and have a lot of stock, accounting for more than 70%-80% of my country's total medical service resources; on the other hand, public hospitals are responsible for 80%-90% of the medical service workload! Therefore, it is difficult to say that China's medical reform is successful if it does not solve the medical service problems of public hospitals and public hospitals do not invest in medical reform.

　　China's medical reform cannot bypass the difficulty of public hospital reform. So, what are the difficulties in the reform of public hospitals? First, there are huge deviations and gaps in the investment mechanism, service mechanism and public welfare responsibility mechanism of public hospitals. If this problem is not solved, it will be difficult for public hospitals to play an active role in medical reform. Second, the management system of public hospitals is backward, rigid, and relatively outdated. It is difficult to play a unique legal role in health care reform. Therefore, the dependence of public hospitals on the government and the health administrative department is particularly prominent. Third, public hospitals lack motivation to cancel the use of drugs to support medical care. If the hospital does not open a pharmacy, it will be inconvenient for patients. If a hospital opens a pharmacy and the government does not subsidize it, it will suffer losses. Hospitals are not motivated. Fourth, a reform and innovation mechanism to mobilize the enthusiasm of medical staff has not been truly formed.

　　In addition, governments at all levels and the competent departments of governments at all levels have an understanding of and investment in medical reform, especially the true realization of the linkage between the medical insurance department and the three medical institutions, which is a highly relevant option. If the environmental factors of China's medical reform are ignored, it will be equally difficult to succeed. For example, the State Council has proposed to streamline administration and delegate power. Now medical insurance pharmacies no longer need approval from the Municipal Bureau of Human Resources and Social Security. However, there is no way to go through the procedures for medical insurance pharmacies. Therefore, this kind of streamlining administration and delegating power may actually result in the inaction of some departments, making it more difficult for the people and society to do things! It will also make it more difficult to implement China’s medical reform!

　　To sum up, China’s medical reform must solve “four difficulties”. The first is to solve the financial investment difficulties of public hospitals. This is a fundamental guarantee and a public welfare support. The second is to solve the survival difficulties of public hospitals. Don't rely on patient service charges to support hospitals. This can fundamentally solve the problem of medical reform. The third is to solve the coordination difficulties among government departments. More departments should take the initiative to participate in medical reform and help hospitals and grassroots solve practical problems. The fourth is to solve the difficulty of synchronizing the reform of medicine, medical insurance and medical care. We cannot only reform medical care and let the reform of medicine and medical insurance lag behind.