Worldwide, the second wave of epidemic has struck, the global economic recovery has been greatly affected, and the situation of stabilizing foreign demand is still grim. Therefore, expanding domestic demand has been placed in a very important position. In the context of the epidemic, there is a domestic demand that deserves special attention, that is, the demand for medical services.
Medical service is a short board on the supply side, a key area that needs to be focused, and a major project that should accelerate the construction. Making up for this weakness can not only boost GDP, but also promote the transformation and upgrading of economic structure. To make up for the shortcomings of medical services, we should focus on two areas: hospital construction and doctor training. How to build and how to cultivate should not follow the old road of creating a short board, but should have a new idea of “post epidemic era”.
Domestic demand I: public welfare hospitals
How to build a hospital?
The epidemic has taught people a profound lesson and given people new thinking. From the perspective of the “economic benefits” of the hospital, “people waiting for beds” can better maximize the economic benefits of the hospital; However, from the perspective of the “health benefits” of the whole society, “bed and others” are more able to maximize the social health benefits. So, after accepting the lessons of the epidemic situation, what new ideas should be put forward to guide the hospital construction? Is the allocation of resources considered from the microeconomic benefits of the hospital? Or from the macro health benefits of society?
The shock of the spread of the epidemic has made many people realize that if they focus on micro economic benefits and despise macro health benefits, the micro individual economic benefits will also be damaged in the epidemic, and paying attention to macro health benefits can make the micro economic benefits obtain long-term benefits. Focusing on macro health benefits is the correct idea to guide hospital construction. In the past, when hospital construction was carried out, there were many measures focusing on micro economic benefits, which need correction and adjustment, such as the “independent income generation” of public hospitals.
The government’s financial allocation to public hospitals accounts for a small proportion of the total hospital expenditure. Hospitals need to generate income independently and focus on their own micro economic benefits in order to survive and develop. As a result, many phenomena are beneficial to the short-term micro and detrimental to the long-term macro. For example, in order not to maximize the economic benefits of “bed and others”, some hospitals let patients stay in more hospitals and check more, which greatly increased the expenditure of social medical insurance; Other large hospitals have tried their best to expand in order to collect more patients and generate more income. As a result, patients with minor diseases have been attracted to large hospitals, making small hospitals at the grass-roots level unable to develop due to the lack of patients. These small grass-roots hospitals play a very important role in epidemic prevention and anti epidemic. If the grass-roots hospitals can provide enough good services, patients with mild diseases can be treated nearby, and those who are not ill can be taken care of by prevention. However, if the grass-roots hospitals can not provide enough good services, a large number of people will flock to large hospitals, resulting in cross infection and spread of epidemic diseases.
The so-called “bed and others” does not mean that the more beds the better, nor does it mean that the number of beds should be taken as the standard to guide the hospital construction“ The idea of “bed and others” is to focus on the health effect of the society rather than the profit of the hospital. The number of beds should be determined according to the scientific law rather than the market law. The author and American medical workers have visited medical institutions in Cuba and seen different ideas, different decisions and different social health effects in “bed and others” between the United States and Cuba.
When we visited a Cuban medical rehabilitation institution for the elderly, American medical personnel asked how long the waiting list of the institution was, because entering such an institution in the United States needs to queue up. First sign up for inclusion in the waiting list, and then notify the patient when there is a vacant seat, so as to minimize the possibility of vacant waste of medical personnel. When Cuban medical personnel heard this question, they were very confused and couldn’t understand what the “waiting list” was, because they didn’t have this concept at all. After repeated interpretation, they understood it. They said: “we don’t have a waiting list. Now we have the ability to treat 100 patients, but only 81 patients.”
A similar phenomenon of “bed waiting” is also reflected in the service time of hospitals. The grass-roots community general clinics in Cuba serve 24 hours a day. This kind of service time surprised American medical workers, because American clinics close at night, and large hospitals do not provide normal services even if they do not close at night. Cubans are surprised to hear that American clinics close at night. They say that night and early morning are the high incidence periods of many diseases. The best effect can be achieved only by treating them at the first time. They also said that many people have to work during the day and have time to see some less serious diseases at night. If they don’t open the door at night, these people will carry minor diseases and don’t see them, which will lead to serious diseases.
The two different practices of the United States and Cuba reflect that they make decisions according to different laws. American clinics close at night according to the law of the market, because it can reduce labor costs and increase profits. The 24-hour service of the Cuban clinic is because it does not follow the market law, but follows the scientific law of medical care. Therefore, it considers less human cost and more medical effect.
In terms of the macro index of social health effect, Cuba is obviously better than the United States. According to the data of the World Bank (2015), the life expectancy in the United States is 78.69 and that in Cuba is 79.57; The under five mortality rate (per 1000 people) is 6.6 in the United States and 5.6 in Cuba. Cuba is much poorer than the United States. Poor countries generally have worse life expectancy and child mortality than rich countries. Cuba’s superior performance is due to its public welfare medical institutions aimed at “social health effects”.
The construction of public welfare hospitals is a huge domestic demand, which can stimulate the economy and produce long-term social benefits to enhance health.
Domestic demand II: doctors covering the grass-roots level
How to train doctors?
If only hospitals are built and there are not enough doctors in the hospitals, the treatment services that such hospitals can provide will be greatly reduced. The number of doctors is not only related to treatment services, but also related to prevention, which is very important in epidemic prevention and control.
Judging from international experience, adequate doctors can make up for the lack of hospital facilities, and Cuba is also a prominent example in this regard. If hospital facilities are used as an analogy, Cuban hospitals are like backward township hospitals, while the United States is a “top three hospital”, but when fighting the same epidemic, Cuba’s effect is better than that of the United States.
For example, in the Chikungunya fever epidemic in 2014, 31 people died in the Caribbean Puerto Rico autonomous state of the United States, while the mortality rate in its neighboring Cuba was zero; Another example is the SecA virus epidemic. In the United States, there are 211 cases in South Florida alone, while there are only 3 cases in Cuba.
According to the data of the world bank in 2014, the number of doctors per 1000 people is 7.5 in Cuba, 2.4 in the United States and 1.4 in China. Due to the abundant number of doctors, Cuba has established a fully covered primary health care network, with high-density family doctors working in grass-roots communities. Therefore, it can move the prevention gateway forward, weave the first line of defense, and avoid minor diseases from becoming major epidemics.
Cuba once learned a profound lesson from the epidemic. In 1981, dengue fever killed 158 people in Cuba. Having learned this lesson, Cuba has vigorously developed the primary health care system with family doctors as the backbone, which has not only effectively controlled the epidemic, but also improved the macro health indicators of the whole society, such as life expectancy and child mortality.
Cuba not only has a large number of doctors, but also has a scientific and rational distribution of medical personnel. Its medical system includes three levels of medical institutions: primary, secondary and tertiary.
Primary medical institutions are composed of family doctors and community comprehensive clinics, which are arranged according to population density. One family doctor is responsible for every 120-150 families. The doctor lives near these families and has a small clinic to provide services nearby. Every 15 to 40 areas under the jurisdiction of family doctors, a community comprehensive clinic with a variety of specialties has been set up to provide 24-hour services. Primary medical institutions have solved 80% of medical problems and effectively guarded the first line of defense of prevention.
Secondary institutions are mainly municipal general hospitals. Diseases that cannot be handled by primary institutions are referred here, and 15% of medical problems are solved in secondary institutions.
Tertiary institutions are mainly provincial specialized medical institutions with the nature of scientific research, and only 5% of medical problems need to be solved in tertiary institutions.
The world bank and who have a very high evaluation of Cuba’s medical system, especially primary health care.
Doctor service is a huge domestic demand. To meet this domestic demand, we need to vigorously train doctors.