In August, 20021,a newborn was born in Shenzhen Maternal and Child Health Hospital, Guangdong Province. Figure/vision china
Dongba is not the only one who has experienced the "obstetric crisis". Beijing Henghe Hospital is a second-class high-end private hospital. However, in recent years, the number of obstetrical patients has decreased and they can't run. It will be merged by the private General Hospital of Obstetrics and Gynecology and United Family. According to informed sources, the acquisition is now in the "contact" stage, not the "licensing" stage.
According to the data released by the National Bureau of Statistics and National Health Commission, from 20 16 to 202 1 year, the newly born population in China decreased year by year, namely18.83 million,17.65 million,15.23 million and/kloc-0 respectively. China Academy of Social Sciences pointed out in the Green Paper on Population and Labor released in June 20 19 that the era of negative population growth in China is coming. The obstetrics department of the hospital is the first place to feel this change.
Once the baby boom.
"201June, 10, is the peak of delivery in our hospital. * * * Delivered about 300 babies, with an average of 10 babies per day. I remember that one night, I basically didn't rest, I received 7 pregnant women and had 4 cesarean sections. " Wang Xia, deputy chief physician of Dongcheng District Maternal and Child Health Hospital, recalled.
At that time, ten months after the implementation of the "comprehensive two-child" policy, the first batch of two-child demand was released. "After the introduction of the policy, many couples feel that they will seize the tail of childbearing age and have a second child," Wang Xia said. "Many couples aged 70 to 40 have a second child." According to the statistics of the National Health Planning Commission at that time, in 20 16, the population born with two or more children accounted for more than 40% of the total population born in China.
Yu Yabin, president of Chaoyang District Maternal and Child Health Hospital in Beijing, told China Newsweek that in 20 16, Beijing, like the whole country, was at the peak of childbearing. In addition to having two children, the increase in the number of births in that year was also due to the recovery of the suppressed fertility demand in the Year of the Sheep the previous year. Influenced by traditional culture, many people in China don't like to have children in the Year of the Sheep, but prefer to have babies with dragons, monkeys and pigs.
At that time, the media reported that "one bed is hard to find" in obstetrics was overwhelming: "adding beds in the corridor" and "it is difficult to file files, and traffickers are asking for sky-high prices" ... In order to cope with the rising delivery volume, Beijing Chaoyang Hospital transformed seven single-room wards into double rooms, and Beijing Dongcheng District Maternal and Child Health Hospital also added beds in the outdoor courtyard. "I heard that other hospitals also have benches, numbered as Bench 1 and Bench 2 ..." Wang Xia said.
At that time, in order to solve the problem of insufficient resources for maternal and child health services, the National Health and Family Planning Commission proposed to strengthen the construction of three-level maternal and child health institutions in provinces, cities and counties, adding 89,000 maternity beds, and striving to increase the number of obstetricians and midwives by 65,438 +0.4 million during the 13 th Five-Year Plan period.
Private hospitals therefore saw the potential market of maternal and child health care. A special report on maternal and child industry released by soochow securities in June 20 16 pointed out that in the past few years, the overcrowding of public hospitals, the annual increase in per capita medical and health care costs, the implementation of the second child policy, and the utilization rate of obstetric beds in eastern cities exceeded 95% were all favorable factors for the development of private maternity hospitals.
The policy is favorable and the market prospect is attractive. In addition, maternity hospitals need less equipment, the threshold of funds is low, and a large number of players enter the game. Maternity hospitals that entered the market earlier focused on the high-end market, targeting foreigners and high-income groups in the north, Guangzhou and Guangzhou, while the "Putian Department" that entered the market later focused on filling the gaps in second-tier cities such as Chengdu and Qingdao. From 2065438 to July 2005, Hemei Medical, one of the four major Putian families, was listed on the Hong Kong stock market.
When public and private hospitals are gearing up for the baby boom, reality is like a pot of cold water.
"Overcapacity" in the industry
20 19 is the year of the pig, and Yu Yabin found that the delivery in that year did not exceed 20 17 the year of the rooster. As a result, she felt that the delivery volume began to decline. If the decline of women's fertility desire in 2020 is affected by the epidemic, then the obstetrics has not recovered its previous vitality in 20021year, which means that the decline of fertility rate has become a fait accompli.
There are figures to prove it: the delivery volume of Beijing Chaoyang Maternal and Child Health Hospital in 20 16 was close to 5800, and then it decreased year by year, reaching the early 2000 in 20021year, which was less than half of that of four years ago.
In Hangzhou, Liu Jiangang, deputy chief physician of obstetrics and gynecology in a private 3A hospital, said that compared with a few years ago, the delivery volume in his hospital was almost reduced by half. Before 20 13, I worked in the local public 3A Gynecology and Obstetrics Hospital. According to his understanding, the maternity ward of the hospital is now about 20% empty. As far as Liu Jiangang knows, the maternity ward of Anji County Maternal and Child Health Hospital in Huzhou City, Zhejiang Province has three floors, but now one floor has been demolished, and the maternity ward of Hangzhou Second Hospital has been closed by half.
In Guantao County, Handan City, Hebei Province, 400 kilometers away from Beijing, Zhang said that the number of deliveries in his department dropped from 438+06 in 2065 to 789 last year. "In the first two months of this year, our department only gave birth to more than 50 children. I don't think the data this year will be good. " She said.
"When I went to the countryside for a free clinic last year, the secretary of the township health center told me that from the New Year to the National Day, less than 20 people got married in the village." Zhang said to him. She also explained that Guantao County is an underdeveloped county with a serious phenomenon of population outflow. Most local men go out to work, while many women are married to other places.
The number of pregnant women in Dongcheng District Maternal and Child Health Hospital, where Wang Xia is located, has also dropped sharply. Now there are only 30 to 40 deliveries per month, which is only one fifth of that in previous years. The reason for this phenomenon is not only the weak fertility will, but also related to the population relief policy in Dongcheng District in recent years.
Duan Tao, a professor at Shanghai No.1 Maternal and Infant Health Hospital, told China Newsweek that the impact of declining fertility rate on obstetrics was significantly greater in public hospitals at the second and lower levels than in tertiary hospitals. Most district-level maternal and child health hospitals belong to secondary hospitals, so they are greatly affected.
Liu Jiangang explained that, with the overall decrease in delivery, pregnant women who were unable to file in tertiary hospitals before, but went to secondary hospitals to file, can now go to tertiary hospitals to give birth, so the number of obstetric clinics in tertiary hospitals is still relatively large as a whole.
Duan Tao said that among public tertiary hospitals, women's and children's specialized hospitals are less affected. On the one hand, the reason is that these hospitals "specialize in their professions", which has formed competitive advantages and barriers. Many people regard tertiary hospitals as the first choice for giving birth to children. On the other hand, due to the epidemic situation in recent two years, the epidemic situation control in general hospitals will be stricter, and many people will turn to maternity and child specialized hospitals for production.
From 20 14 to 20 19, China CDC Liu Yanhui monitored the allocation and utilization of obstetric health resources in Beijing (Haidian District, Chaoyang District), Chengdu City, Wuhan City and Shenzhen City, and found that "after 20 17 years, the utilization rate of obstetric beds and the workload of obstetricians in other types of midwifery medical institutions decreased significantly".
In terms of private hospitals, Duan Tao said that small single private hospitals are the most affected because they are small in scale, often over-marketed and lack a good team of experts. The situation of large high-end private hospitals is slightly better. Duan Tao believes that these head hospitals have a foothold, a first-Mover advantage, and caught up with the wind at that time, so they have developed rapidly and have brand advantages, so they can survive the impact.
A decrease in workload means a decrease in income. Whether public or private, the salary structure of doctors is composed of basic salary+performance. Wang Xia said that her salary has been reduced by about 30% in recent years due to the depression of obstetrics, and Liu Jiangang also gave a similar figure, saying that sometimes it will be reduced by half.
On February 23, 2022, in the Department of Obstetrics and Gynecology, Hohhot Maternal and Child Health Hospital, Inner Mongolia, medical staff prepared to monitor the fetal heart rate of pregnant women. Figure/Xinhua
Zhang said that at 20 10, her department was too busy. It was divided into three departments, obstetrics and gynecology, and there were nearly 30 obstetricians and gynecologists. Now it has been changed to two departments, and there are only a dozen medical staff left. "Some midwives have changed careers. Some attending doctors and above have gone to hospitals in Handan as gynecologists, so their income will increase relatively. "
Departments in Wang Xia will adjust the personnel ratio according to the situation of gynecology and obstetrics. About 20 16, there are 7 doctors in obstetrics, accounting for the vast majority of obstetrics and gynecology. In recent years, with the decline of delivery, obstetricians began to flow to gynecology, almost flat.
Obstetric involution
At the same time, the average age of pregnant women is increasing. Many doctors interviewed said that primiparas who gave birth at the age of 24 or 5 are rarely seen, and most primiparas are around 30 years old. Yu Yabin said that the increase in the age of first delivery of pregnant women means that the risk of childbirth will increase to a certain extent. From this perspective, obstetricians are facing increasing challenges. However, according to the requirements, the maternal mortality rate should be reduced, which requires higher and higher medical technology in obstetrics and gynecology.
She also explained that "the maternal mortality rate is an indicator of the government's health capacity and will also rank globally. Every time a pregnant woman dies, it needs to be discussed in the whole city. All doctors in the hospital and medical staff contacted by pregnant women should attend. Every comment is arrogant. "
In order to meet the needs of pregnant women at different levels, Yu Yabin also plans to build a special needs ward, that is, a VIP ward with hardware facilities comparable to hotels, warm environment and comprehensive services.
20 16 February16, from the first day of the first month to the eighth day of the first month, Gansu Provincial Maternal and Child Health Hospital welcomed 352 "monkey babies". Figure/vision china
In Yabin's view, in the past few decades, public hospitals have mainly solved the problem of whether pregnant women can live in hospitals and have children. Now the contradiction has become a question of how to make them comfortable. "The post-90s generation of pregnant women are basically only children. They slept in a room since childhood and grew up under the care of their parents. Where can they stand a room with eight people and no privacy at all? " Yu Yabin said.
Guantao County People's Hospital also indicated that it will build a special needs ward. Professor Wang Shijun, director of the Obstetrics and Gynecology Department of Beijing xuanwu hospital, told China Newsweek that the hospital has completely renovated the maternity ward, and the obstetric medical staff and beds will be adjusted in time with the changes of pregnant women. The hospital is also ready for unlimited filing.
Both public hospitals and private hospitals have extended the service chain. From prenatal care to postpartum rehabilitation, hospitals try their best. Over the past year, Beijing Dongcheng District Maternal and Child Health Hospital has started the integration of pre-pregnancy health care and clinic. The hospital is responsible for pre-pregnancy and pre-marital examination in the whole region. "During the physical examination, we will find patients with medical needs, including pre-pregnancy counseling and pre-pregnancy treatment. The health center hopes to seize these patients and refer them to the corresponding departments of the hospital to solve their needs. " Wang Xia said, "In the past, there were many patients, and our work in this area was not so detailed. Now that there are fewer patients, I hope to provide a more comprehensive one-stop service. "
Beijing xuanwu hospital and Hebei Guantao People's Hospital also plan to carry out postpartum rehabilitation clinics to deal with pelvic osteoporosis and some postpartum complications.
Beijing Dongcheng District Maternal and Child Health Hospital has also established a medical association with Union Medical College Hospital, and obstetricians from Union Medical College Hospital regularly visit the former hospital. Some critically ill patients should have been referred to Sheikh for surgery, but they didn't have to go there when experts from Sheikh Hospital arrived. Under the mode of medical association, Dongcheng District Maternal and Child Health Hospital can also receive some difficult patients.
Although a number of supporting measures for three children have been introduced in various places, the fundamental reason is the fertility will of women of childbearing age, and the unknown fear of childbirth pain is one of the wishes that hinder women from getting pregnant. From 2065438 to 2007, Ma Rongrong, a parturient in Yulin, Shaanxi Province, jumped off a building, which was an extreme manifestation of women's anxiety about the pain and risk of childbirth. In order to improve women's fertility desire, hospitals at all levels are also vigorously promoting labor analgesia technology.
When public hospitals begin to build special wards, it will inevitably encroach on the living space of private hospitals step by step. Private hospitals have always taken quality service as their selling point, but the ward environment, lower price, higher social credibility and high-level medical team of public hospitals will attract more pregnant women.
Duan Tao believes that health care is a heavy asset investment. A hospital starts to make profits after 5-7 years on average, and the medical industry is not profiteering. Therefore, the field of private obstetrics and gynecology has entered the era of stock competition, and the number of private hospitals will be less and less in the future.
Private obstetrics and gynecology hospitals that are still struggling to survive either expand their business or directly transform. Liu Jiangang told China Newsweek that some hospitals are vigorously developing private plastic surgery, postpartum medical beauty and other businesses, while others will keep a small number of obstetricians and beds, and will focus on the development of stomatology.
Duan Tao pointed out that private hospitals should also transform into academics and improve their technology, which is a long-term work; In addition, it used to be the incremental era, and now it has entered the stock era. Private hospitals need to manage and serve existing customers well. Although many private hospitals used to have month-end centers and postpartum rehabilitation programs, they were not systematic, and professional teams should be set up to do these services.
"In the future, obstetrics in public hospitals and private hospitals will become more and more similar. The former will begin to provide services and quality, and the latter will begin to improve delivery and postpartum technology. " Duan Tao said.