Shanghai Launches New Exploration of Its Healthcare System: Pilot Program for "Localized Management of Healthcare" Begins

The healthcare reform—long-awaited as a solution to the challenges of “difficult access to medical care” and “high medical costs”—has consistently drawn intense attention. With the launch of the new healthcare reform initiative, people are now seeing a clear roadmap ahead. In Shanghai—a region that boasts one of China’s most advanced healthcare systems—the government authorities, district and county governments, and various medical institutions have cautiously begun piloting reforms, striving step by step to tackle the toughest issues and ultimately benefit citizens. Starting today, our newspaper will publish a series of reports providing an overview of some of the ongoing pilot programs in Shanghai.

　　These pilot programs all revolve around optimizing the allocation of medical resources—enabling people to place the same level of trust in community hospitals as they do in tertiary hospitals, encouraging public hospitals to shoulder greater social responsibilities, and shedding light on the gray areas between medicine and pharmaceuticals. All these initiatives represent efforts toward systemic reform, with the ultimate goal of enabling people to enjoy higher-quality, more convenient, and more affordable medical services.

　　The path to breakthrough has no precedents to follow and is likely to be fraught with thorns and numerous challenges. Yet every new path must be forged by those who dare to take it, and medical reform is no exception.

　　The anticipated outcome is this: In the future, tertiary hospitals will no longer be overcrowded, allowing specialists ample time to provide careful diagnosis and treatment as well as conduct research on complex and challenging medical cases; secondary hospitals will no longer suffer from low patient traffic, boosting the enthusiasm of medical staff; and community doctors will no longer simply prescribe medications for patients—they will become health guardians for every family.

　　“Localized Management of Healthcare”—a brand-new hospital management model—is currently being piloted in Shanghai. This model aims to break the current situation in the city, where first-, second-, and third-level hospitals operate independently with unclear divisions of responsibility. Under this new approach, hospitals will be “repackaged” according to their respective regions, integrating public medical resources to build public trust in the tiered diagnosis and treatment system and deliver medical services to citizens with greater efficiency.

　　Pilot programs are being launched; Chongming and Luwan already meet the necessary conditions.

　　Xu Jianguang, Director of the Shanghai Municipal Health Bureau, recently revealed that Chongming County in the suburban area and Luwan District in the city center already meet relatively mature conditions and are expected to launch pilot programs in the near future. However, he also noted that the pilot programs will encounter certain challenges and will proceed by exploring as they go along.

　　So-called localized medical management refers to establishing a closer "vertical linkage" between primary-level medical institutions and large public hospitals, thereby forming regional medical consortia. Within these consortia, large city-level hospitals serve as the designers and implementers of comprehensive disease management plans for residents, taking charge of talent development in first- and second-level hospitals, formulating clinical practice guidelines and standardizing disease treatment procedures. Meanwhile, tertiary hospitals within the consortium assume management responsibilities and authorities.

　　In other words, hospitals at levels one, two, and three within the same region will no longer merely differ in name; instead, they will establish a clear hierarchical relationship. Specifically, tertiary hospitals will have management authority, training rights, and operational guidance over primary-level hospitals, while also assuming corresponding obligations and responsibilities. This groundbreaking initiative aims to standardize and homogenize basic medical care and diagnosis within the region.

　　Improve quality and build residents’ trust in community healthcare.

　　A preliminary framework has been established among Ruijin Hospital, a Grade-III hospital located in Luwan District, Luwan District Central Hospital, a Grade-II hospital, and four community health service centers. Over the past year, the community health service centers in Luwan District have successively set up specialized management programs for diseases such as diabetes, hypertension, and cerebral infarction. Senior specialists with deputy senior titles or higher from Ruijin Hospital and Luwan District Central Hospital have been dispatched to the communities to provide guidance and support.

　　For patients, the most fundamental change is being able to seek medical care with peace of mind in their local community. Wang, a 69-year-old woman, lives right next to the Jinan Community Health Service Station at the Huaishihai Community Service Center. Yet in the past, she only went there to pick up prescriptions and receive intravenous drips—never to see a doctor. It wasn't until last October, when she noticed that specialists from Ruijin Hospital had also started seeing patients next door, that she finally felt comfortable enough to go for medical treatment. “Before, I wasn’t confident about the skills of community doctors. But if I knew the doctors’ competence was guaranteed, of course I’d be happy to get treated right next door.”

　　It is understood that physician management within this system is hierarchical. Zhao Liebin, Executive Director of the Specialized Community Office at Ruijin Hospital, explained that experts from Ruijin Hospital’s departments of neurology, rehabilitation, endocrinology, and others have been “delegated” to secondary hospitals to serve as department heads, providing mentorship, assistance, and guidance to help elevate the specialized diagnostic and treatment capabilities of these secondary hospitals. At the same time, specialists from Ruijin Hospital and district central hospitals regularly “go down” to communities such as Huaihai and Wuliqiao each month. Ji Hui, a general practitioner at the Jinan Community Health Service Station under the Huaihai Community Service Center, said: “This kind of collaboration has provided us grassroots doctors with invaluable opportunities for learning and professional development.”

　　According to a recent survey, 92.1% of patients in Luwan District believe that seeking medical care has become more convenient under the new model. Satisfaction with both general practitioners and specialists exceeds 97%, and nearly all patients are willing to receive further diagnosis and follow-up care within their communities. Almost 90% of patients would like to see more types of chronic diseases treated in this manner.

　　Core breakthroughs ensure positive interaction among hospitals at all levels.

　　Chongming County, another area meeting the criteria for a pilot program, has been exploring the integration of medical resources within the region since last year. The municipal-level hospital that is paired with Chongming County for collaborative efforts is Xinhua Hospital, affiliated with Shanghai Jiao Tong University School of Medicine. Dean Xu Weiguo said, “Cooperation between municipal hospitals and grassroots hospitals has actually been underway for over 40 years. Xinhua Hospital has consistently provided counterpart support to Chongming County; however, in recent years, the excessive marketization trend in the healthcare system has eroded mutual trust between the collaborating parties.”

　　What Xu Weiguo is referring to is that over the past decade, patients have become “resources” coveted by hospitals at all levels. As a result, despite ongoing efforts by health authorities to promote two-way referrals among hospitals at different levels, only a small number of such referrals have actually taken off. The reason is simple: hospitals at levels one, two, and three are under the jurisdiction of two separate “families.” Specifically, tertiary hospitals are funded by municipal finances and fall under municipal administration, whereas first- and second-level hospitals are funded by district-level finances and are managed by districts and counties. It’s extremely difficult for these two groups to coordinate effectively.

　　Xu Jianguang, director of the Municipal Health Bureau, said, “The new ‘localized medical management’ model is very likely to achieve breakthroughs starting with core asset management.”

　　Peng Guifang, Director of the Health Bureau of Chongming County, has just completed a detailed study. She said, “If this approach proves successful in the pilot phase, it could very likely become a highly noteworthy innovation in Shanghai—and even nationwide—healthcare reform.”

　　Xu Jianguang believes, “From a theoretical perspective, this breakthrough is feasible.” This is because both district-level and city-level finances are funded by the state. The most ideal approach would be to pool city-level and district-level funding into a single “larger fund,” thereby completely streamlining the relationships among public hospitals at all levels and of all types.

　　In a recent report submitted to the Municipal People's Congress, Ruijin Hospital suggested that the key to the next stage of regional healthcare resource integration may lie in asset consolidation, which would help establish closer links and stronger connections among medical institutions at all levels. They proposed: “Could medical consortia within the region be piloted as independent legal entities?”

　　To tackle the difficult challenges, we still need to proceed steadily and in an orderly manner.

　　Since 2003, asset integration among medical institutions at all levels has consistently been a topic that everyone wants to address but dares not touch. Zhao Liebin from Ruijin Hospital said, “This round of reform differs from the asset integration proposals made in previous years under the backdrop of excessive marketization; the focus now is on restructuring and making more effective use of state-owned assets.” However, achieving a breakthrough in asset integration has always been the most challenging aspect. Peng Guifang remarked, “We’re somewhat hesitant about exactly how to proceed. For instance, what will happen to the substantial public health tasks currently handled by community medical institutions? How exactly will they be managed going forward? Right now, there’s still no clear answer.”

　　Xu Jianguang also stated: “This step must be taken steadily and in an orderly manner. Under the current circumstances, we should first focus on localizing management and integration within the scope of medical services.” Earlier this year, Shanghai had already laid the groundwork for localized integration of medical services by adjusting its healthcare layout to ensure that high-quality resources from tertiary hospitals were fully extended to all suburban districts.

　　In addition to Luwan District and Ruijin Hospital, which already enjoy relatively mature conditions, as well as Chongming County and Xinhua Hospital, Shanghai’s Baoshan District and Changning District have also come onto the radar of government authorities as potential pilot areas. The anticipated outcomes are as follows: In the future, tertiary hospitals will no longer be overcrowded, allowing specialists ample time to provide careful diagnosis and treatment and conduct research on complex and challenging medical cases; secondary hospitals will no longer suffer from low patient volumes, boosting the enthusiasm of medical staff; and community doctors will no longer simply prescribe medications for patients—they will become true health guardians for every family.