Interface News reporter | Huang Hua
Interface News Editor | Xie Xin
There are fewer people who have children, what about the obstetrics in the hospital?
"It turned out that the number of births in the country at a maximum of more than 200 million, and then dropped to more than 10 million. After the opening of the most, it rose to 1400-15 million. Now it is less than 10 million.When the most in the past year, the annual delivery volume is close to 34,000, and now the number of childbirth is about 25,000, which is nearly 10,000. "For the changes in the number of obstetrics, the former dean of a woman and infant in Shanghai, the founding of Chuntian Medical Management was foundedHuman Duan Tao described.
Like Duan Tao, many obstetrics and gynecology practitioners have similar feelings. At the moment when the dividend of population has gradually disappeared, the obstetrics of large cities have been from the former "one bed difficult" to "the resources are not so scarce".In addition, it is a single room. "In small cities," the decline in the county seat is already obvious, and my contact experience is more than half of it. "" Medical institutions generally decline by 10%-20%or more. "
Behind this description, the "obstetric cold winter" seems to be quietly coming.In addition to the decline in childbirth, the beds are waiting for crying, the proportion of second and third babies in the childbirth group increases, and the elderly pregnant maternal occurs. The increase in complex pregnancy has increased, which constitutes the difficulties of obstetrics.As a result, the obstetrics were under the pressure of shrinking scale. On the one hand, we must continue to carry the banner of safe production, and the survival string further tightened.
On February 28, the National Bureau of Statistics issued a statistics of the national economic and social development statistics in 2022.It shows that at the end of 2022, the national population was 1.4117.5 billion, and the birth population was 9.56 million throughout the year, and the natural growth rate was -0.60 ‰.
This is the first time since 1950, the number of domestic births has fallen below 10 million for the first time.In addition, the number of new domestic population has declined for 6 years.Since 2016 reached 17.86 million, there are almost 2 million in China in China.In 2022, it was only about 50%of 2016, almost "cutting".
As a result, the source of the birth of the population was directly affected, and the grass -roots hospitals took the lead in feeling the chill.
In an interview with interface journalists in an obstetrics and gynecology hospital in Zhejiang, a gynecological and gynecology hospital managers said that "the decline in childbirth in the county seat has been obvious. From my contact with several childbirth units, it has fallen by more than half."He introduced that in Zhejiang, there are already only 500-1000 childbirth in the area in Zhejiang; but in the past, it was also the area in the area, and the birth population was more than 2,000 within a year.
However, he also said that such an influence is mainly concentrated in the county level.The unit is a regional level of central obstetrics and gynecology hospitals. The current number of delivery is still relatively large. "The number and the previous year have not declined than the previous year. There are still many maternal mothers who come to large hospitals to students."
In China, there are significant differences in medical levels in different regions and different levels of medical institutions, and the obstetrics are naturally in this system.Under the guidance of the long -term concept of "going to the large hospital", the current status of the obstetric cold winter is: the grassroots "first cold" and the third level temporarily collected "fisheries".Of course, this is a region with relatively developed economic conditions.
Qi Guoqun, deputy dean of Nantong Ruici Xingyuan Club Maternal and Gynecology Hospital, introduced to the interface journalist that the mainstream people of pregnant women are post -90s and post -95s.A better place is born "; in addition to the post -90s and post -95s, in the second child and three childs, the elderly maternal maternal, there are more mothers with pregnancy and complications, and they will also want to be born in a large hospital.The doctor is more experienced and safer. "
The aforementioned analysis of the obstetrics management personnel in Zhejiang region, the reasons for different changes in county and district -level hospitals and tertiary hospitals are still the guidance of policy.He said that at present, hospitals at all levels have performance assessment. Public hospitals and three hospitals across the country must participate in the "national examination". The policy has promoted the strengthening of high -level hospitals and enhanced endogenous motivation.Strong, now stronger, more pregnant women are willing to give birth to a third -level hospital. This is also manifested in the service attitude of the doctor group.Just say you can come now. "
In fact, these explain why the grassroots first affected when the total amount became less.Another reason for the "cold grassroots" is that the functions of different levels of medical institutions at different levels are gradually transforming.
From the perspective of the level of the medical institution, Qi Guoqun believes that many grass -roots medical institutions in China, like first -level medical institutions, are mostly maternity institutions, but now they have gradually shrinking and no longer live. On the whole, overall, overall,, overall,, overall,, overall,, overall,The first -level medical institutions no longer have the ability to give birth, and the ability of secondary medical institutions to regulate is gradually decreasing. On the contrary, third -level medical institutions have obtained the number of childbirth in secondary and first -level medical institutions.
It is also based on the third level temporarily in the dividend, and provinces and cities have also strengthened construction.Taking Nantong City as an example, Qi Guoqun introduced that the current Affiliated Hospital of Nantong University (Tongda Affiliated Hospital), Nantong First People’s Hospital, Maternal and Child Health Hospital, etc., all have established new hospitals. Obstetrics are expanded. Obstetrics are increasing and obstetric services.It is strengthening, so it is not difficult to speculate that except for Zhejiang and Jiangsu regions, the industry volume of head hospitals in other provinces and cities in China is still relatively stable.
As for the changes in the first, secondary, and third -level hospitals, the management staff of the private obstetrics and gynecology hospitals in Taizhou, Jiangsu, said that at present, the first -level hospitals have basically undertaken the card building and the initial inspection function.For the second -level hospital, according to the "five -color management", the second -level hospital cannot accept the "orange" and above maternal maternal. On the whole, the current tertiary hospitals are less affected.The hospital is most affected.
However, no matter what level of medical workers, they actually feel chills.
The aforementioned interviewees also believe that even if it is a third -level hospital, the trend of the decline in the overall perspective has existed, and it starts from the policy of opening up the second child. "During that time, the amount of childbirth quickly got up, and later went down. "" In the past two years, many obstetricians had been busy with resistance, so everyone was not strong.So it was empty, but the changes in the obstetric business have already begun. Once upon asking if I would sleep on the corridor, now I asked if there was a single room. "
Still taking Nantong as an example, Qi Guoqun further introduced that in 2022, the number of delivery institutions in eight in Nantong urban area decreased by 11.2%year -on -year, and some hospitals had a decrease of 20%year -on -year.Terror is not a cliff -like decline, "she said.
In Taizhou, the above -mentioned private obstetrics and gynecology hospitals also introduced that it is consistent with the domestic birth population and birth rate. The overall childbirth volume of Taizhou is also declining.%.
The reason why in 2016 and 2017 will be deeply impressed by the feelings of the obstetrics managers of the head hospitals because since January 1, 2016, the domestic "comprehensive two -child" policy was officially implemented in China.The number reached 17.86 million, a significant increase from 16.55 million in 2015.However, from 2017 to 2021, the dividend of the "comprehensive two-child" did not appear as expected.During this period, the number of annual births in China was 17.23 million, 15.23 million, 14.65 million, 12 million, and 10.62 million, showing a stable and decreasing trend year.
The aforementioned personnel believe that the current business volume of obstetrics has declined except for women of childbearing age, especially in the period of fertility, in addition to the decline in the scale of childbearing age, in other reasons, the main reason is that the concept of marriage and childbearing in contemporary young people has changed significantly.At present, the main body of the post -90s and post -00s, most of the growth and work in the town, the long -term education period is longer, the pressure of employment competition is greater, and the postponement of marriage and childbirth is very prominent.In addition, the poor living habits of modern young people have increased the possibility of marriage and infertility, and further suppressing the fertility level.In addition, in the process of socio -economic development, under the influence of multiple factors such as housing, education, and employment, the cost of fertility education is high, which has made many young people hesitate and discouraged on fertility issues.
Of course, the three major hospitals may not "close the door" directly as the grassroots, but even the head of obstetrics and gynecology hospitals, its operating environment is changing.For example, compared with more than 20 years ago, there is no longer a giant billboard similar to the "Po Ling Pregnancy" around the hospital. The sculpture of the mother’s embrace of the baby is gone. Later, the outpatient, emergency and general ward.
Inside the hospital, more and more new gynecological businesses have been carried out, and the proportion of more than more investments such as surgery and minimally invasive business is also increasing.The nurses started to flow towards other ward, hospital and outpatient clinics.In the communication and learning project of the grass -roots team, childbirth and newborn care are no longer priority.
While obstetrics are marginalized inside medical institutions, nursingists and doctors in some confinement centers have begun to appear personnel with professional obstetrics qualifications.The confinement center directly opened to the nearby unit of the obstetrics and gynecology institutions. When introducing the advantages of the maternity agency, "I am a maternity hospital downstairs, and there are problems with doctors to check the house."
These all show that some obstetric resources have been transferred outward under the adjustment of the market.There is an institution that has a longing for transfer.Among them, some high -end private institutions.
Lu Meng, deputy director of the Shanghai Jiahui Medical Obstetrics and Gynecology Department, said in an interview with interface journalists that within the Yangtze River Delta, high -end private medical institutions have begun to have a rainbow effect on patients.As long as economic conditions allow, more and more people will choose high -end private institutions for delivery. "This is a development opportunity for Jiahui.
"Jiahui has not yet seen a significant decline in childbirth,", Lu Meng introduced, Jiahui Medical (referred to as Shanghai Jiahui International Hospital) was put into operation in October 2017, and has been established for more than 5 years.In the past 4 years of the Karming Department, in these 4 years, the business volume of obstetrics has increased very fast. From the beginning of a monthly delivery of more than a dozen people, by 2022, the number of peak monthly delivery has reached 130-140.The growth rate will not be so fast, but the current amount of delivery is still stable. "
However, Lu Meng also acknowledged that as far as he understood, the number of new population in China has fallen significantly, and the clients at the grassroots level do have a decline in business volume.Essence
If it is said that the obstetrics and gynecology department of the head is still hiding in the strong, and the high -end private institutions are relying on a relatively independent system and strong wealth support in the airport.But in any case, the impact exists.
Duan Tao analyzed in interview interface news interviews that the number of births in the country’s annual birthplace was up to 20 million, and then it fell to more than 10 million.By the time, "In a woman and baby, when we were the most in the past few years, the annual delivery volume was close to 34,000, and now the number of delivery is about 25,000, which is nearly 10,000." Under this situationSmall influence.
According to the Chinese Health and Health Statistical Yearbook, the overall number of domestic maternity and gynecology (department) hospitals in 2017-2021 showed an upward trend. In 2021, the number of domestic maternity (department) hospitals was 793, an increase of 20 compared with 2017.However, from 2018 to 2020, the number of domestic obstetrics and gynecology (department) hospitals was 807, 809, and 807.This also means that data in 2021 has declined compared to the previous three years.That is, in the middle of 2021, there was a suspension of the obstetrics and gynecological hospital in China.
The more intuitive change is that from 2017 to 2021, the proportion of domestic obstetrics and gynecology beds and the proportion of beds in hospitals in the country showed a decline in the overall decline.In the domestic medical system, "bed" is a critical indicator.How many beds, how much a department bed, is directly related to the agency’s professional, weak, operating income, and industry influence of the department.
But in this indicator, in 2021, the number of beds in obstetrics and gynecology in China was 442,900, a decrease of 3.4%year -on -year, a decrease of 22,100 from 2017.In 2021, the number of beds in obstetrics and gynecology in China accounted for 5.98%of the number of beds in hospitals across the country, a decrease of 1.62 percentage points from 2017.
From the perspective of the outpatient service of domestic obstetrics and gynecology (department) hospitals, from 2017-2021, the number of diagnosis and treatment of domestic obstetrics and gynecology (department) hospitals and the number of outpatient diagnosis showed a decline.In addition, in 2020, the number of diagnosis and treatment of domestic obstetrics and gynecology (department) hospitals ushered in the minimum value, respectively, 3738.86 and 36.34 million, respectively.In 2021, the number of diagnosis and treatment of domestic obstetrics and gynecology (section) hospitals and the number of outpatients rose slightly, with 4058.52 and 39.7152 million, but 367 and 3.52 million were reduced compared with 2017.These all reflect that the income of obstetrics is declining.
In addition, in the trend of the number of domestic doctors, the average daily affairs of doctors fell from 7 in 2017 to 5.8 in 2021.As the workload of doctors (subjects) is generally declining, it also means changes in their income.
Behind this series of data, business shrinkage, institutional closes, and unemployment of personnel also exist.In response to this phenomenon, there are currently media reports.
At the beginning of February, the industry media Dingxiang Garden once mentioned that there were more than 60 cases of childbirth in a private hospital in Hebei Province in January this year. At the beginning of February, it was found that there were fewer people who had the due date of the month than last month.Since 2018, the amount of monthly delivery is at the scale of 100 cases.The industry media eight o’clock Jianwen also had similar reports in February 2022.The article tells that in 2016, Shandong, which is still "the most capable", has reduced the situation of obstetric ward after 2019, some of which reduced one -third of them, some were cut directly;The obstetric ward is reduced from 6 to 3, and the income of obstetrics has fallen to the level of ten years ago.
Regarding the problem of how to deal with the amount of obstetric delivery after childbirth reduction, the aforementioned obstetric business managers in Zhejiang believe that on the issue of personnel, the nurse is relatively easy to transfer to the job.The doctor obviously cannot go to work in other departments, and chose to be limited to the "internal circulation" between gynecological and obstetrics, so some obstetricians may go to gynecology.Essence
In addition to gynecology and obstetrics, he said that doctors can also go to maternal and infant health department and infertility. Of course, some doctors choose to leave the original work unit to the community hospital for general health care, but after leaving the hospitalThe difficulty is that "it is easy to go to a community hospital, and there is almost no possibility of reverse."
This also shows that under the current medical system, it is not easy for medical workers to move.
In terms of equipment, Qi Guoqun said that the more requirements for childbirth lies in the medical technology and service quality requirements of medical staff. It is not as high as other specialties for medical equipment. Except for some newborn equipment, other equipment can also be used in other departments. NoThere will be large equipment idle; if it is a cesarean operation room, other specialist surgery can also be performed, which is common.
Compared with how the doctor and nurses are transferred and how to deal with the equipment, where the maternal goes to give birth and how to ensure that production safety is more concerned.
The aforementioned obstetric business managers in Zhejiang believe that the country must ensure at least a relatively large childbirth center at least in every region.Concentrated mergers, directly merged if you have less birth. "At present, the risk of having children in small institutions is that if it is calculated at 1,000 annual delivery volume in the region, the amount of childbirth in a single day is 2-3 cases.The maternal is "too unsafe" because "the less born, the easier it is to happen, and the emergencies have not responded to the force."
Duan Tao also agreed with this view.It said that fewer and fewer births will enter a "malignant cycle" -the less born, less departments income, less construction investment, less opportunities for doctors to grow, and increase risks during childbirth.
From this, to resolve the current obstacles of obstetrics, it is actually necessary to find growth.But the difficulty is where the growth of fertility will come from where the growth must be from.
At present, the obstetrics and gynecology hospitals are working hard.Among them, private and high -end solutions show a possibility, the core is to provide more services.The specific idea is that on the one hand, extend the scope of service of obstetrics, "Bao Yuan" from prenatal to postpartum; second, to strengthen the risk warning of the birth period for the actual situation of the current production population;Follow the disease to the attention of the attention.
According to the obstetrics management personnel in Zhejiang region, in the traditional sense, the business of obstetrics can be divided into three aspects: first, normal physiological, that is, the main is to carry out pregnancy management, pregnancy management until childbirth, including natural delivery and cesarean section;Pathological pregnancy is also a special concern for obstetrics. For example, complications and complications that will be available during pregnancy. In most cases, the maternal body, such as the front placenta; the third is that the fetus related to the fetus, such as fetal abnormalities.Based on such a business model, "the county -level business is mainly normal delivery, and less this type is born less." This is also an important reason why the cold winter occurs at the bottom.
"The current obstetrics are pseudo -production, which is far beyond childbirth." Qi Guoqun said that this is because the number of elderly maternal women with the risk of complications and complications is increasing."Professional difficulties are much larger than in the past, which requires doctors to have some expertise in the Asian specialty and specialty."
To solve the situation of elderly pregnant women, almost all obstetrics managers focus on it.On the one hand, in the popular cognition of the public, "size is safe" is the bottom line of pregnancy production; at the domestic policy level, the mortality rate and baby mortality rate of pregnant women are red lines, which is the strings that are always tight in all obstetrics.
According to the "Expert Consensus on Management Experts (2019 Edition) before pregnancy, pregnancy and childbirth (hereinafter referred to as" Expert Consensus "), the national health regulatory department predicts that from 2017-2020, elderly pregnant women will reach more than 3 million cases per yearIt is about 1.3 times in previous years.At the same time, more than 30 % of the elderly maternal maternal males of 3 million also occupy more than 30 % of the total number of gestational groups.As we all know, the fertility risk of elderly pregnant women is higher than that of maternal mothers.
As a result, based on the principles of risk management, major obstetrics and gynecology institutions are actually more focused on prenatal diagnosis and tracking of pregnant women than before.Among them, the object is not only a maternal maternal, but also involves the fetus.The aforementioned obstetric business managers in Zhejiang are introduced that there are currently increased due to "difficulty pregnancy", such as the pregnancy of some families with infertility;The consciousness has also become stronger. "What you ask can treat or not be cured, will there be sequelae after treatment." These have put forward higher requirements for the development of fetal medicine.
Qi Guoqun also introduced that in 2023, the hospital also plans to set up a tire -breeding center combined with Chinese and Western medicine, which also includes tire clinics and fetal nourishing ward.She explained that the elderly mother is more likely to have early abortion, mid -term dead tires, advanced premature births, and with the popularity of IVFs, twins, third -child, and even multiple fetuses are increasing.It is not so easy for a month’s pregnancy, so special departments such as a tire center need to "protect the escort".
At the same time, Nantong Ruici Xingyuan Club Maternal and Gynecology Hospital also conducted a forward movement of obstetric services. The hospital applied for the marriage and pregnancy inspection institutions designated by the development zone to carry out eugenics guarantee services such as marriage inspection.center.Of course, this is also to attract pregnant people and mothers, while integrating the medical resources of their comprehensive third -level hospitals.In 2022, the number of delivery of Ruici obstetrics increased by 26.2%year -on -year.In addition, the hospital opened a single survive and gynecology building in September 2022.The hospital currently owns gynecology, obstetrics, family planning, marriage and pregnancy examinations, confinement, production, medical beauty, comprehensive international department and other departments.
The aforementioned managers of the obstetrics and gynecology hospitals in Taizhou, Jiangsu said that in the context of the decline in population, the hospital will extend the service chain and upgrade services.; Among them, the expansion of the confinement center, the postpartum rehabilitation project extension, as well as the on -site service of pediatric eye vision construction, traditional Chinese medicine diagnosis and treatment, and on -site services for maternal and child health care.Qualification.
In addition, he believes that as far as the development of obstetrics is concerned, compared with the comprehensive hospital cultivation, the advantage of the development of obstetrics is that the doctors and medical equipment equipment of the college will be more targeted.The individual needs of maternalization are also easy to be satisfied; and in the cultivation of obstetrics in the comprehensive hospital, the ability to treat pregnant women’s pregnancy and critical complications will be stronger. Both methods are necessary.
Lu Meng also mentioned the importance of multi -discipline.She said that another reason for Jiahui to be able to get rapid development is that her back relies on comprehensive hospitals. Due to the increase in elderly women and frequent occurrence during pregnancy, the problem of blood glucose, cardiopulmonary dysfunction, and other complex issues of immune diseases and other complex issues during pregnancy.In fact, multi -disciplinary cooperation is needed.
In addition, Lu Meng also mentioned that on the basis of ensuring the medical needs of pregnant women, high -end privacy will take more care of people, such as soothing psychological pressure, supporting health needs during pregnancy, and guiding emotional solutions.At the same time, this group also pays more attention to the group of gestational experience.These all require high -end privately to provide better services.As of now, the Karming Section has opened a total of four years, and there have been cases of having a third child.
Lu Meng believes that from the national perspective, domestic medical personnel are not high, and the medical forces and health care for pregnancy in pregnancy are still insufficient; at the same time, the development of regions is extremely unbalanced.The decline in fertility rate will not first lead to the reduction of medical practitioners, but will be promoted by the market to adjust the structural adjustment: do boutique in the central urban area to provide more detailed services; improve diagnosis and treatment technologies in remote areas, implement basic medical care and guaranteeEssence
At present, a series of problems in obstetrics are not only a problem of population changes, but also a problem with the medical system.
In an interview with the interface news, Duan Tao said that in any comprehensive hospital, the obstetrics have never been the main theme, and they are originally in less or more.If you can’t make it out, you will close it when you turn it off. The risk is small.
Behind this mentality is the imbalance of obstetrics input and output."You have so many people, and the delivery room has to be opened 24 hours a day. Even if you only have 1-2 children a day, you have to raise obstetricians, dillages, newborn doctors, newborn nurse, and you have to raise nicu.(Newborn intensive care unit), it is really not cost -effective, the risk is strong and not cost -effective, so it is closed. "Duan Tao explained.
Duan Tao believes that at this stage, there are only some small and grass -roots medical institutions that are closing the obstetrics, and other hospitals can accept this part of traffic, which has little impact on the industry.The decline in comprehensive hospitals is not a big problem. However, it is estimated that the impact on maternal and child health hospitals, maternal and children’s hospitals, which are mainly obstetrics. It is expected that obstetrics will not only decrease in the future, but also become more and more difficult to survive in the future.Essence
Duan Tao said that the problem behind the difficulty of obstetrics is still charges. "The charges of Chinese obstetrics are charged at the price of the child. Public hospitals have a hundred dollars, and the cost cannot be covered.The business is that it cannot be charged, because the public hospital must have a charge standard and charging code. Private pricing can be priced autonomously, and some people are willing to pay. There are people who are willing to pay. If you have a child tens of thousands of dollars, the business model can run. "Essence
At present, the total price of public and private children is about 10 times the gap.According to the new medical service price list released in February this year in Zhejiang Province, in clinical diagnosis and treatment, the price of a single childbirth is 900 yuan/time, and the biography is 1210 yuan.Gongbu surgery (two babies and above) is 2232 yuan/time. The secondary cesarean section (including abdominal scar removal) is 2228 yuan/time, and the vaginal delivery after cesarean section is 2,900 yuan/time.The aforementioned items do not include drug use and hospitalization charges.
According to social media, the harmonious family -made package, which was published earlier this year, costs 59,000 yuan and the cesarean section price is 88,000 yuan.The services in these packages also covered the production inspection, hospitalization, nursing and other links, and explained in detail the common medicines and laboratory of mothers and babies.The package also shows that complex delivery must be charged another 10,000 yuan.The situation of complex delivery includes: hip delivery, front placenta, and any complications of mother and infant complications that need emergency treatment.
Duan Tao believes that there is no way to do not solve the fee.
Qi Guoqun also feels touched by this issue.She said, "As a hospital manager, I am also thinking about how to survive in this shrinking cake." Under the actual conditions, the benefits of obstetrics are difficult to compare with other departments.Performance bonuses may need to be re -positioned for the assessment of obstetrics.At present, Nantong Ruici Xingyuan Club Obstetrics and Gynecology Hospital is that the hospital gives obstetrics and medical staff with tendency to evaluate the performance assessment, so as to mobilize the working motivation and passion of obstetric medical staff.
In addition to obstetric charges, medical staff’s tired state was also revealed.At present, even if the macro data at the national level has shown "chill", the working status of the head hospital is still hot.In the "White Paper of the Chinese Physician Practicing Status" released in December 2017, the average weekly working 51.05 hours per week, the average of 51.13 hours per week in the second -level hospital physician, the average of the first -level hospital physicians per dayThe weekly working hours are 48.24 hours.
Duan Tao believes that the current workload of obstetrics is a state of return to normal. In the past, they were so busy. "Patients added bed to sleep on the corridor.I feel less, but I am still very busy. "
This may also be explained that when the domestic population decreases by 2 million each year, some hospitals are still busy.Behind this continuous busy, it also reflects the model of medical development.In the process of pursuing quantities, the individual spirit is highly nervous, the doctor -patient relationship is difficult to talk about trust, the leverage is pressed to the obstetrics, which exacerbates fertility anxiety.Therefore, in this issue, in addition to the need to guide the guidance at the social level, it also needs to change and upgrade medical services.
Lu Meng believes that the trend of reduced fertility reduction rate is irreversible globally. Compared with other countries, China’s population base is still large; in the development of obstetrics, the development of graphics is the development.Quality development; the particularity of obstetrics is that pregnancy and childbirth are not a disease. It is a physiological phenomenon, which is related to medical care, but it is more related to people.At present, the decline in the birth population forces obstetrics to transform.And in a larger range, medical care needs to be transformed.