“大三甲基建潮”渐退，县医院“夹缝生存”窘境待破

Core Insights - Public hospitals are increasingly recognizing the dual nature of scale expansion on economic efficiency, with many experiencing financial losses despite increased fiscal input and medical service revenue [1][7] - The core of achieving the "public welfare" positioning of public hospitals lies in establishing a sound compensation mechanism, as the proportion of fiscal subsidies in total revenue remains low [1][3] - The "Fifteen Five" plan emphasizes the need for reform in public hospital compensation mechanisms, focusing on performance-based funding rather than fixed allocations based on bed numbers [8][9] Financial Performance - In 2022, fiscal subsidy income accounted for 12.92% of public hospital revenue, a decrease of 3 percentage points from its peak in 2020, while medical income constituted approximately 84.1% of total revenue in tertiary public hospitals [3] - The asset-liability ratio of public hospitals remains high at around 49.2% to 49.3%, indicating financial strain despite the expansion of services [6] Expansion and Resource Allocation - The trend of urban public hospitals expanding into multiple branches has led to an increase in total bed capacity, with hospitals averaging 3 to 6 branches each [4] - The expansion has resulted in a dilution of quality medical resources and significant disparities in service quality between branches [7] County-Level Hospital Challenges - County-level public hospitals face operational challenges due to patient siphoning by urban hospitals, leading to insufficient medical income and increased expenditure pressures [10][12] - The current reimbursement policies favor urban hospitals, exacerbating the financial difficulties of county hospitals [11] Policy and Reform Directions - The "Fifteen Five" plan outlines four key areas for reform: enhancing fiscal support for county and grassroots medical institutions, increasing government investment, implementing personnel funding subsidies, and providing financial support for underfunded medical services [14][15]