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Inner Mongolia Sustainable Cross-Border Development Investment Program (RRP PRC 51192)

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Inner Mongolia Sustainable Cross-Border Development Investment Program (RRP PRC 51192) Supplementary Document Assessment on the Medical Equipment Upgrading for the Erenhot International Traditional Chinese and Mongolian Medicine Hospital People’s Republic of China: Inner Mongolia Sustainable Cross-Border Development Investment Program Prepared by Xiaoli Guan (Health Facility Specialist) for the subproject in Erenhot – Medical Equipment Upgrading for the Erenhot International Traditional Chinese and Mongolia Medicine Hospital 1 A. Summary 1. The Erenhot International Traditional Chinese and Mongolian Medicine Hospital (EITCMMH - formerly Erenhot City Hospital) is the only modern comprehensive secondary level hospital in Erenhot City, with a 188-bed capacity but only 131 functioning available bed. EITCMMH has a setup of 38 departments (16 clinical departments, 7 medical departments, 8 medical auxiliary departments and 7 administrative departments and engages a total of 262 employees (86 doctors, 103 nursing staff, 10 medical technicians, 12 pharmacists, and 51 other medical staff), which meets up with the government hospital staffing standard. Compared with similar hospitals at the same level, the total income of EITCMMH is low. General average hospital revenue per bed in the People’s Republic of China (PRC) is usually around 600,000– 1,200,000 CNY/year, while the EITCMMH’s averages 275,000 CNY/year. The medical equipment at the hospital are outdated (i.e. over 10 years old) and levels for utilization of beds are low (45.7%), indicating a potential for income growth. In 2018, 600 patients had to be referred to other hospitals due to lack of diagnostic or treatment capacity at EITCMMH. 2. The project will support the establishment and upgrading of emergency and stroke centers, as well as the upgrading of operating rooms which will increase the capacity for cost recovery. Overall, the upgrading of hospital facilities is expected to address many of the concerns highlighted by city inhabitants and will likely increase the profitability of the hospital. 3. Since Zamyn-Uud City is 550 kilometers (km) away from Ulaanbaatar, the capital of Mongolia, but only 9 km from Erenhot, its proximity will lead citizens to seek medical support in EITCMMH. Because of this reason, EITCMMH and Zamyn-Uud City Hospital in Mongolia have been working collaboratively since 2014. EITCMMH has carried out a series of activities, for example, medical outreach services in outlying areas, in particular the cataract operations for Mongolia patients. In addition, the EITCMMH has provided the Mongolian patients with medical costs that are 20% lower than those for the local residents. Therefore, the project will very likely strengthen this linkage between the two hospitals for the benefit of border communities. Activities facilitating the care of Mongolians, such as medical fees and discounts and translation services will help increase the use of services by Mongolians. B. Methodology 4. The following methodologies have been applied for preparing this assessment report: ➢ Field study of the EITCMMH; ➢ Interview with the Dean and hospital management group of EITCMMH, such as Financial, Human Resources and Administration staff; ➢ Interview with the Director of Erenhot Municipal Health Committee; ➢ Interview with the Representatives from Erenhot Municipal Insurance Board; ➢ Review on the EITCMMH’s financial report and all the necessary documents; and ➢ Survey from the Internet and related medical websites. C. An overview of Erenhot Hygiene and Health Care 5. Erenhot City is located in the Inner Mongolia autonomous region, west of the Xilin Gol league area, with Mongolia’s bonder on the door. The distance between the two cities is 9 km. The area under its jurisdiction is 4,015 square kilometers, and the urban built-up area is 27 square kilometers. It has a mid-temperate continental monsoon climate and arid desert grassland climate. The total population of Erenhot is about 100,000, and the household registries population is 31,000, of which males make up 49.78% and females 50.22%. The age structure is as follow: 17.26% are of ages 0-14 years old, 79.8% are of ages 15-64 years old and 2.93% are over 65 years old. The top three diseases with the highest mortality rates in Erenhot City are the same as the other city in the country. They are cardiovascular and cerebrovascular diseases, cancer and respiratory diseases. 2 6. In the city, there were in total 44 medical facilities which includes 11 public facilities and 33 private clinics. The Erenhot City Hospital (currently the Erenhot International Traditional Chinese and Mongolian Medicine Hospital) is the only modern comprehensive secondary level hospital in the city. Among them, there are 326 health technicians which include 127 medical doctors, 126 nurses, 38 technicians, 25 pharmacists, and 29 other health technicians. The ratio between medical doctors and the inhabitants is 3.26/1,000 people now. This ratio has to increase to 3.5/1,000 people by 2020 according to Erenhot City Council’s request. 7. According to the Erenhot’s Municipal Statistical Bureau’s report (2019-04), the per capita expenditure of Erenhot on basic public health services was increased to CNY 55, and 68,384 people have made electronic health records registration. The level of disease prevention and control has been improved in recent years. In the field of prevention and control of infectious diseases, 241 cases of class B and C infectious diseases has occurred with a decrease of 18.06% compared to the same time of year in 2017. In addition, both rate of infectious disease network reporting and rate of timely audit are 100%. 8. In 2018, 31 medical specialists from superior hospitals were invited to attend a total of 71 short-term visits and 7 long-term hospital involvements. There are 543 fields under supervision (417 public places, 49 medical institutions, 15 schools and kindergartens, 4 radiation hygiene, 53 infectious diseases prevention and 5 drinking water supplying institutions). 9. In 2018, The primary health care institutions have provided service to the 75,484 inhabitants, building up 67,738 electronic health files and a registration rate of 89.13%. They have provided health management for 5,844 children with a health management rate of 95.74%. Furthermore, 308 patients with severe mental disorders and 128 schizophrenia patients have been registered. They have provided health management for 14 tuberculosis patients with a management rate of 100%. 8,501 school-age children have received vaccination cards and certificates. The vaccination rate was over 98.82%. In 2018, free distribution of contraceptives was also included in the basic public health services. A total of 243 cases of class of B and C infectious disease occurred, with a total incidence of 32,193 cases among 100,000 inhabitants. Compared with the year of 2017, the incidence was increased by 7.05%. 10. In general, the health insurance of Erenhot City is balanced with a surplus of CNY 1.1 billion of employee medical insurance and CNY 19.87 million in 2018. As the EITCMMH is the only comprehensive hospital in Erenhot City, the municipal health policy and development plan are highly consistent with the hospital strategy. D. Introduction of the Erenhot International Traditional Chinese and Mongolian Medicine Hospital 11. The EITCMMH was founded in 1956. The hospital was moved to its present location in 2007, covering an area of 120,000 square meters (m2) with a building area of 25,000 m2. It is the only modern comprehensive level A hospital that integrates medical treatment, first aid, and prevention under the investment of the Erenhot Municipal Government. Erenhot is located in the northern part of the autonomous region and faces the Mongolian port city of Zamyn-Uud across the border which is the largest inland port open to Mongolia in PRC. Therefore, early in 2002, Erenhot City Hospital was designated as an international medical assistance hospital and fulfilled its international assistance obligations. 12. From 2008 to 2017, EITCMMH was fully hosted by the affiliated hospital of the Inner Mongolia Medical University. During these ten years, EITCMMH hospital relied on the hosting influence from the affiliated hospitals, and the number of patients gradually had been increased. New technology and new business continued to expand. Hospital revenue continued to climb year after year. In 2015, it was successfully promoted to the ‘level of Secondary A’ hospital 3 with excellent results and completed the hosting, meaning that the key goal of the hosting was accomplished. In 2017, the agreement resigned from full hosting to technical assistance. 13. There are 38 departments including 16 clinical departments, 7 medical technical department, 8 medical auxiliary departments, and 7 administrative departments. EITCMMH’s number of beds are 188, but only 131 have been functionally available up to now. There are 262 employees, including 86 medical doctors, 103 nurses and 22 medical technicians. Among the employees, there are 3 with master degrees, 54 with undergraduate degrees, 199 health professionals, 27 with deputy senior professional titles and 49 with intermediated professional titles. Figure 1: View of the EITCMMH (July 2019) E. EITCMMH Operation Related Data Collection and Analysis 14. Outpatient Clinic. In 2018, the number of received patients at the outpatient clinics in EITCMMH was 87,432, with a 9.28% increase rate in comparison with the year of 2017. The average fee of outpatient is 202.5 CNY per patient and the average number of daily visits is 57.28. The income from the outpatient clinic contributes 51% of EITCMMH’s total medical related income. The main income composition is 28% from inspection, 20% from laboratory and 19% from the drug. 15. Hospitalization Component. EITCMMH is the only comprehensive secondary level hospital in Erenhot with a 188-bed capacity, but only 131 functioning available beds right now. In 2018, the number of discharged patients were 2,987, with an increasing rate of 5.4% over the previous year.
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