A recent draft setting a mortality ceiling on Chinese hospitals as one of the criteria to assess their medical services has provoked widespread controversy among the public. Issued by the National Health and Family Planning Commission (NHFPC) in late July, the draft stipulates that there should be no more than eight deaths per every 1,000 inpatients and no more than 1.4 deaths per every 1,000 inpatient operations in China's Class-3 general hospitals. While for Class-2 general hospitals, the figures should remain less than four and 0.28 respectively.

As the draft was released to solicit public opinions, people were divided on whether there should be such a limit. Supporters believe setting a ceiling on mortality as a criterion to assess hospitals will stimulate hospitals to improve the efficiency of management systems and the quality of their medical services. However, some criticize that a rigid standard will only encourage hospitals to shut doors down for patients in critical conditions and with no hope of recovery.

Pro

Chen Changwei

Medical expert from Guangdong

As a matter of fact, many hospitals have been comparing their mortality rates with those in previous years so as to judge whether the figure rises or falls within an acceptable range. The ceiling given by the nation's health authority set a much clearer and unified standard for hospitals at the same level, with which they are able to make horizontal comparisons and learn from each other. In this sense, I think it is a positive move.

When a hospital's mortality reaches the ceiling, it has to introspect and find out the reason. Is it an inevitable consequence of natural disaster or public health emergency? Or is it just poor medical service that should be blamed? If it turns out to be the latter, such a hospital should take measures to improve its management and service. The government's role under such circumstances is to guide the hospitals and to make sure they take the guideline seriously.

Con

Xiao Chang

Media commentator

A standard, no matter a guideline or a compulsory directive, is judgmental. As long as the mortality is taken as an index, it becomes one of the criteria to assess the performance of hospitals. Mortality statistics is actually a description of facts, while a ceiling will be an expectation to the ideal scenario. In many cases, the authorities just confuse the facts with an ideal scenario. When making policies, they simply choose to set an index as quantitative numbers, ignoring the ultimate purpose of the policy, which is to improve the management efficiency and service quality in hospitals.

It is good to evaluate the performance of hospitals with numbers. However, the index should be based on medical practice and given by professionals in the field. Chances of curing certain diseases depend on the advancement of the medical service. When accidents happen during an operation, are they malpractices or just beyond the capacity of doctors? Only professionals can tell. Thus, it is meaningless to set the mortality ceiling.

Pro

Wu Shuai

Doctor

Mortality in operations and possibilities of complications and accidents occurring during the process of medical treatment are important information that people seeking medical service need to know.

Setting the ceiling is an effort to reduce mortality. Instead of taking it as a burden, hospitals could share experiences of success and failure on medical management and service under the guide of the standard. Every reduction in the percentage of mortality means a life is saved. From this perspective, attaching importance to mortality can help improve a hospital's service quality.

However, in reality, there are many reasons causing high mortality. If the ceiling is used as a standard to evaluate a hospital, in what way should it be referenced? As a common international practice, an average mortality on certain serious diseases and operations is generally given as a reference. Therefore, instead of introducing a general ceiling, setting respective ones for specific diseases and operations is of greater guiding significance.

Con

Chen Anwei

Medical professional

Rather than focusing on mortality, the health authorities should guide hospitals to improve the medical service and safety. Hospitals should give priority to saving patients' lives. No hospital would refuse treatment in pursuit of lowering the mortality rate. However, as long as there is a standard, they will be restrained and will take measures to reach it.

Before evaluating hospitals' performance through a mortality ceiling, health authorities have problems to solve. For instance, how should we deal with dying patients whose conditions only need emotional care more than medical treatment? If those patients are counted as part of the number of deaths, it is very likely that hospitals will not accept them.

Pro

Zhao Minggang

Official with the NHFPC

The mortality ceilings are actually medians calculated by relevant medical societies that have conducted surveys on mortality rates among hundreds of Class-2 and Class-3 general hospitals nationwide. As a matter of fact, the rates are lower than the medians in many hospitals being surveyed. We just offer the ceilings as guidelines, not as a compulsory directive. It aims at urging hospitals who fail to meet the standard to find out reasons behind that failure so that they can improve the management system to ensure the quality and safety of their services.

Hospitals will not refuse to admit and treat patients with critical conditions since every medical practitioner is well aware that turning a blind eye on people in need of their professional help goes against medical ethnics. The government will also fully play its role as a supervisor. If there were such hospitals or doctors, they would be punished according to laws and regulations with no hesitation. It is also a common international practice for health authorities to adopt a similar index to assess and regulate medical institutions.

Con

Yuan Guangkuo

Media commentator

Improving management by setting targets has often proven to be effective. However, this rigid system of assessing hospitals by mortality will only lead to unexpected consequences.

In medical practice, the better the hospital is, the higher the mortality would be. Patients in critical situations are generally sent to hospitals with better facilities and better-skilled doctors. The most complicated surgeries often fall on the shoulders of those skilled doctors. However, with the rigid ceiling for mortality, those hospitals may fail in evaluation as the mortality of patients they treat is unavoidably high.

Furthermore, some hospitals may refuse to accept patients with serious illness so as to meet the assessment standard. Some may even keep patients who are not supposed to be hospitalized in order to lower the mortality rate, thereby wasting precious medical resources.

Finally, with the pressure of meeting standards, medical institutions and doctors will refuse to accept or treat patients with no hope of recovery, further aggravating the strained doctor-patient relationship. Even though the draft has been done with good intentions, the authorities should think twice before implementing it.