Originating from Union of Soviet Socialist Republics's nursing home model, China introduced the concept of modern rehabilitation by adapting the rehabilitation model from western countries. After the 2008 Sichuan earthquake, the Chinese government released a series of policies to promote the development of rehabilitation industry when it entered an expansion period. With the coronavirus outbreak, the Chinese government paid more attention to the development of rehabilitation industry again, and the industry entered a phase of accelerated development.
Rehabilitation is meaningful for patients, hospitals and local governments. Rehabilitation therapy can help patients ease the pain, accelerate their recovery and reduce the psychological burden. Besides, effective treatment can shorten the length of hospital stay for patients and reduce the consumption of drugs and the financial burden on patients. Through building an orderly rehabilitation system and developing a hierarchical medical system, rehabilitation medicine can improve the quality of medical services and the utilization of medical resources. For local governments, once the patients recover from their diseases, they can return to their workplaces and relieve the burden on society.
There are three factors contributing to the rapid development of rehabilitation industry in China. Firstly, the Chinese government has issued policies concerning rehabilitation therapy, especially Traditional Chinese Medicine rehabilitation, surgical rehabilitation and geriatric rehabilitation. Moreover, the government has been actively supporting the supplement of rehabilitation resources, the enhancement of service capacity and the innovation of rehabilitation models. Under the guidance of national policies, local governments in pilot provinces and municipalities released programs to develop the rehabilitation industry accordingly. Secondly, the elderly population continues to increase in China. According to the research from Peking University, if China doesn't control the population aging, the number of disabled people in the country will surpass 136 million in 2030, among which the elderly people will account for over 57%. Therefore, the government is expected to develop the rehabilitation industry to extend the population's healthy life expectancy and achieve healthy aging. Lastly, GDP per capita in China reached CNY 80,976 (USD 11,725) in 2021. With economic development and the increased health awareness of citizens, a better understanding of rehabilitation will be reached by both citizens and society.
However, to facilitate sustainable development of the rehabilitation industry still requires scientific development and management. Currently, as the distribution of rehabilitation resources is unequal which makes it hard to meet patients'needs, the number of patients receiving rehabilitation therapy is limited. Four significant bottlenecks hindered the development of the rehabilitation industry in China.
The first one is the lack of uniform criteria for functionality evaluation. Without uniform criteria, the rehabilitation service capacity in medical institutions at all levels is incomparable. As the service quality varies among different regions, patients in rehabilitation prefer to stay in tertiary hospitals rather than primary and secondary health facilities. Thus rehabilitation resources in tertiary hospitals are insufficient, while rehabilitation equipment in primary and secondary medical institutions is of lower quality and unused. The second is that rehabilitation physicians and therapists don't cooperate reasonably and clinical treatments can't achieve rehabilitation goals. Therapists are responsible for part of the rehabilitation program, and they often control the effectiveness of the treatment based on their experience, but they lack the uniform quantification of rehabilitation goals set by physicians. On the other hand, the information systems in most hospitals can only present medical advice and treatment results and hardly show specific treatment process data, making it difficult for physicians to know the latest recovery of patients in real-time.
The third one is the lack of a function-oriented payment management system to meet the need for the rehabilitation industry. The payment per bed per day is suitable for patients with chronic diseases or mental illnesses, and it will become the payment trend for the rehabilitation industry in the future. For a long time, a majority of Chinese hospitals adopted fee-for-service model for rehabilitation. But fee-for-service model often leads to unreasonable increases in medical costs. And the payment by diagnostic-related groups or big data diagnosis-intervention packet is not suitable for rehabilitation. Thus, some Chinese hospitals adopt the payment per bed per day for those who need long-term inpatient treatments. However, patients who receive rehabilitation treatment suffer from functional disorders, while the existing payment per bed per day lacks function-oriented management methods.
Regarding this, related departments should make more criteria to modify the payment per bed per day. The fourth one is the lack of qualified personnel. The number of therapists is insufficient. Most conditions of practice entry and title promotion for personnel in the rehabilitation industry emphasize theoretical knowledge and pay less attention to clinical practice ability. What's more, transferred physicians represent a high percentage of rehabilitation physicians. Still, most hospitals don't have an appropriate assessment mechanism for these transferred physicians, resulting in a significant difference in professional level among physicians and a shortage of qualified talent.
The combination and application of informatization and standardization is crucial to alleviate the rehabilitation industry's four bottlenecks above. Informatization is a basic tool for establishing standards adapted to China's actual situation. It is essential to develop a data system through analyzing and comparing the establishment and promotion of the U.S. assessment standard. On the one hand, a uniform function assessment standard taking medical data of China's demographics, health and various hospitals into consideration should be made. Advanced technologies such as cloud computing and big data can be deployed to analyze and make good use of the medical data. On the other hand, informatization is also a basic tool for the promotion of standardization and application of normalization.
Chinese government and hospitals pay more attention to the informatization construction of rehabilitation. After the Ministry of Health of China promulgated Basic Standards for Rehabilitation Hospitals in 2012, the country promoted the informatization construction of rehabilitation specialties by upgrading information systems and electronic medical records ratings and improving rehabilitation's development in 2018. The informatization of rehabilitation has obvious advantages and can meet multiple business needs of medical departments. The rehabilitation specialty system includes various function modules and connects rehabilitation business data with HIS system, leaving the electronic retention of the complete rehabilitation process data for patients and providing strong support for hospital operations management, medical business implementation and instructional system. The informatization of rehabilitation medicine can also help medical departments solve the pain points such as appointments for treatment, team collaboration, medical records and instructional training.
Although rehabilitation informatization has various advantages, its market size grows slowly and companies specializing in this field are limited. There are three types of companies in this field: rehabilitation informatization companies, integrative informatization companies and rehabilitation medical device companies. The number of rehabilitation informatization companies is the least, but as these companies entered this field earlier, their market share is the most. Although the number of rehabilitation medical device companies is the most, their market size is the least. As for integrative informatization companies, although these companies were the last ones who entered this field, they have a comprehensive understanding of medical institutions' needs and well-accumulated product development experiences. As rehabilitation informatization companies have accumulated experience in techniques, products and markets, they are comparable with integrative informatization companies.
As the structure and composition of the rehabilitation business in each hospital are differentiated, the system should also be customized according to each hospital's features. However, at present, about two thirds of these products are standardized systems and include only basic function modules, making it hard to meet each hospital's needs. Even if hospitals have installed a specialized rehabilitation information system, the utilization rate of the system is less than 30%. Only 10% of health facilities think the system is helpful. Many hospitals think the informatization system can't help them improve their efficiency, so the system is unused. Besides, the systems installed in earlier times had some defects, leading to duplication of systems in some hospitals.
To better meet the needs of hospitals, with the service-oriented concept, some companies upgraded their products to provide comprehensive solutions for their clients. Take Neusoft Group (Chinese: 东软集团) as an example which focuses on rehabilitation assessment and treatment and the needs of rehabilitation physicians, therapists and nursing staff, the company designed diverse function modules for rehabilitation assessment, treatment, data analysis and knowledge base. It has made comprehensive solutions that support function assessment criteria and adapt to standards of electronic medical records. The rehabilitation system can connect with the hospital's HIS system to achieve the full process informatization of the rehabilitation business.
Rehabilitation Center of ShengJing Hospital of China Medical University (Chinese: 中国医科大学附属盛京医院康复医学中心) is a regional rehabilitation medical center with the largest building scale, high-level treatment and advanced equipment among Chinese integrated hospitals, combining rehabilitation, education and training. With a building area of 68,000 square meters, the rehabilitation center has over 600 beds, 20 treatment rooms and 260 doctors, evaluators and therapists.
Rehabilitation Center of ShengJing Hospital relies on the construction of the rehabilitation information system to innovate and develop a rehabilitation service model and to provide a better patient experience. Focusing on collaboration efficiency, whole process closure, quality control and refined management, the center is dedicated to improving rehabilitation service capacity and management quality. The multi-dimensional statistics and clinical data analysis can provide practical support for prospective scientific research and empower the development of the rehabilitation industry.
Although informatization products are upgrading towards a service-oriented direction, they have many challenges when in use in hospitals. For example, local governments and hospitals don't make enough efforts to develop the rehabilitation industry; hospitals don't have a comprehensive understanding of the values of rehabilitation informatization; the financial investment is also limited. As a result, the coverage rate of rehabilitation informatization products in medical institutions at all levels is still low in China. And most rehabilitation informatization businesses face profitability problems.
To better develop the informatization of the rehabilitation industry, the government, hospitals and companies should cooperate and make efforts together. First of all, the government should release more detailed guidance and provide financial and funding support. Secondly, top regional hospitals should take the lead in developing the rehabilitation industry and promoting the application of standard and information-based technology. Lastly, companies should continue to improve the capacity for developing informatization products, cultivate more talent, provide service-based comprehensive solutions and optimize system suitability.
If government, hospitals and companies can collaborate, the informatization of rehabilitation will have a promising development in the future. EqualOcean thinks there will be two significant trends for the informatization of the rehabilitation industry in the future. The first trend is that the complementation of rehabilitation resources and the enhancement of medical records' application will increase the demand of medical institutions for rehabilitation specialty informatization. The other trend is that with more detailed policies released, the standard application of rehabilitation informatization will extend from hospitals to other places.