Classification of Chinese hospitals

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Within the health system, the Classification of Chinese hospitals is a 3-tier system according to the Ministry of Health of the People's Republic of China.[1] Hospitals are classified in a system that recognizes a hospital's ability to provide medical care, medical education, and conduct medical research. Hospitals are designated as Primary, Secondary or Tertiary hospitals.[2][3][4][5]

1. A primary hospital is typically a township hospital that contains less than 100 beds. They are tasked with providing preventive care, minimal health care and rehabilitation services - i.e. primary care. A primary hospital is similar to community hospitals in the West.
2. A secondary hospital is one that tend to be affiliated with a medium size city, county or district and contain more than 100 beds, but less than 500. They are responsible for providing comprehensive health services, as well as medical education and conducting research on a regional basis. A secondary hospital is similar to a regional hospital or district hospital in the West.
3. A tertiary hospital is a comprehensive, referral, general hospitals at the city, provincial or national level with a bed capacity exceeding 500. They are responsible for providing specialist health services, perform a bigger role with regard to medical education and scientific research and they serve as medical hubs providing care to multiple regions. The tertiary hospital is similar to a Tertiary referral hospital in the West.

Further, based on the level of service provision, size, medical technology, medical equipment, and management and medical quality, these 3 grades are further subdivided into 3 subsidiary levels: A, B and C (甲[jiǎ], 乙[yǐ], 丙[bǐng]). This results in a total of 9 levels. In addition, one special level, 3AAA (三级特等), is reserved for the most specialized hospitals, though no hospitals have yet been placed in this level.[2] This system is hence referred to in Chinese as 三级十等 (sānjí shíděng), 3 Grades and 10 levels.

In 2015, the Ministry of Health's National Health and Family Planning Commission, used the terms community hospital and top level hospital in describing hospital planning.[6]

## Contents

* 1 History
* 2 Grading
* 3 Grade A tertiary hospitals
* 3.1 Criteria
* 3.2 Quantity
* 4 See also
* 5 References
* 6 External links

## History

A three-level classification of healthcare is present during the Mao era. The first level consisted of neighborhood, workplace, and village clinics; the second level was city district and village health centers; the final level was city and town-level hospitals.[7]

The current classification took shape in November 1989.[8] There was a long pause on hospital classification between 1998 and 2008, when a new guideline was produced. Hospital classification was officially restarted in 2010.[9]

## Grading

A 1000-point system is implemented, with 900 points and above being rated as Grade 3A, 750 points to 900 points as Grade 3B, and 600 points to 750 points as Grade 3C. Hospital grades are not lifelong and are managed dynamically. In addition, the comprehensive medical quality evaluation standards highlight the "patient-centered" service concept and require hospitals to regularly solicit patient opinions and hold patient opinion seminars every quarter. Hospitals must also set up free drinking water supplies, public telephones, implement online and telephone appointment booking for medical treatment, require laboratory test reports to be issued within 24 hours, publicize charging prices, provide cost inquiries, and implement a cost list system.[10][11][9]

## Grade A tertiary hospitals

Grade A tertiary hospitals (simplified Chinese: 三级甲等医院; traditional Chinese: 三級甲等醫院; pinyin: sānjí jiǎděng yīyuàn), shortly 3A hospitals (simplified Chinese: 三甲医院; traditional Chinese: 三甲醫院; pinyin: sān jiǎ yīyuàn), provide high-level specialized medical and health services to several regions and perform higher education and scientific research tasks.

### Criteria

Grade 3A refers to those who score no less than 900 points (or 90%) according to the grading criteria. The evaluation of Grade A tertiary hospitals is generally carried out by provincial health administrative departments.[11][10][12]

Tertiary (Level 3) hospitals (with more than 500 beds) are regional or higher level hospitals that provide high-level specialized medical and health services to several regions and perform higher education and scientific research tasks. The evaluation adheres to emphasis on service, management, quality, safety, foundation, and guarantee, no campaigns, no formalities, and no fraud. Private hospitals can participate in the grade assessment on an equal footing with public hospitals. The main items of assessment include medical services and management, medical quality and safety, technical level and efficiency.[10][11][9]

### Quantity

According to statistics in the "Statistical Bulletin on the Development of the National Health Care Industry in 2023" issued by the National Health Commission, as of the end of 2023, there were 1,795 Grade-A tertiary hospitals in China mainland.[13]

As of December 10, 2019, there were 673 3A Western medicine hospitals under the supervision of health commissions at all levels.[14] As of the end of 2022, there were 705 3A Traditional Chinese medicine(TCM) hospitals under the jurisdiction of TCM administration bureaus at all levels, including 571 TCM hospitals, 76 TCM and Western medicine combined hospitals, 24 TCM specialty hospitals, and 34 ethnic minority medicine hospitals.[15] Another type of Grade A tertiary hospitals are the military hospitals affiliated with the People's Liberation Army and the People's Armed Police Force. The information of this type of hospitals has not yet been made public.

## See also

* Medicine in China
* List of hospitals in China
* Public hospital § India

## References

1. ↑ Guo ZH: Hospital Management. 1990, Beijing, People's Health Publishing House
2. ↑ 2.0 2.1 Li, Xingming; Huang, Jianshi; Zhang, Hui (2008). "An analysis of hospital preparedness capacity for public health emergency in four regions of China: Beijing, Shandong, Guangxi, and Hainan". BMC Public Health 8. doi:10.1186/1471-2458-8-319. PMID 18803860.
3. ↑ Zhang, W.; Deng, Z.; Evans, R.; Xiang, F.; Ye, Q.; Zeng, R. (August 9, 2018). "Social Media Landscape of the Tertiary Referral Hospitals in China: Observational Descriptive Study". J Med Internet Res 20 (8): e249. doi:10.2196/jmir.9607. PMID 30093370.
4. ↑ China's National Health and Family Planning Commission; China Health Statistical Yearbook, 2008
5. ↑ "Yunnan Public Health Insurance Information Service: Medicare FAQs". http://www.ynyb.org.cn/Default.aspx?tabid=100&ArticleID=308. ,
6. ↑ "China sets up new system to optimize medical resources". China Daily. September 16, 2015. http://www.chinadaily.com.cn/m/chinahealth/2015-09/16/content_21893813.htm.
7. ↑ "医改进程（上）：曾经的全额公费医疗，为什么现在消失了？". 2011. http://med.china.com.cn/content/pid/260519/tid/1026/iswap/1. "计划经济时期的医院全部由政府管控，建立了我们现在较为熟知的三级医院结构，即城镇由市、区两级医院和街道、厂矿门诊组成的三级医疗服务及卫生防疫体系；农村以县医院为龙头、以乡（镇）卫生院为枢纽、以村卫生室为基础的三级医疗预防保健网络。所有的医疗设备、医务人员均由国家统一分配管理。"
8. ↑ Chinese minister of Health (November 1989). ":s:cn:医院分级管理办法（试行草案） [Rules for classifying hospitals]"
9. ↑ 9.0 9.1 9.2 刘庭芳 (September 2019). "我国医疗机构评审的制度变迁与路径选择". 中国卫生质量管理 第18卷 (第5期). http://www.sce.tsinghua.edu.cn/research/detail.jsp?id1=1659. Retrieved 2018-11-01.
10. ↑ 10.0 10.1 10.2 "国家卫生健康委关于印发《三级医院评审标准（2022年版）》及其实施细则的通知 (Notice of the National Health Commission on the issuance of the "Three-level Hospital Evaluation Standards (2022 Edition)" and its implementation rules)" (in zh-cn). 2022-12-06. https://www.gov.cn/zhengce/zhengceku/2022-12/18/content_5732583.htm.
11. ↑ 11.0 11.1 11.2 Ministry of Health, PRC. "三级综合医院评审标准实施细则 （Implementation Rules for the Evaluation Standards of Tertiary General Hospitals, 2011 Edition）" (in zh). http://www.nhc.gov.cn/cms-search/downFiles/02b5187a195c42e0855e4e27445fc2f0.pdf.
12. ↑ "卫生部医管司关于请提供辖区内三级医院名录的通知 (Notice from the Department of Medical Administration of the Ministry of Health on providing a list of tertiary hospitals within the jurisdiction)" (in zh-cn). http://www.nhc.gov.cn/yzygj/s3586q/200908/a369b92339c64f26956523338425da7f.shtml.
13. ↑ "2023 年我国卫生健康事业发展统计公报 (Statistical Communiqué on the Development of the National Health Care Industry)" (in zh-cn). 2024-08-29. http://www.nhc.gov.cn/guihuaxxs/s3585u/202408/6c037610b3a54f6c8535c515844fae96/files/58c5d1e9876344e5b1aa5aa2b083a51a.pdf.
14. ↑ "中国医院等级查询系统 (China Hospital Grade Query System)" (in zh-cn). www.hqms.org.cn. https://www.hqms.org.cn/usp/roster/index.jsp. Retrieved 2018-12-16.
15. ↑ "关于印发2022年度全国三级公立中医医院绩效考核国家监测分析情况的通报 (Notice on Issuing the National Monitoring and Analysis of the Performance Assessment of Level 3 Public Traditional Chinese Medicine Hospitals in 2022)" (in zh-cn). State Administration of Traditional Chinese Medicine. 2024-03-19. http://www.natcm.gov.cn/yizhengsi/zhengcewenjian/2024-03-19/33637.html.

## External links

* A collection of China's 3A hospitals (in Chinese)
* List of 3A hospitals in China with addresses and tel. numbers (under development, in Chinese)

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