During the period of Major Heat, when the sun blazes fiercely, Aunt Chen from Chayuan Town in Baisha Li Autonomous County was worried about going out to see a doctor.

What troubled her was not the hospital, nor the cost of medicine, but the scorching weather.

“I went early in the morning to see the doctor, but it takes time for the hospital to decoct the medicine. I have to wait until the afternoon or the next day to pick it up. If I pick it up in the afternoon, just standing under the sun for a few minutes would give me heatstroke. But if I come back the next day, I’m worried the decocted medicine will spoil,” she said.

The hospital also faces troubles brought by the high temperatures. Baisha has more than 400 mountains, and residents live scattered across the area. Township health centers all face pressure from the improper storage of medicinal herbs and drugs, which easily leads to waste. From the perspective of the county medical group, the number of patients varies across townships. In some places, pharmacists may only prepare a few prescriptions a day — a waste of human resources.

These frustrations on both sides — doctors and patients — are being resolved as Hainan pushes high-quality medical resources downward. In 2023, leveraging the province-administered county model and the flattened medical system, Hainan arranged for large provincial hospitals to directly “go all the way down” and provide segmented assistance to county hospitals.

In August that year, 22 specialists from Hainan Provincial People’s Hospital were stationed at Baisha County Hospital. In less than two years, with improvements in talent, technology, management, and services, the county has seen a steady increase in patient retention and significant improvements in public satisfaction and medical experience.

Provincial hospital specialists guide Baisha Branch in performing adenoid ablation surgery

Responding to People’s Needs

Innovating Based on Local Realities

When Aunt Chen arrived at the Chacheng Campus of Baisha County Hospital, she realized her worries were unnecessary. After the doctor issued the prescription, a simple click uploaded it to the county hospital pharmacy, where it was reviewed, decocted, and then uniformly delivered. Once she finished her consultation, she could directly go home.

At the hospital’s Intelligent Shared Traditional Chinese Medicine Decocting Center, pharmacists tap a few buttons, and a robotic arm automatically grabs the herbal packages and drops them into the pot. Once the set decoction time is completed, the robotic arm lifts them out, drains them, and the medicinal liquid is piped into 400 ml bottles. Postal vehicles waiting at the pharmacy entrance deliver the medicine to township health centers or directly to patients’ homes.

This way, patients no longer need to wait at the hospital for their medicine, and township health centers no longer need pharmacists for decoction, avoiding waste caused by improper storage. There are many stories like Aunt Chen’s in Baisha.

Resident Fu Yubo said:

“In the past, the county hospital had no pediatrics. Internal medicine doctors could only treat common colds — anything more serious meant going to Danzhou or Haikou. When we traveled for treatment, the whole family had to mobilize. It was time-consuming and exhausting, and sometimes there were no available beds — we didn’t know whether to advance or retreat.”

After the experts arrived, a pediatrics department was quickly established. As a provincial specialist in genetic rare diseases, Dr. Chen Zefu from Hainan Provincial People’s Hospital has dedicated himself to local rare disease screening and prevention.

“We’ve now established a tiered linkage system,” he said. “Village clinics conduct preliminary diagnosis, county hospitals confirm the diagnosis, and then organize online multidisciplinary consultations. This solves the difficulty of patients having to travel long distances. As emergency and critical care capabilities improve, many newborns with severe asphyxia, intussusception, ABO hemolysis, respiratory failure, and other conditions have been successfully treated or recovered.”

“With provincial specialists consulting, the previous carpet-style excessive examinations have stopped, and large prescriptions and irrational drug use are being avoided. The average inpatient cost has stayed below the national level for two consecutive years,” said Wang Kaiqiong, president of the Baisha Branch of Hainan Provincial People’s Hospital.

The expert team implemented multiple measures:

– Comparing drug and surgical consumable prices with national centralized procurement and negotiating secondary reductions;

– Standardizing diagnostic behavior and strictly limiting optional auxiliary drugs;

– Completely canceling performance indicators tied to doctors’ income.

Statistics show:

– In 2023, Baisha County Hospital had 160,000 outpatient and emergency visits. By the end of 2024, the number increased to 200,000 — an increase of more than 40,000.

– Average inpatient cost dropped from 7,666 yuan in 2022 to 6,686 yuan in 2023, and further to 5,370 yuan in 2024.

Teaching Hand-in-Hand

Comprehensive Improvement in Service Capacity

“Ow — ow — that really hurts!”

“Okay, try moving it now.”

“Huh? It really feels better… it doesn’t hurt anymore? How come?”

At the Chacheng Campus, provincial expert and campus head Wu Weiwei is performing floating-needle therapy while explaining to Li Jian, a county hospital doctor and her apprentice:

“This patient has tennis elbow and trauma to the lateral humerus. Traditional Chinese medicine usually uses acupuncture, but the treatment cycle is long. Floating-needle therapy sweeps along the superficial fascia layer under the skin, quickly reducing pain and shortening treatment, easing patients’ burden.”

After taking over Baisha County Hospital, Hainan Provincial People’s Hospital implemented a dual-choice mentor-apprentice training model focusing on teaching people how to fish. They also enhanced township and village-level medical capabilities through volunteer clinics, online training, and skill-upgrading sessions — accelerating the establishment of a quality county-town-village medical service system.

Chen Fu, a doctor at Mian Cotton Village Clinic in Qifang Town, now has a “mysterious assistant” he can call 24 hours a day — a 5G all-in-one telemedicine device.

“In the past, when patients came, I could only measure blood pressure. When someone had chest pain, I had to refer them to the township clinic, and then they would be referred again to the county. Running around like that wastes the golden rescue window. Now, after training, if someone comes with chest pain, I can run an ECG in two minutes. With remote assistance from county or provincial experts, once we confirm myocardial infarction, we can immediately administer emergency medication.”

Last year, Baisha’s rural areas saw 15,000 uses of the 5G devices, greatly improving accessibility for patients seeking local treatment.

“The implementation of distributed testing and centralized diagnosis has strengthened county-level medical alliances and enhanced township and village service capabilities,” said Zhou Yu, provincial expert and director of medical administration at the Baisha Branch. “Across the province, there are currently 21 certified chest-pain treatment points — 13 of which are in Baisha.”

Institutional Support

Drawing a Unified Circle for Health Reform

“Every weekend we conduct volunteer consultations, carrying equipment from village to village,” said Wang Kaiqiong. The expert team has already conducted 189 mobile clinic sessions.

To ensure talent, technology, management, and service resources cascade downward, Hainan divided its 16 cities and counties into three regions — east, central, and west — with the three strongest provincial hospitals providing segmented assistance. During their posting, specialists have their prescription rights suspended so they can fully devote themselves to grassroots support.

Dr. Chen Zefu (first from left) at a volunteer consultation

In addition, the Provincial Health Commission and the Medical Insurance Bureau jointly designated29 basic diseases under a “same disease, same price” policy, meaning these cases should not be lightly transferred outward — guiding targeted assistance from provincial hospitals. The provincial government also allocated special funds and provided performance-based subsidies to ensure specialists’ incomes remain no lower than their provincial-hospital levels.

At first, some specialists worried that working in基层(basic-level healthcare institutions) would affect their teaching and research. But they soon discovered immense value at the grassroots.

Dr. Chen Xingyu, provincial specialist and director of Li ethnic medicine, said:

“My biggest dream now is to help preserve Li medicine and allow more people to benefit from it.”

Provincial experts not only revitalized the Chacheng Campus but also promoted Li medicine while building the Traditional Chinese Medicine Center. They have already introduced several Li medicinal formulations and launched产学研(industry–academia–research) collaborations with hospitals and universities such as the Guangdong Provincial Hospital of Chinese Medicine’s Hainan branch and Hainan Medical University.

As the county hospital’s capacity increases, public recognition has risen significantly. Before the takeover, from January to July 2023, township health centers referred only 7 patients to the county hospital, and the county hospital virtually never transferred patients to the provincial hospital.

After more than a year of management:

– Township health centers transferred 495 patients to the county hospital.

– The county hospital transferred 126 patients to the provincial hospital.

– Most patients are now treated within the county.

– The provincial hospital transferred 20 patients back down to the county hospital.

A tiered diagnosis and referral system has begun to take shape.