Recently, Zhengzhou Jinshui General Hospital Zhou Guoping interview with this reporter , tells his views on some of the issues that exist in our current health care reform , the summary of 12 puzzles . Zhou Guoping puzzles, from the hospital, said that in a certain sense , represents the voices of some of the grass-roots Hospital .
"At present, China's medical reform has been carried out in the third year , and in the health reform process, the country invested 850 billion yuan to improve the social security system , urban medical insurance for urban workers , the establishment of Medicare residents in rural NCMS , right reform of primary health care institutions , the basic drug system , drug "0" increase, nine public health services, and gave the masses has brought benefits, greatly easing the masses medical treatment is difficult and expensive problem , however, is currently in the reform process there are still some problems and some unhealthy phenomenon.
First, why are the rapid expansion of large urban hospitals , increasing beds , they bring nothing to the hospital, the community , the patient ?
Large increase in hospital beds , to a certain extent to meet the needs of patients , to ease the difficult problem of residents' hospital , but behind this phenomenon has led to what ? Rapidly expanding hospital size , the inevitable need for more technical strength, so to form a provincial hospital to the municipal hospital dig talent, municipal hospital personnel to dig the county hospital , had finally led to the lack of talent on the primary county hospitals, clinics talent is more scarce. If some of the county hospital , it was only a few good technology talent in supporting , these people were poached , department also paralyzed. On some difficult patients to go to the municipal hospital , provincial hospital. As a result, farmers have to go to big city hospital sick , causing difficulty metropolitan hospital , hospital expensive. While increasing the economic burden on farmers , new rural cooperative funds to bring the pressure , this result is further aggravated the masses medical treatment is difficult and expensive .
Therefore, large urban hospitals can not dramatically , unplanned expansion, should the county hospitals, township hospitals built, the use of special policies to retain talent County Hospital , which is to solve difficult and expensive in a fundamental way .
Second, why the reform of public hospitals was carried out slowly ?
Health care reform three years brought many benefits to the people , health care, implementation of the new rural cooperative , the implementation of public health programs , hospitals improve quality of service , etc., so that people really benefit from it. However, the public hospital reform measures being implemented is not comprehensive , does not solve the problem fundamentally , the existing measures that benefit the few , but to further improve the social security system. Real reform from institutional reform , such as the household responsibility system in rural collective land management, such as the restructuring of state-owned enterprises , this is the real reform ! City government organized several hospitals , due to lack of financial investment , hospitals have to think of ways to generate income , behind revenue is to find ways to make money . Money comes from the patient ! While increasing the burden of the patient. If the government focused on the limited funds invested part of the public hospitals , so that some hospitals do not rely on revenue to survive , thanks to government investment, these hospitals in general terms, low fees, to provide people with basic medical services . Dean of these hospitals , doctors do not earn money and worry , single-minded to treat patients , so the doctor will be cheaper. Another part of the hospital or hospital restructuring into joint-stock private hospitals , it to operate in a market economy , these hospitals accomplishing good environment, good condition , good service, high fees hospital , let the rich go to a doctor , Medicare does not reimburse or reimbursement lows themselves points. Many countries are doing , our country can learn from .
Third, the primary hospital Why promote reform difficult ? Hospital reform currently in remission grassroots masses difficult and expensive in terms of how much can play a role ?
Implementation of the primary hospital reform to alleviate mass medical treatment is difficult and expensive to play a role. The implementation of the basic drug system township hospitals , drug "0" increase, government investment in basic hospital , to a certain extent, ease the peasant masses medical treatment is difficult and expensive problem. Implementation of the primary hospital reform the central issue is somewhat difficult to pay enough attention to local governments to finance no money as a reason , the main reason for the problem is not money or not , but the idea of local government officials in question . They do not pay attention on health care reform , hospital biased , engage in economic development they think it should be , but the investment to the hospital to see a doctor only put people do not see the direct output, and can not see the image of the project , so the slow pace of capital investment , health reform implementation difficult .
Currently the primary hospital practices to solve difficult and expensive it can play a role in how much ? Consecutive years of health care reform to some extent alleviate the masses difficult and expensive problem , but did not completely solve the fundamental . Because the doctor is difficult , expensive is difficult to large hospitals , expensive in large hospitals . Large hospitals do not change, only the primary hospital health care reform , the level of benefit the masses is limited.
Fourth, the health administrative departments with control of hospital revenue "medicine accounting " to reduce the burden on the patient , this approach can reduce the burden on the patients achieve the purpose of it?
Health administrative departments to control hospital revenue "medicine accounting " , to some extent, should be able to reduce the burden on the patient , but now basically every hospital is lack of government investment funds , hospitals rely on business income to run. According to the department or hospital release personal income wages, bonus distribution , if the patient does not increase the amount of the patient's spend less , department revenue will certainly be reduced, as a doctor certainly find ways to increase revenue in other income other than drugs , such as treatment costs more open , to open inspection fees , so the increase in total revenue, a decrease of drugs , but the burden on the patient increase. If a patient spent 5,000 yuan, 3,000 yuan of which drug costs , other costs 2,000 yuan, accounting for the drug high. Doctors immediately think of a way to open spot checks or other treatment costs , such as open source CT3000 dual yuan, accounting for such drugs on the low .
Fifth, after lowering drug prices , people see a doctor cheap yet ?
Theoretically is cheaper, but actually not. The Government 's intention is good, but it is difficult to implement . Pharmaceutical companies do not want the first price, a price certainly affect benefits, then they do not want to produce these drugs , it will go to develop more "good medicine" , it is naturally a cheap price . Again, pharmaceutical companies do not want to lower drug prices too much , once down a lot, Lee fewer drug dealers , salesmen gone power , pharmaceutical companies likely to say ' these drugs out of stock ' , over time these drugs have not people use, it is also because the affected interests. Hospitals to survive, while government investment in hospitals is inadequate . Doctors are reluctant to use these drugs , because there is no rebate of this drug . There might say that these drugs ineffective, the hospital also said drug prices , and to open up more to check it, or how we live that way ? Based on the above , to reduce the price of drugs , not people see a doctor on the cheap .
Sixth, what are the root causes of drug rebate ? For hospitals, social , patient brought what ? How to solve ?
The root of the problem drug rebate is in line with the market economy and a planned economy is the institutional issues . Pharmaceutical market economy system , the hospital is planned economy system , these two systems can not be good practice, so it appears the phenomenon of drug rebate . Pharmaceutical companies to sell drugs , they and other companies, such as car dealers , dealers eat " rebate " ; selling appliances also eat " rebate ." Some products on the market for sale , selling or even lower than the ex-factory price , and why ? Also eat factory rebate . If selling 50 rebate 5% , selling 100 rebate 10% lower than the ex-factory price to sell , but there are benefits . Buy one get one , etc. It also called kickbacks . So the market economy operates this is a common way of doing business . In some low- quality hospitals kickbacks to doctors will give the patient more drugs , a good medicine , open your medicine , opened a rebate of drugs. Pharmaceutical sales representatives in order to complete the task , a portion of their personal interests to the doctor , the doctor to open his medicine , this phenomenon makes some doctors' ethics declined greatly increased medical expenses , medical and serious waste of resources , so that patients do not trust doctors , tense doctor-patient relationship , the distribution of benefits doctors and physicians, doctors and nurses between conflict, give the patient a heavy burden on health care .
Suggestions on how to solve : 1 , drug monopoly , as the tobacco monopoly , the state strictly controls prices. 2 , increase investment in hospitals , doctors improve treatment , doctors do not let their own money to feed themselves. Hospital revenue turned over fiscal expenditure financed by the fiscal , the government does not actually earn more money , but to make reducing medical costs to the state, individuals save money .
Seven, now the drug tender way , you can reduce drug prices ? People see a doctor on the cheap yet ? Using this approach can govern drug rebate yet ?
The current tender way in reducing drug prices to some extent , but there is no real down position . If a drug factory price of 15.3 yuan , 100 yuan to tender , why ? Because the drugs only this one plant , the only one distribution company , he does not drop, no way, you have to move. There are several drug dealers or manufacturers combined not price , so drug prices can not be fundamentally resolved . In addition , the low drug prices , low profits, the pharmaceutical companies do not produce clinically nobody used . The current approach seems tender is open, transparent, and in fact is not the case , people see a doctor did not feel cheap, drug rebate went ahead .
Eight , why doctors pay , low income , how to solve ?
Doctor's career is a high- risk, high- paying industries. Average hours worked per physician to more than 10 hours , or even more, no Sundays and holidays. Inpatient physician rounds for every day and night as well as emergency care, critically ill patients , but also to work overtime after work , physically , mentally with a lot of pressure. Doctors phone requires 24 hours ( nobody phone charges reimbursed ) , but also to participate in the emergency rescue at any time . Coupled with little government investment , they have to earn money for the hospital , so the hospital development. One worry for the patient to cure the disease ; two is also to find ways to generate income for the hospital , so they too much pressure . Their income is much less than the ordinary civil servants , they do not have the money to spend resistant Civil money , their unbalanced mind . Increased patient disputes in recent years , they are not your effort and the respect of others , the Government must introduce policies to solve . Some doctors kickbacks is an open secret. So the doctor's " gray income " will become an open secret . Doctors kickbacks patient burden, patients have different views, mistrust between doctors and patients , but also exacerbated the doctor-patient conflicts . We can think about it, what line do not own the so-called "norm ." Market economy, eat a variety of promotional tools rebates, buy one get one , etc., are essentially kickbacks , but we got used to recognized ! Some may not interfere with each person's own interests only, which is the heart Chuaizhuo understand confused. But the doctors kickbacks is absolutely wrong and should be stopped.
Nine , the NDRC statistics of the National People lose an average of 8 bottles of liquid per year , several times higher than foreign , which is why ?
Some national policy is unreasonable, such as out-patient clinic or not reimbursed reported rarely, and only hospital was reimbursed. So inpatients increased ! Hospitalized only after opening the medication , health care department, said refusing to do so Medicare pays ' only opening the medication does not require hospitalization ' . To reimbursement only hospitalization, hospital only after the infusion . As a result, inpatient much, much more fluid , and do Medicare reimbursement . Hospital transfusion and money , the patient has no money , so will result in an average of 8 bottles per person per year lose fluid .
X. Why is it difficult to promote traditional Chinese medicine ?
TCM drugs are cheap, the patient is a good choice. But for hospitals , medicines are cheap, so that the hospital can not make a profit . Another more cumbersome to use traditional Chinese medicine , Chinese medicine and its use , it is better to use the convenience of medicine , but the price is high, the profits are huge , why not? Therefore the promotion of Chinese medicine in the hospital it is hard. The solution is not to make money for the purpose of a doctor , and to spend less optimistic about the disease for the purpose only by increasing government spending , the doctor did not revenue pressures , natural Chinese medicine to promote easy.
Eleven , why large urban hospital bed expansion times, still an extra bed , hospital still can not solve difficult , it just because the patient increase this reason?
Large hospital beds increased to some extent alleviate the difficult problem of hospitalization , but no matter how big the expansion of hospital beds , are unable to solve the difficult problem of hospitalization . This increase patient is an indisputable fact, but what is behind and reactions ? Expand the hospital beds increased personnel expenditures have increased , so you need to earn more money , not make money and not feed so many workers . For this large hospital received the relaxation of standards in hospital , illness , minor ailments are hospitalized . First, as long as inpatient hospital will be able to make money ; Second, excessive medical , hospital revenue ; Third, doctors prescribe a rebate . Additional hospital beds so big , can not solve the difficult problem of hospitalization . How to solve this problem should be implemented first medical grade , first diagnosis , referral system .
Twelve , why some large hospitals several hundred million a year income ---- several billion this normal? Phenomenon with a disproportionate increase in national income is Why ? Give society what kind of consequences club ?
Large hospital several hundred million a year to tens of million of income is not normal. In recent years the state of health investment increases. NCMS , urban workers , a large number of residents in health care put into the hospital to increase revenue, marking the establishment of China's medical insurance system, providing medical services for the masses , the people are very satisfied. However, the waste of medical resources is also very serious . Hospital in order to survive and the pursuit of the highest profits , excessive doctors kickbacks to prescribe to patients , open inspection , this phenomenon is also frequent . The reason for the rapid growth of medical costs can not be ignored : the illness are admitted to the hospital for minor illnesses , no beds on the extra bed, 45 -bed ward will be living in 90 patients, and more, high income , and bonuses to more. Doctors happy, Dean also happy. State funds may be wasted , to the community , the patient brings a huge economic burden. This continues eventually lead to a waste of funds, health insurance, new rural cooperative funds overdrafts , medical burden heavier masses . More investment in the country , it will not reach to solve difficult and expensive problem . Many aspects of the country are in need of money , you can not put money into the medical waste limited money invested in the country where my son really make use of that . "