Medical network on April 20 - the national development and reform commission on April 11 at the medical service price reform work symposium, Hu Zucai requirements, deputy director of the national development and reform commission (NDRC) at various levels and of public hospital before the end of September to cancel all drug addition, in addition to the Chinese medicine yinpian drug implement zero rate of sales.
This is since 2009, a milestone in our country since the reform of public hospitals. But at the same time, it also became a mark, so many public hospitals to cancel the drug addition, hospitals rely on "live"?
The state to the public hospital opened a "prescription" is -- medical service price adjustment to compensate for cancellation of drug addition to lower the hospital income. China youth daily, a popular online supplement the reporter understands, in the United States and other developed countries, the absence of drug addition, hospitals and doctors as well, an important reason is that medical service price is high enough, for example, call an ambulance to pay about $1000, treat the dislocated $200, $1800 vaccinated against rabies, etc. (different in different areas, collect fees).
But in our country, this round of reform to allow patients to accept the registration fee from 8 to 60 yuan, the operation cost from thousands of yuan rose to nearly ten thousand yuan, this is the current public hospital, dean of common concern. That is to say, the medical service prices, can truly make up for all the "drug addition" gap? See the price go up, whether patients will to go to a doctor? Hierarchical diagnosis and treatment, whether the large hospital patients will sharply decrease?
A few days ago, sponsored by the central health management and policy center health policy roundtable meeting in Shanghai, from Beijing, Shanghai, shenzhen, nanjing, Qingdao and other regions of big hospital deans, a heated discussions about the reform of public hospitals. The China youth daily, middle online reporter discovery, in care hospital deans "revenue whether" at the same time, more concerned about how to improve the medical service quality and core problems such as how to keep patients.
Big hospital looking forward to and to delegate
"If fully into the market environment, first of all to pieces is we the hospital!" Bing-yin shi xi 'an jiaotong university first affiliated hospital of a start, gave the scene 3 armour hospital deans to knock the alarm.
What he means, now looks bullish, overcrowded public hospitals every day, once they are on equal competition and marketization of civilian battalion hospital environment, die. For the simplest case, if the private hospitals can use health care and public hospital, then the patient is willing to elegant environment, good service attitude civilian battalion hospital, or go to crowded, acrid taste of public hospitals in the toilet? If doctors civilian battalion hospital and public hospital doctors can attend the title assess, practicing standardized training, high levels of a doctor is willing to stay at 7 days a week without 2 days on duty of public hospitals, or prefer to stay in the high income of private hospital?
Bing-yin shi believes that the biggest problem in system, mechanism, "we don't have six months to decision one thing, decided not to. In addition, we have a lot of burden, if the real market in the future, our hospital will suffer."
Similar problems, the affiliated hospital of Qingdao university, dean of xin-sheng wang admitted that a lot. He introduces, at the beginning of this year, the hospital the ambulance was suddenly broken, hoping to purchase an ambulance, but the hospital financial department of the opposition, "said why can't I get? And they said, because there is no budget report must be in the next year's budget, to buy it."
More troubling question is yet to come, xin-sheng wang said, "now we want to buy medical equipment, buy what kind of, have to report to the province, the province unified tender, then in any case, the lowest bid price, what you have to want what cheaper."
Xin-sheng wang in recent years began to explore a new kind of corporate governance structure, one of the most important one annulus is "cancel, releasing, the post responsibility system", "we want the government really and decentralization, or the size of our public hospitals in the future competition, a bit not autonomy, how to compete?"
Bing-yin shi has tasted a little "autonomy". In 2015, xi 'an jiaotong university first affiliated hospital, apply to the national health development planning commission to set up a company was approved in 2016. The new company is mainly responsible for the hospital scientific research achievements conversion, look forward to after the zero drug addition, the company to do "subsidy" hospital.
In fact, after cancel the drug addition, increase the medical service, such as xi 'an jiaotong university YiFuYuan exist large hospital, compared with the past tens of millions of dollars a year of income gap, "the transformation of scientific and technological achievements, the company earn back that money every year, no problem." Bing-yin shi said.
"The company also acquired a confined center, the hospital all the bus, you can foreign operations, can also provide services to us." Bing-yin shi said.
"Loose" couplet of medical powers-not
Peking University third hospital (hereinafter referred to as the founding of) the research in recent years, actively participate in the reform of public hospitals, medical couplet body led by characteristic discipline establishment, to help more basic-level hospitals.
But it is a process, involving the hospital more energy. Hospital dean georgy argues that these "loose" couplet of medical, because there is no clear responsibility, power and interest distribution, it is hard to do, do. For example, a couplet of gynecological experts were sent to the grassroots medical units, in the community to visit a day, and on this day, is most patient to interrogation, and almost no specialized counterpart of the patient, "this is a waste of resources, the experts in our hospital for at least a day to see dozens of" ZhuanBing ", the patient and incurable diseases, let him to come down and visit at the grass-roots level, one day to see a few patients, is really a waste of resources."
Some 3 armour hospital actively involved in the couplet of "loose" underpowered, more willing to accept the government's invitation, directly managed a after completion of the new hospital. In fact, after closely, big hospital really have the power to "service" at the local level.
, secretary of the party committee, vice President of the guangdong hospital ZhaiLiXiang has received a lot of similar invitation, he introduces, in guangdong, including affiliated hospital of sun yat-sen university, inter-city hospital, most received the invitation of the local government, the government built a hospital to entrust our management, or do the sorting invited us to hope in that area."
It is reported that guangdong hospital now there are five on campus, more than 3000 beds, more than 5000 staff, 2016, 7.41 million, the total outpatient service expand the number of patients treated for 118000, 140000 (were) surgery, efficiency is higher.
According to the construction of the civil affairs bureau of guangzhou city charity federation of "charity hospital in guangzhou as an example, the assets of the hospital's civil affairs bureau, and the medical staff is guangdong hospital of pie, daily operation and management shall be the responsibility of the guangdong hospital; 3 armour hospital and hospital of zhuhai, a region, the whole assets, personnel, fully to guangdong hospital trusteeship.
Hierarchical diagnosis is a challenge to big hospital
In an interview with China youth daily, middle online reporter discovery, each big hospital for "cancel drug addition, the current reform of the biggest highlights of the already prepared. By contrast, they worry more about classification diagnosis and further advance since.
Bing-yin shi calculated brushstroke zhang: "a big hospital, for example, if the revenue of 3 billion yuan a year, drug income accounted for about 1.2 billion yuan, the profit is 180 million yuan. 90% of the $180 million that have to be offset by the medical service price adjustment, that is to say, we are going to its own internal digestion of 18 million yuan, 18 million yuan for our big hospital the proportion is not too big."
Hierarchical diagnosis is different. According to the national plan, 90% of the patients in the future should be in the local grassroots hospital. "If the patient number dropped substantially, very fatal for us." Bing-yin shi believes that all the big hospitals are the planning for the future. Such as xi 'an jiaotong university YiFuYuan layout early 30 grassroots managed by the hospital, the hospital of xi 'an the basic coverage of the surrounding counties and cities, "this can ensure that our patients have certain resources in the future."
First affiliated hospital of chongqing medical university has focused on "difficult critical cases" on, vice President of the Lv Furong, said the practice is to put "big supermarket" to make "boutique". Takes out 30 million yuan last year, the hospital, to encourage departments were difficult critically ill patients, "from the original assessment index (were) the total outpatient hospital surgery, adjust the proportion of difficult critically ill patients in our hospital, such as surgery emphasize how many surgery patients among 100 patients to receive, these three level of patients with surgery and accounts for many."
At the same time, "hurry slow divide and conquer" be put into consideration in the important position. First affiliated hospital of chongqing medical university branch of the new set up last year old maintenance center, which increased the "slow", ward, receive referrals in the last year of 800, the 800 people accounted for 0.6% of total hospital patients, but it accounts for more than 6% of the hospital beds, "severs disease, slow disease Angle, can ensure a smooth transition hospital."
China Europe international business school, health management and policy research center director CAI jiangnan predicted that in the future, China depends on number of treated patients, hospitals will be the overall transformation by the meager profit but high turnover.
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