Hierarchical diagnosis and treatment of breakthrough in where?

08:52 on November 24, 2015

Source: southern daily

west-wing

Implement grading diagnosis, lack is to attract the doctor supply mechanism and primary care for what people to solve.

The first two edition published in this column the grading diagnosis and why is it so hard?" Caused widespread concern. Today, I continue to ask: why Europe and the United States and other countries can implement hierarchical diagnosis and treatment, we past level 3 medical system also can do it, why now can't you do it? I think that the main crux of the problem lies in the doctor's practice patterns and payment system.

As we all know, in the past our tertiary health care system is very perfect, in the UK today "level 3" is our basic prototype of the year. It can work, because the government's "pay." The government paid what it? The doctor kept! As a result, the doctor just obey distribution can gain stable income, and doctors in the same region, almost no income disparities, even in different areas, the gap is not big. Basically, in this case, the doctor's status as in Europe and the United States, the doctor's basic income gap. And after that, we headed?

Medical reform in our country, one of the reasons is that the government couldn't afford to universal health care, is essentially couldn't afford a doctor, thus to overthrow their own system, establish the market mechanism. However, in terms of the current situation, characteristic of market mechanism is whatever attributes of the hospital, have to seek survival and development in the market. Therefore, public hospital and public hospital patients divide market, both in the market and compete for the doctor resources - hospital expansion become one of the biggest reasons for hospital based on the market. Today, we will make the medical couplet body makes expansion more justified.

Not only now of the state council put forward control expansion, public hospital as early as ten years ago has already seen the disadvantages of public hospital expansion also banned several times. Recent file is tough rhetoric: according to the population proportion, pu Zhang Weiyi; 500-1000 Municipal Zhang Weiyi 800-1200; It is advisable to 1000-1000 or so, at or above the provincial level to big will be submitted to the state development planning commission.

In principle, medical and other industries, with the "scale effect" such a simple market rules to explain. The United States there is no limit to the hospital, but no one to do such a big aircraft carrier. Even if the world, also not so high as China. Because they do not think "scale effect" will bring profit to them. On the contrary, they believe that the most appropriate data between 500-800. In today's Internet age, medical treatment to decentralized development, is not conducive to the hospital's expansion monomers. Beds in recent years, the United States is shrinking, and the day ward is in constant increase, the main concern is the operating cost, because of this, the human cost is one of the biggest cost.

Considering the marginal cost of time, people have to consider from the Angle of management the cultivation of medical talents. Our current status is the insufficient medical talent reserves, but also has the problem of medical waste serious, there is a "doctor's ailment, small doctor to see a doctor about" phenomenon, is not really from the principle of reasonable division of labor to consider. Shortage and waste, expanded social injustice, also restricts the cultivation of the talent, the flow and development. Hospital, for example, blind expansion is behind a drop in the quality of talent. At present, the talented people retire much faster than the speed of the graduates of speed. Cultivate a doctor may require more than a decade, and hospital expansion speed may be a few years, have no money can borrow, and no one? Just take people's talents poached! So, if not expanding, this some talent is still there, just the Matthew effect. But now, the phenomenon of "hear" the more to the more obvious at the grass-roots level. No wonder some experts said: this is a strong monopoly system formed by the high dam, the water surplus together with large medical resources, cannot be released to the market; Under the dam was nothing grows drought, the public inconvenience and expensive struggling to see the doctor. To master their medical resources, just as ants move the resource handling passing the dam... While the dam designers and managers, busy with something called "health care", hope to be able to open the sluice gates of the already rust, orderly gathered by the huge potential energy release of the dam.

We again under the state council issued a set of digital proof this kind of phenomenon of "high dam" : in 2014, is the new reform after five years, China's total medical 6.888 billion person-time, among them, the community health service center (station) to complete 599 million person-time, accounted for 8.67%; All levels of hospital to complete 2.542 billion person-time, 36.9%. Grassroots health institutions MenZhenLiang fell from 59.1% in 2013 to 57.4% in 2014. Hospital MenZhenLiang rose, from 37.5% in 2013 to 39.1% in 2014. In 2014 the number of hospital, hospital, 153.75 million people, accounting for 75.2%; Grassroots medical and health institutions, 40.94 million people, accounted for only 20.0%.

On the surface, this embarrassing situation because of hierarchical diagnosis was not well done, but actually because no grading medical measures for its implementation, is a kind of "encouraging". Grading medical plainly not hospital work, but working mechanism. In 2009, I took part in the health care organizations under the state council pointed out: when the new program is symposium "encourage" the doctor to the grassroots to "attracted" to the doctor at the grass-roots level. So many years, has been verified the laws of the market. Fact also proves that the hierarchical diagnosis and treatment to the doctor so many unhappy people don't even support, the fundamental reason is that under the market environment, the government guidance and market driven not organically unifies in together, even is against both. Implement grading diagnosis, lack is to attract the doctor supply mechanism and primary care for what people to solve.

Here, you may see a lot of, also know where is the breach of the implementation of hierarchical diagnosis. The doctor's professional status and payment system reform is to implement hierarchical diagnosis and treatment of confusing gripper. Hospital blind expansion bring another "prosperity", but behind it is to be less machines, medical patients hospitalized much - less a high-volume, low-margin business. Why is it that doctors complain: "so busy, even didn't even have time to drink water, which still have time to go to practice more?" Change the Angle to think, if not expansion, you or he is still at large hospital? You will be in a state of "wartime"? So much of inpatient and outpatient, you are not busy to get down to blame, patient rights and damaged just strange!

Liao new wave (guangdong health development planning commission inspectors net: doctor wave son)