Health officials: new order more and

cannot leave the village doctor

The newsweek looked out on "

"I say of these things actually you know, has been not solve. We analysis, root is rural doctors in this group identity is a farmer."

WangLuSheng are committed to one thing: for village doctor battle cry.

He pointed to the desk a stack of letters said: "from the village doctor letter see, rural grassroots health policy also has some problems."

These problems make WangLuSheng rather alert: "if you do not pay attention to the village doctor, leading to village doctor collapsed, so our team for the efforts of cure of new problems is to."

WangLuSheng current health, deputy director of the development research center. Once in the rural grassroots when clinical doctors, after the administrative department of public health in a provincial engaged in health management in 1993, he transferred to the membership of the ministry of health of the national research institutions, has been committed to the rural health research. He had completed a health ministry and country hosted the relevant ministries, international organization entrusted by the various policy research subject. These involve rural health service system construction, rural medical security system construction of research results, has seen a number of into the government decisions.

At present, the research direction WangLuSheng will focus on the village-level health organization: "new order five key tasks in four and village health organization, but at present is closely related to the village-level health organization policy arrangement, still do not reach the designated position in a certain extent influence the development of village health organization, also influence the effectiveness of the new order."

June 10,, to accept the WangLuSheng looked out on "newsweek interview, with more than two hours of time, to talk about his of village health organization research and thinking. In his view, the "new order up to now, we have the policy of village doctor unavoidable, village-level health organization to the problem of unavoidable, they can't also needed in the new order. They need to reform outside policy, so that the sustainable development, reform also need them, otherwise reforms was going."

"The identity of the village doctor, and they are engaged in profession is contradictory"

"Looked out on" : we found in the interview, the contradiction of the contingent of rural doctors have three prominent. What do you think?

WangLuSheng: this phenomenon exists. We have made investigation, village doctor over the age of 50, 23% 40-49 years old, 24% of the sum, both for 47%. This means that, nearly half of the rural doctors in more than 40 years old. It is a pity that at the age of 2029, only 7% of rural doctors. This explains the contingent of rural doctors have the problem of temporary shortage of aging, the team there is.

The rural doctors looked out on ": the team why aging?

WangLuSheng: on the one hand is professional yearn to person of hometown to work to have medical feelings do down; On the other hand, the young man, and not willing to receive not on dry, he also only go on.

The young man looked out on ": why did not want to be a country doctor? The rural doctors practicing environment?

WangLuSheng: should say, rural doctors practicing environment is not very good.

Our investigation shows that, village doctor income level is not high, average 1000 yuan every month or so. If go out to work with farmers, their income than than the mechanic, such as electric welders, are generally low, with sewing worker, such as tile setters, almost. If similar compared with rural industry, such as primary school teacher, and it is far from a times, probably want bad.

I said this income, including business income, including government subsidies to etc.

Of course, the income level of village doctor vary from person to person, a few small famous income is good, but this is, after all, a few. And you will see, go out to work, the income in rural migrant workers rise. So young people don't want to be in this industry, we also found that have left the village doctor, out to work to make money.

Besides the social security, such as pension, basic 77% are no village doctor, endowment insurance, this year may be good point, village doctor can attend farmer's endowment insurance, but the security level is very low.

Can say, village doctor welfare, old-age security etc is really bad, so young don't want to come in, the old had to keep the position.

The ": that looked out on what causes rural doctors practicing environment today so" bad "?

WangLuSheng: I say of these things actually you know, always can't be solved. Our analysis, root is the identity of the rural doctors this group are farmers.

Many of the policy is in our country according to industry, identity for work. From the industry, education is the education see policy, health has health policy, from identity look, workers and cadres policy is not the same.

The root of the problem lies in village doctor, he used to call barefoot doctors, now called village doctor, but his identity has not changed, and is still farmers. So, always to farmers some policy he can enjoy, contributes to the farmers no policy he cannot enjoy.

More specifically, although they do the doctor's job, but does not belong to 6 million national health personnel, additional kind, so the country is to health personnel to all the policy they stop here.......

For example, the country for medical institutions and their personnel policies, rural hospitals need not divided, don't noisy, there is naturally a, but village clinic and village doctor didn't copy. Be like again, if is the villages and towns the hospital doctors, through their own efforts, their title can to rise, but village doctor, no lifetime or village doctor dry title.

In other words, the identity of the village doctor, and they are engaged in profession is contradictory.

"Looked out on" : generally, village doctor is half agriculture and a half of healing.

WangLuSheng: yes. The first, called the rural doctors in 1965 to 1980 called barefoot doctors, it is very typical half agriculture half medical status.

That time, their time in half and half time to give farmers farming read little injury ailment. This also right, after all, that's great, there are not so many doctors, in the early days of the XianShang can have a county hospital, can send that the doctor good, let alone village, the village can have personal doctor always better than no strong, so, the situation at that time we have used some decision or a busboy farmers and a half of the medical doctor.

The situation has change greatly. We have made investigation, from rural doctors work time to see them, 365 days a year, engaged in medical service time is 217 days, make preventive care is 98 days, farming time only 45 days. This means that, assuming that planing away on holiday, they are actually full-time village doctor, not half agriculture half a medical.

"New order more and cannot leave the village doctor"

"Looked out on" : now that village doctor so is ignored, that they have no longer necessary?

WangLuSheng: I think that we cannot leave the country doctor.

The latest survey is at the end of 2008, China had 613100 in the village clinic, administrative villages of coverage rate is 89.4%.

If you consider that quite a number of administrative villages in rural hospitals, according to the location of the health requirements, rural hospitals, the seat of the clinic, so do not set village, the village clinic coverage can still.

From the village to the clinic service radius look, eastern and central China area 2.5 kilometers, the average basic can realize the world health organization to health accessibility (go out on foot and a half hours to find health agency requirements, but the western region is 5 kilometers above average.

If take off village clinic, let the farmers have to rural hospitals to go to a doctor, so, the new service in an average of ten even dozens radius, the more big, kilometers it is impossible to achieve availability requirements.

Again from service, the average population see village clinic service of about 2000 people, every village doctor service is about 1000. Research shows that, if less than the number, service, higher than the number of deficiency, the service is not over.

So, the village clinic cannot be cancelled. Since the village-level health organization in the temple, that the monks, the monk is a village doctor. We cannot leave the village doctor, the later development depends on village doctor.

"Looked out on" : you can say, would you tell us about the new order village doctor, two years, farmers health role of village doctor?

WangLuSheng: many people, including some leading comrades have recognized that the new order more and cannot leave the village doctor.

We can count, the new order five key reform, in addition to the reform of public hospitals had little relation with village doctor, others besides four are closely related with village doctor.

Basic drugs system does not participate in village doctor do? In light of the new drug zero rate differential, not in a village clinic drug zero rate differential is a completely drug zero rate differential?

From the equal access to public health, it according to our statistics, almost half the work here, to village doctor to do. With chronic disease management for example, the new service in 20000, the average DuoRen if no village doctor, rural hospitals can finish measure blood pressure, blood sugar test regularly the work?

And the health service system construction, township and village is typical of the basic level, the village clinic if WangDe collapsed, the worse the strong, can?

As for new farming and the security system, village doctor offers farmers of outpatient services is indispensable. Our results is, rural patients in the village clinic as high as 57.3% of the primary, and the data is on the rise.

Obviously, the new order or farmers health needs of all right, is inseparable from the village doctor, this team. If this team make not, let it collapsed, so many of the new medical task could be carried out not bottom go to.

But unfortunately, there is on the introduction of the new order policy, about the village doctor work there, but about the policies are not many village doctor.

I know the situation, not to the ministry of health and other departments to forget, but don't know how to village doctor write, how to say the policy of the village doctor. Because the identity of the village doctor is farmers, so even if put forward some policies, boldly say to the village doctor as long as status as farmers can't dialogue with the relevant departments.

But the problem is ignored. Such as new cure changes in the new requirements of drugs to village clinic, zero rate differential of ambiguity is whether. But if the new drug only in a zero rate differential, then in such two system, don't say selection in village clinic first diagnosis of nearly 60% of farmers to rural hospitals to go to a doctor, even if only half ran to the rural hospitals, rural hospitals stand?

Therefore, some places have already accepted the fact. For example Beijing, every month to village doctor subsidy of RMB 800, the money inside the drug contains a zero rate differential compensation, don't let the income of the village doctor decline.

Some place to practice medicine leng village doctor zero rate differential would not give subsidies, only by the public health service of money to a small village doctor, leading to the village doctor subsidies income declined obviously, and results some village doctor, do not do, work out. Local government may see village doctor to spread, the team put up money. The money if you don't fill, village doctor, that is about to collapse team out of the question.

"Let the farmers end to farmers a doctor"

"Looked out on" : you think village doctor, how to solve the problem of the team?

WangLuSheng: I entrust in the ministry of a project report, to put forward in "old back, optimal jin, unhealthy, and strict into" the curve 8 words under the framework of the identity of the village doctor, completely solve problems.

The so-called old back, is to set up a retirement system. Old village doctor, staring at the post is a good thing, but on the other hand, always occupied position, young people into do not come, is also a problem, so to age will retire. Of course, want to have a humanized return policy, according to the regions properly, can be old man, new old way of new measures, old man can give a pension, can also be one-time give a sum of money, in short don't a kick out, that's hurt the heart. On-the-job personnel to now and for the future of the new personnel must attend social endowment insurance, established on the basis of the system, year after year slowly to retreat.

The so-called jin, is to make the optimal has certain cultural foundation and with certain degree of young village doctor rise for space. For example, if a village doctor, can take an examination of assistant practicing doctors' license, that give him some incentive policy, male, subsidies or turn believing, anyhow let him improve or a BenTou. Of course, the assistant practicing doctors want to change the content of the past, the trouble is a big hospital with test of specialized subject doctor problem to test village doctor, it's not fair, should take an examination of the general practitioner is used to test his problem, but can't drop, or level in the level is not.

The so-called bad, is aimed at those curve culture level and is hard to learn performance also not line, of the roughly at about 10%. Through the village doctor, take an examination of the employment mechanism phased out, eliminated mechanism must have, the exit mechanism is favorable for the incentive village doctor, progress, and strive to work to, but must give them some time to control in the least scope.

The so-called strict, is to increase the access requirements, ensure the future into has professional degree, have the qualification examination of assistant practicing doctors' after a certain time, work experience can pass or assistant practicing doctors practicing doctors.

Head six words to the existing team is the transformation of a word, and then after 2 is for the people into later. We hope that through this 8 words policy, in 10 years time, finally let village doctor realize two changes, team a is the identity, 2 it is male, change blood to completely turn believing, achieve renewal.

"Looked out on" : this wasn't something very urgent? Why with emphasis on 10 years to slowly to turn?

WangLuSheng: indeed, our teacher of run by the once be achieved overnight "people" turn "male", this of course is a good thing, but also exposed some of the problems is that some teachers level is too low, their promotion up very difficult, but since has turned a "male", the country will have to raise the....... Our idea is to realize the conversion of the village doctor upgrading, not simply change a name and simply turn "male".

"Looked out on" : is there a measure of "public" may turn village doctor with the economic burden?

WangLuSheng: when teacher of run by the 1 million overnight shifts also.

We calculate, 900000 village doctor, not a Posting, but points in turn in 10 years, the annual turn 90000, turn again to the country's 2000 DuoGe share county, about a year on average, each county of increasing financial expenditure is more than 30 ten thousand yuan.

Of course, the number is accumulated, and may be the first year is more than 30 ten thousand yuan, the second year will be more than 60 ten thousand yuan, total up. The current economic conditions can be first in have practiced in places where the poor western region, the central should give support. The key is now should publish such policy, 10 years gradually realize.

And see, our country after 10 years with the financial resources are now. If we looked back, be in "SARS" popular in 2003, the national finance income was first breakthrough 2 trillion yuan, in 2010 is more than 80000 yuan.

I always think impassability, our country has developed to this time, how do we still hold farmers to farmers to see a doctor? I want to ask, farmers to farmers to continue the present situation of the doctor to what time?

I think, this is unfair to farmers. Why the city community doctors is so serious health personnel or practice doctor? Why rural farmers to farmers to see a doctor is? This isn't a kind of discrimination policy, is on the irresponsible?

Want to know, to let farmers to farmers a doctor, if the past is understandable, so now he said it. I think, this is not the problem of financial resources, is understanding question, do or not.

"Some people think that looked out on" :, teacher of run by the public welfare, but is pure rural doctors to sell drug money, they are not completely public welfare.

WangLuSheng: what on earth is that let village doctor, public welfare or not let pure? Indeed, rural doctors have medical, pharmaceutical income, which is in the government not to give any assistance, to survive, village village doctor, health organizations should exist, that he will from medical, pharmaceutical, in fact the main products from income for, if the government of teachers like village doctor as the wages, village doctor can drug zero rate differential, this also is the goal of reform.

The government subsidies to the village doctor has been very few, this two years improved, but the allowance standard on all is different, some only 100 DuoYuan money, have a plenty of 800 DuoYuan money.

The actual village doctor work is the public welfare, just because the government didn't give relevant subsidy, he had to rely on drug income maintenance livelihood.

We've always said "heavy medical light the", actually this is a policy of medicine medical compensation mechanism of the decision. Just think, no government compensation, not heavy medical line? The heavy which have money?

Now take the public health service to do before the equal access to the village doctor, public health is not to give money, according to $15 per person now, so village doctor work is rich. The system design is quite good, being rich and occupy, and things very specifically, what to do, do what extent was clear, and subsidies in the money required township, village two level. So, before the rural hospitals only one or two people make preventive care, now have a group of people make preventive care is busy. This year the government in this piece of added money also added a work, the situation is very good.

And, since the new order, to reflect public welfare, to implement the drug zero rate differential. At present in many places, the income of the village doctor, mainly by three pieces: one is to provide the public health service, from 15 yuan to share a few dollars money, 2 it is medical income, from the general fee to share a few yuan, three is a government must subsidies.

I also want to say, even in the new order before, also cannot say that village doctor is for-profit. In the government under the condition of the salary, the rural elementary and middle schools is not also have some of the long-standing fee? It doesn't say schools are for-profit?

Village clinic can go to the market

"Looked out on" : you think village clinic should be how to qualitative, positioning?

WangLuSheng: now it's a question of village clinic attribute is unknown. What is the public welfare, or private clinic, is not clear.

The new public welfare attribute is already clear. Village clinic should also go this way, should be in each by the government or the administrative village village collective run a public welfare of the village clinic, take on the basic public health and basic medical services. Other says private clinic.

Now the situation is, the village clinic, nominally a collective do of, in fact some of the individual to do is-the house is his home, equipment is bought, collective, the government didn't give money. This kind of circumstance, you make people do the public health service, what do you say?

Of course, now do the public health service back to some money, the past is white do, is forced to do, don't do don't when village doctor.

I think, in the future should clear the village-level health organization of public welfare, by the government to hold attributes.

As for the location, the village clinic at present very awkward, no legal person, have a plenty of legal person, director of the village committee so once out of the accident, director of the village committee is suckers.

We think, should be integrated management in the framework of the village clinic as will the new agency, by the new as its legal person.

As long as the system could change, just that 8 words of policy, the village doctor problems such as identity change is good implementation. For example, once the village doctor, take an examination of assistant practicing doctors' license, that naturally becomes a national health personnel, also entered the new health personnel), the columns of the government's budget nature is not only the new headquarters, should also include the new agency, including village doctor, so that all the problems were solved. In fact some place now has done so in suzhou city, chongqing, such as some of the area, etc.

"Looked out on" : some people have different opinions, the village clinic why don't the government to do? Why can't walk, let the private market to do?

WangLuSheng: can bring the market mechanism place could certainly use market. For example, you can run the city hospitals, clinics, can go to the market. But the market in some places, such as the market is failure in the village and township is failure, especially the more remote areas, where the population is little, the more no one do private clinic.

The reason is very simple, the market on the benefit as the guide, have interest to have the market. We don't rule out market, do not eliminate social capital, but a village clinic or should the government to do, because the village clinic to undertake the a lot of basic public health service and basic medical service, is the most basic service organizations.

I think, the cultural undertakings, the division of cultural industry is very good, the cultural undertakings to define the city community, rural villages, enterprise; the honorary And nine years of compulsory education in primary and secondary schools, government to define.

The basic health in primary. Rural grassroots is township and village.

"Looked out on" : in your opinion, to change the health condition? What are the key factors

WangLuSheng: first is the government investment. As long as the government invested in place, I believe that the situation will soon change.

Next is the talent team. Rural grassroots facilities conditions have improved a lot, at present the key is health team construction.

The third is to build a good set of mechanisms, including compensation, operation and supervision, let rural health organization sustainable operation.

I think, the new order up to now, we have the policy of village doctor unavoidable, village-level health organization to the problem of unavoidable, they can't also needed in the cure of new outside. They need to reform policy, so that the sustainable development, reform also need them, otherwise reforms was exactly. Zhang Ran burning