At the end of 2014, General Secretary Xi Jinping went to Zhenjiang to inspect this saying that some large hospitals are always in a “wartime state†and need to change. The new medical reform has been in its seventh year since its inception. However, due to the high degree of congested patients in the large hospitals, it is difficult to see a doctor and expensive to see a doctor, but it has not been alleviated. On the contrary, it has been intensified. General Secretary Xi pointed out that this is the medical and health system. The most urgent problem to be solved in reform.
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Relevant functional departments have also acted on this, but so far, whether the health department has strengthened the medical association through administrative means, or the medical insurance department has different proportions of compensation between medical institutions at different levels, it is difficult to see actual results. Just as high-end talents always gather in big cities, high-quality resources always gather in the best environment in the industry, and China's medical and health system has been operating under the administrative hierarchy for more than 60 years. Good doctors are siphoned by large hospitals. It is also a matter of course, whereby the patient follows and naturally is a rational choice.
Therefore, the key to achieving graded diagnosis and treatment is that the medical resources are no longer allocated in an administrative hierarchy, rather than strengthening the hands of the government. The greater the administrative power within the system, the higher the administrative level and the more resources, further increasing the number of doctors. Attraction, this undoubtedly runs counter to the direction of reform.
Some of our top three public hospitals are invaluable in the exploration of medical associations and graded medical treatments, and it is difficult to obtain some valuable results. For a long time, there was a bit of deep feeling that public hospitals were somewhat "obedient": the government let him do it, and he went to work. This is very similar to the fact that the health department has long asked high-level hospitals to help the grassroots, and has been doing it. The top three hospitals have been contributing to the state as a state-owned unit. This is a behavior of learning Lei Feng. I personally doubt how much benefit the medical association has for the top three hospitals. Therefore, the medical association has not formed an effective mechanism for a long time, and the effect is not ideal for the original design. It can be seen that it is impossible to learn from Lei Feng alone.
The government requires high-level hospitals to work as a medical union to help the grassroots. This process reflects that the tertiary hospitals are undertaking the government's tasks. As a public, state-owned, and party cadre, they actively undertake the tasks of the government. But the effect did not reach the ideal pattern, reflecting the idea of ​​our government departments to do such things: what the government asks you to do, what the hospital is required to do, such as a medical association, and what patients are required to do, such as patients should first diagnose in the community! This is a kind of command thinking. Some people say that planned economic thinking is command thinking. In fact, the government should change the angle of thinking, consider what the hospital wants to do, what the doctor wants to do, and what the patient wants to do? All these grading treatments reflect the government-led thinking: government hopes, government requirements, and government implementation.
One of the most important practices in the medical association is to send experts from the top three hospitals to the grassroots. However, I personally have doubts about this practice. If the graded diagnosis and treatment is only a third-level hospital doctor who can go to the grassroots clinic regularly to form a graded diagnosis and treatment, I really doubt it.
In fact, if the large medical system has not changed, the current medical model is the most convenient and efficient. An expert is sitting in Chaoyang Hospital, seeing a five-day clinic a week, four hours in the morning and afternoon, the patient is waiting in line to find him, from 60 to 60, and 160 to the largest, if the expert is on Monday, Tuesday, On Wednesdays, I went to different communities and spent two hours on the road every day on the traffic conditions in Beijing. There are fewer patients to see. What I mean is that the formation of graded care is not simply achieved by relying on existing high-quality medical resources to sink to the grassroots.
As I just said, even if the clinics of the top three hospitals are cut off, the doctors in the top three hospitals are not allowed to see the general clinics, and the doctors in the top three hospitals are scattered to the community. This is still such a doctor, or a service model, or an expert sitting. Sitting there, patients lined up to see his illness, is it necessarily convenient for the people? We went to Chaoyang Hospital and went to an expert. There were 160 numbers a day and 160 patients lined up. If the experts went to the community, it might be convenient for the people in this community. Are other communities going to see it?
I know that when the new medical reform is proposed, it emphasizes the graded diagnosis and treatment. However, this year, the leadership seems to suddenly realize that after four years of medical reform, the graded diagnosis and treatment has not only formed, but has not progressed, but has regressed. The data we are seeing now are not to mention hospitalization. The general door emergency department is increasing the share of tertiary hospitals, and the medical insurance funds are siphoned by tertiary hospitals. Therefore, this year, all the ups and downs are shouting to build a graded diagnosis and treatment system, then this year will definitely be the focus of work. However, if the basic ideas are not clear, I am afraid that this year's pattern will not be changed, or the tertiary hospitals are overcrowded.
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