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| There are too many tertiary hospitals, and Chinese hospitals will be reshuffled |
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| Author：中國銘鉉 企劃部 Release Time：2017-8-7 14:40:49 Number Browse：614 |
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Medical website August 7
Party secretary of Beijing health and family planning commission, party secretary fang laiying
[dialogue motive] on April 8, 2017, Beijing medical separation reform was officially launched, with more than 3,600 medical institutions participating in the reform.
The Beijing health reform has chosen a path that is different from other cities: cancelling drugs, setting up medical service fees and adjusting the price of medical services, while implementing three policies simultaneously.
Why are the three policies of Beijing health reform gathering at the same price? How effective is the reform? The elimination of drug addition, the hospital revenue to see a significant decline? Establishment of medical service fee, the patient's medical care cost increase? After the hospital cancels the drug addition, does Beijing have financial compensation for the hospital?
Beijing health reform is about to last four months. The Beijing news reporters spoke with the party secretary of the municipal commission of health and family planning of Beijing. He answered these questions.
▍ Beijing health care reform is actually supply side
Beijing news: why choose such a reform path when Beijing cancels the drug addition, setting up medical service fees and adjusting the price of medical services?
Party to ying: Beijing, the city health management system is very complex, the central unit, unit, a city, and other enterprises and institutions, in the same area, but they so their basic health policies should be consistent.
There are some places in the provinces that adjust the proportion of financial compensation, which we feel is not going to work in Beijing. In Beijing's medical system, the financial affiliation of various medical institutions is different. So we're going to talk about this public policy, it's going to be the same policy for all the medical institutions in this region, and that policy is the price.
In fact, all the policies of Beijing health reform are gathering price. This is a lever that can shape regional public policy. We see that cancel the drug addition, intuitively see change is price and set up the medical service is price, adjust the medical service price or price, drug bidding final result is also reflected on the drug prices.
The Beijing news: why the three must be synchronized, and how do they relate to each other?
Fang laiying: for health reform, there are three sentences in the center. The first is the people's benefits. How do common people call benefits? The service is better, the price is lower. Second, the medical staff are encouraged. How can health workers be inspired? First income should not be less, not only income, his social identity, career development prospect, will affect his enthusiasm. Third, capital security is sustainable. If you talk about free health care now and you're completely dependent on health care, the government can't afford it.
These three factors must be taken into account when designing the overall policy for health reform. But that's a problem. We have to balance the relationship between the three. Where is the money?
We combined these three reform policies to make them interconnected. I think what we're actually doing is supply-side structural reform, we're adjusting different structures.
First of all, drug zero bonus to adjust the hospital income structure and the hospital financial revenue structure has changed, don't rely on drug prices in the hospital, supplemented by the price adjustment, set up the medical service and medical service price adjusting hospital medical behavior, medical behavior of citizens also have changed.
▍ tertiary hospital MenZhenLiang decline after reform
Beijing news: how has the public's medical treatment changed?
Fang lai-ying: most of our patients are chronic patients, and after medical reform, this part of the patients will settle their own accounts. For example, he went to a tertiary hospital, a drug that used to be 100 yuan, and now the drug price is down 20 percent to 80 yuan. Medical service charge, grade 3 hospital starts at 50 yuan. If the doctor's doctor's words are 80 yuan, the health insurance is 40 yuan, he will pay 40 yuan, and then the patient will calculate, in the three grade hospital just to prescribe the drug, then he may go to the community.
The Beijing news: do you mean that it promotes graded diagnosis?
Mr. Fang: yes. We can go to see that, since the start of medical reform, the number of outpatient visits to tertiary hospitals has decreased, and the primary level of outpatient visits has been rising. Why is that? The service charge of the basic outpatient service is 20 yuan, the medical insurance pays 19 yuan, oneself only spend a dollar, the Beijing household registration that is over 60 years old person, this one yuan also is free, do not spend money.
You go to the third level hospital to see, also in the shunt. The chief physician's outpatient rate was much lower. The chief physician charges 80 yuan for medical services and 40 yuan for insurance. And you're like, I've got a cold, isn't that worth it? I could start with a low-paid doctor.
Beijing news: the impact of grading diagnosis and treatment, have specific data?
On April 8, the health and family planning commission (NHFPC) monitored 373 tertiary and secondary hospitals, some level 1 hospitals and community health services.
Monitoring showed that er visits in tertiary hospital door compared with the same period last year decreased by 12.9%, secondary hospital door always compared with the same period last year decreased by 5.2%, er visits level hospitals and community health service institutions doors er visits compared with the same period last year increased by 8.6%.
The data shows that the number of hospital visits has decreased, and the number of visits by primary hospitals and community health services has increased. This indicates that since the reform, the trend of hierarchical diagnosis and treatment has been gradually presented.
In addition, the number of doctor visits by the deputy director of the monitoring unit decreased by 9.9%, and the number of doctor visits by the chief physician decreased by 22.1%, which made the problem of the expert difficult to be alleviated generally.
▍ hospital overall stable income after the reform
The Beijing news: the hospital for this reform, enthusiasm is not high? Can a patient's structural change make up for the profits from zero addition to the drug?
The reform is to the hospital, must adjust the structure above all. This kind of adjustment, on the one hand is the society forces the hospital to do, at the same time the hospital oneself also should see clearly the situation, the initiative to do, not the government complete administrative call.
For the first two months, the hospital's income levels were stable after the reforms. We monitored more than 300 hospitals, including cities, central, enterprises and communities, with a total increase of 3 per cent.
The Beijing news: is this meeting expectations?
Fang laiying: Beijing medical reform started on April 8 this year, but we have been preparing for it for nearly a year. On the one hand, we can calculate the total amount of hospital, and we will set up the Beijing medical records in 2015. Each patient, each square son, adjust the previous amount of money, adjust, the drug price how much, medical service charge how much money, we a hospital to do actual measure.
On the other hand, for the patients, we also calculated the actual situation in 2015. We calculated the 30 diseases with the highest incidence in Beijing. In accordance with the new pricing system, will the individual pay rise or fall? We measure, most of it is down.
The Beijing news: what was the impact of the expected reform on hospital revenue and patient spending?
Fang laiying: the conclusion of the calculation is basically stable, and the total average fluctuation of hospital income and patient expenditure is within 2%. Our monitoring showed that the expenditure of patients in the emergency room was reduced by 3 per cent, and hospital income was at the same level.
The Beijing news: do you think the reform will benefit patients, hospitals and doctors?
Fong: of course. For example, I am a diabetic patient, which is maintenance therapy. After the reform, I went from grade 3 hospital to a community hospital. The registration fee is 1 yuan. I will take some medicine and the price of the medicine is lower, so my personal cost is decreased.
So for tertiary hospitals, this part of the patient went away, freeing up more space. Tertiary hospitals the original 100 patients, which may have 20 patients is to medicine, his profits may be 10 yuan for the hospital, the 20 people to the hospital to create the profits of 200 yuan, but the medical service resources of the hospital 20 people. Now, this part of the people go, that hospital 20 free medical service resources, used for incurable diseases, 1 patient incurable diseases, him to a hospital making cash flow may be a person more than 200 dollars. For hospitals, the patient's structure changes and the patient's structure changes, resulting in changes in hospital income.
The Beijing news: is there an increase in financial investment in the process?
We do not make financial compensation for this reform. No financial input. Beijing hospital to use financial compensation, that agreement and hospital what to do, Peking University hospital how to do, 301 hospital how to do? So we can only pass the price.
▍ hospital will reshuffle in the future
The Beijing news: there was a concern that the zero-addition of drugs might suppress the urge to prescribe drugs, but would the future of excessive medical care be transferred to an over-examination?
Fang to ying: things always go forward in contradiction, have problems, adjust constantly. There is a problem that our medical institutions at all levels should recognize, which is the impact of this reform on the health market. In order to adapt to this pattern, the hospital should adjust. For example, some hospitals develop medical medias, make referrals, transfer patients who need rehabilitation after surgery, and improve the utilization rate of medical resources.
The Beijing news: where are the patients who need rehabilitation after surgery?
Fang laiying: rehabilitation medical institution. We now have a problem with continuous medical care, which is that there are too few rehabilitation institutions. Last year, six secondary hospitals in Beijing turned to rehabilitation hospitals. Hospital referral, for medical treatment can improve service efficiency. For the whole society, the patient in the rehabilitation stage is in a specialized hospital, which is a waste of medical resources and raises the total social cost.
After the reform price adjustment, the hospital found, turned more economical. The same is true for the development of medical medias. I think there will be a reshuffle in the future hospital.
The Beijing news: how about one direction?
Party to ying: some hospitals gradually to the medicine, teaching and research, integration, become a real medical center, conquer medical problems, and some only for clinical, or some hospitals will become secondary hospital. In fact, we also need secondary hospitals, now there are too many tertiary hospitals, secondary hospitals are not enough. Our medical system should be at the grass-roots level (level 1 hospital), clinical medicine (secondary hospital), medical center (tertiary hospital), such an inverted pyramid structure. But now, we are the hourglass type, the primary medical care is expanding now, but the secondary institutions are shrinking, and various factors are causing everyone to want to be a tertiary hospital.
In this regard, the impact of health care on patient visits is enormous and can play a larger role in this regard. This reform in Beijing, is to the medical department, the department of social security, price management department, financial department, civil affairs departments commander-in-chief in together, carries on the system design, this is a main reason for the smooth reform of Beijing. For example, health insurance, the design of medical service fees, the health care department doesn't support it, it doesn't support the concept of classification, it doesn't work.
Beijing medical reform for 4 months, certainly can't say without criticism, but overall smooth, everybody accepted.
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