Do not decentralize, do not grade the diagnosis and treatment

Medical reform is a worldwide problem. The United States, the United Kingdom and other developed countries are like this. We have been exploring China for many years. The medical insurance system we have established has a wide coverage, but the level of protection is low. In addition, there are still many Inadequacies. In particular, the major hospitals are crowded with people, and it is hard for the people to see a doctor. The grassroots medical institutions that the country has invested heavily in are ill.

The relevant departments have taken many measures such as appointment medical treatment, medical union construction, medical insurance reimbursement grassroots inclination, family doctors signing, etc., hoping to change the current situation of overcrowding in large hospitals and small hospitals.

However, with so many policies implemented, the doctors in the big hospitals have been overwhelmed by the physical examinations, and the strange phenomenon that doctors in small hospitals are busy with business-related work has not changed much. In fact, it is necessary to leave the patient at the grassroots level and truly form an effective grading diagnosis and treatment system. The relevant departments must have real and strong policy support - decentralization.

1. There is no “human rights” in primary medical institutions.

The primary medical institution must undertake the important task of grading medical treatment, and it is inseparable from an important factor - people. The existing primary medical institutions cannot implement the grading diagnosis and treatment work and have a direct relationship with the loss of “human rights”.

First, the basic medical institutions are seriously understaffed. Subject to many factors such as preparation and financial input, the staffing of grassroots medical institutions is approved by the editors and cannot be over-compiled. That is to say, the primary medical institutions cannot recruit enough medical personnel according to the actual situation of the hospital and the development of the business.

In addition to basic medical care, the grassroots level has to bear heavy public health work. These public health jobs are more labor intensive. In some township hospitals, some clinical and preventive health departments such as internal medicine, surgery, pediatrics, child care, maternity insurance, etc. are all light pole commanders, and it is difficult to maintain daily medical treatment, so what can be said about the diversion of superior hospitals? patient.

At the grassroots level, recruitment is required, and the preparations approved by the personnel department are full, and recruitment is not feasible. I want to recruit some temporary workers (also known as contract workers). It is also unreasonable to be subject to compilation constraints. As for the introduction of business leaders, because of the difficulty in matching the treatment, equipment and facilities, and the support team, it started to be lively for a while, and it will die after a period of time.

Second, the loss of personnel has increased. In recent years, the ability of grassroots business has shrunk sharply, resulting in serious loss of the backbone of the original business. Good talents can't be introduced, the original talents are lost, and recruiters are constrained. It is really stressful for such a primary medical institution to undertake the task of grading medical treatment!

Second, the primary medical institutions do not have the right to use money.

The human rights of primary health care institutions are one aspect, but insufficient financial use rights are another important factor. Due to the government's increased investment in primary medical institutions, the interference in the use of funds for primary medical institutions can be said to be comprehensive in all aspects due to the supervision of the use of financial funds. This kind of regulatory benefit is quite a lot, but the side effects are also more prominent. Did not take into account the particularities of the medical market.

The most obvious one is the performance appraisal salary. The original meaning is good, encourage the rewards to be lazy, more work and more, but a total limit, so many backbone tears. If you take more, other colleagues will definitely take less! This is not to provoke internal struggles for medical staff! Moreover, the total amount of this bonus is not determined by the hospital according to its own work, but it is approved by the superior.

The hospital is bigger, the performance may be more; the small performance of the hospital is certainly not much. As a result, small primary hospitals are even less motivated. The second is to work overtime and not to pay overtime. Medical activities are obviously not as early as nine or five hours as in the administrative institutions. A lot of work needs to work overtime to get better. But I am sorry, there is no overtime pay. Even if there is expenditure in the total performance, it is not a monkey's jujube - three to four! Finally, the hospital has a balance and does not allow bonuses.

As a result, hospitals seem to be getting richer, but the income of medical staff is not proportional to the heavier work. Get everyone vomiting!

In today's society, the market economy has led to the marketization of people's social behavior, and money is definitely better than no money! It is difficult to ask the grassroots medical staff to have a high level of thinking and to be willing to contribute to poverty. Primary medical institutions without financial independence cannot adjust the enthusiasm of medical staff through economic leverage. Obviously, there is still a long way to go before the goal of grading medical treatment.

Third, the basic hospital has no real "management rights"

To be honest, the domestic primary medical institutions are not independent hospitals in the true sense, but a department under the management of the health authorities. The person in charge of the health authority is a large dean who is responsible for the day-to-day management of the grassroots medical institutions within the jurisdiction. For example: Responsible for the appointment and dismissal of the dean and vice president of the primary medical institution.

In this way, the management of the hospital is only responsible to the superior, and the others are secondary. In some places, the competent health authorities must also manage the establishment of departments in the primary medical units and the use of middle-level cadres; the competent departments manage equipment procurement and hospital construction in primary medical institutions.

Without the consent of the health authorities, it is difficult for grassroots medical institutions to act; the competent departments are responsible for drug procurement and use supervision of primary medical institutions. Primary medical institutions can only use basic drugs, and the proportion of drugs to be used, the rate of antibiotic use, the rate of infusion, etc. must be strictly supervised by the competent authorities.

It can be said that the superior health authorities have completely controlled the daily operation of the organization through various channels. It is obviously difficult for grassroots medical institutions that do not fully use human rights, have full financial power, and do not have sufficient management power to undertake the task of grading medical treatment.

The goal of medical reform to achieve graded diagnosis and treatment can only be started from the government's own reforms. The government is under the authority of the government, and the market management is handed over to the market. The same is true for the medical market. Grassroots medical institutions must bear the burden of grading medical treatment and must be further reformed.

Suggest

Grant hospitals full use of human rights. Most of the grassroots hospitals are of a public nature, so their human rights are subject to the approval of the relevant departments. The grassroots employers must arrange according to the volume of business, business development, and various government directives. How many people to use, long-term employment or short-term use, etc.

If the workload is large, you can temporarily recruit some personnel. After the work is over, the personnel will leave. If business development needs, people can be introduced, long-term use, short-term employment. The relevant departments do not have to interfere, as long as they are legally compliant!

Give the hospital sufficient financial use rights. Today's primary health care institutions are far from attractive from a large hospital. Coupled with a rigid performance bonus system, it is impossible to attract talents and retain talents.

It is suggested that the relevant departments should not do further involvement in the internal financial management of the primary hospitals, but should do it in three aspects:

First, as long as the relevant departments scientifically verify the funds needed for the operation of the primary medical institutions, they can be fully and timely issued in full; the second is to do a good job in auditing and supervising the financial funds. Prevent the waste of government financial funds; Third, it is necessary to have sufficient funds for sudden and temporary government work. Don't always use the hospital as the country, and do it for free.

Of course, the hospital should do a good job of internal fund management. This should be allocated and used by the hospital according to its own situation. Second, it is necessary to formulate the actual salary plan in line with the hospital. The annual compensation plan still has certain feasibility, provided that the annual salary limit is It is more appropriate than the average level of the local society.

Let the hospital manage itself. As an independent legal entity, grassroots hospitals should also be able to manage themselves. Whether it is medical business or public health, as long as it is fully authorized in the primary hospitals, the government departments can only purchase the services. And don't take things that must be taken care of, so that grassroots hospitals should not simply become an extension of the administrative department. Instead, we must give full play to the ability of grassroots hospitals to self-manage and withstand the baptism of the medical market. The survival of the line, the failure of the line!

Of course, this requires the relevant departments to be embarrassed. The reform starts from itself and truly decentralizes to the primary medical institutions. After some pains, it will definitely bear the fruits of successful graded diagnosis and treatment!