What should "medical reform" change?

Since the promulgation and implementation of "Opinions of the Central Committee of the State Council on Deepening the Reform of Medical and Health System" in 2009, all localities have gone all out to promote it. After three years of hard work, we have finally made some achievements: from a macro perspective, a new medical and health system has been formed, the system of "essential drugs" has been fully rolled out, the trend of "supporting doctors with drugs" and "marketization" has begun to reverse, and the situation of "paying more attention to medical care than prevention" has changed; From the microscopic point of view, the government's health financial investment mechanism has gradually entered the right track, the rising trend of "expensive medical treatment" of the masses has been initially curbed, the operating cost of medical care has decreased, and the treatment of primary medical staff has begun to improve. However, when we are more and more involved in the "deep water area" of medical reform, we suddenly find that the original problems of consciousness, concepts, habits and systems are gradually exposed, which is reflected in the fact that the problem of "difficulty in seeing a doctor" has not changed and the doctor-patient relationship is still tense. We originally thought that simple things were not simple, but complex things became more complicated, especially the adjustment of interest relations and the formation of a new game situation, which not only opened our eyes, but also made us deeply confused and uneasy, and even created a dilemma. From this point of view, the road ahead of medical reform is tortuous and long, and it is far from celebrating now. Under the complicated situation, we think we should "return to the Sect". Only by fundamentally solving the problem can we fundamentally solve the problem. But where is the root of the problem? All problems stem from the problem of understanding. If the understanding is vague, management confusion will be inevitable. Medical reform is no exception. So we should start with understanding the problem. Fuzzy understanding comes from wrong ideas, and wrong ideas come from conceptual confusion. Due to the influence of fixed thinking (also known as "inertial thinking") mode for many years, we not only don't understand the connotation of medical reform, but even have many deviations in understanding the concepts of "medical care", "sanitation" and "health". In common sense, we think that medical treatment means "seeing a doctor", hygiene means "cleanliness" and health means "no illness". These views can be described as "true", but they are not comprehensive. Different groups have their own misunderstandings about medical reform: many local officials believe that medical reform means giving more money and building more hospitals; Medical staff believe that medical reform means raising wages and adding "work"; Ordinary people (patients) are the simplest, and think that medical reform (a sign of success) is to spend less money on medical treatment, and it is best not to spend money. Simply linking the quality of things with the amount of money spent, or even equating them directly, is an intuitive way of thinking that ordinary people are used to, and of course it is also a kind of "lazy thinking". This simplified thinking often lacks connotation analysis and essential thinking, so it is often biased and deviates from the standard. Although there is no reform without money and things, giving money and things does not mean reform. In fact, it is not uncommon that the more money, the worse the situation. Anything that loses its standard and its structure is disordered will lose its normal function. Therefore, only by correcting the misunderstanding of medical reform, returning to norms, and returning to normality can medical and health undertakings get on the right track, give full play to their normal functions, and serve people's health. If we want to "return to normal", we must predict where the standard is and where the normal is. Semantically, "medical treatment" refers to eliminating injury, that is, getting rid of external invasion factors and focusing on treating symptoms; "Hygiene" means "guarding life" and "health care" means "protecting health", aiming at improving one's internal quality and keeping a solid foundation. The sages of past dynasties all emphasized "both internal and external cultivation", "treating both the symptoms and root causes" and "consolidating the foundation and cultivating the yuan", and also emphasized "treating the standard if you are urgent, and treating the foundation if you are slow". This is not only the way of cultivation, but also the philosophy of life. It can be seen that based on the original meaning of medical care, in the modern sense, "waiting for life and protecting health" is the "standard" of medical care. Only by returning to the standard can medical and health undertakings embark on the correct development path. Obviously, eradicating the problem of "difficult and expensive medical treatment" is indeed an important task of medical reform, but it is not the whole connotation. After careful consideration, it is not difficult to understand that the fundamental purpose of medical reform is neither to allow more patients in medical institutions to survive and develop, nor to save lives, but to continuously improve people's health and quality of life. In a word, we should not only let the masses get medical care, but also let them get sick as little as possible. This is the fundamental reason why the CPC Central Committee and the State Council always adhere to the policy of "people-oriented", emphasizing "prevention first" and "paying equal attention to Chinese and Western medicine", vigorously developing public health undertakings and focusing on rural health undertakings. In short, everything is for people's health. Change your ideology. Consciousness determines behavior, and only by correcting the mistakes of ideas can behavior be correct. The first consciousness to be established is "respecting life and putting people first". It is an important mission and basic duty of the government to let the people recuperate and live and work in peace and contentment, and the first condition is health. It is the life value of medical staff to relieve diseases and protect health for patients. It is everyone's responsibility to cultivate the concept of "I am responsible for my own health", establish the awareness of health risks, advocate a healthy lifestyle and develop a "healthy culture". Second, change the emotional attitude. Wang Yangming advocated "unity of knowledge and action" in Ming Dynasty. Today, we also call people who are "consistent in words and deeds" good people, which shows the importance of emotional tendency. No matter government officials, medical personnel or ordinary people, they should turn their correct knowledge and understanding of medical reform into active support, cooperation and participation in medical reform. Only in this way can the policies of medical reform be implemented smoothly and finally achieve results. At the same time, all parties understand and tolerate each other with a positive emotional attitude, and the society can achieve ultimate happiness through the harmony between doctors and patients and the unity of the people. Third, change behavior habits. The correct emotional tendency needs to be reflected by appropriate behavior and become a habit after repeated reinforcement. Once a good habit is formed, it will be smooth and efficient. Harmonious doctor-patient relationship is an important part of a harmonious society, which requires a good social atmosphere (that is, social behavior habits), including doctor-patient communication, disease and health cognition, humanistic care and respect. In particular, the society should care and respect the medical staff, so that they can have a secure life and a promising career, so as to feel their own value and dignity, have a sense of responsibility and professional pride, and better serve the society. Fourth, change the rules and regulations. As the saying goes, "soldiers made of iron and flowing water", only by establishing a sound system of rules and regulations can our cause not be destroyed because of people's contributions. The reform of medical system involves all aspects, among which the macro allocation of resources and elements, micro internal management and incentive distribution are the most important. In terms of resource allocation system, the government is duty-bound to increase financial and health input and improve the input mechanism. In the aspect of incentive distribution mechanism, performance appraisal is an organic combination of balancing efficiency and fairness, and it is the basic foothold of various medical reform operation measures. Therefore, we must brainstorm and conduct in-depth research to make the assessment criteria reasonable, unified and sensitive, and the information comprehensive, accurate and clear, which not only reflects the fairness of the assessment, but also fully mobilizes enthusiasm and creativity. At the same time, the medical security mechanism also needs equal attention. In short, medical reform means that the government will take more responsibility for basic health affairs such as basic medical care and public health services. Endless topics, endless problems, medical reform has brought too many topics. However, due to the limitation of space, I can only describe it briefly here. (Originally published in 20 12, 8th issue of City and County Leaders Monthly, the author is the deputy director of Zengcheng Municipal Health Bureau, and has books such as Learning Code and Kind Words are Gold. )