In order to solve the people, especially the poor people's expensive, difficult to see a doctor, the State Council and its local governments at all levels have taken to help the difficulties of enterprise workers and farmers to participate in medical insurance and cooperative medicine, the establishment of a pilot urban medical assistance system, the establishment of the relief of hospitals in the country's prefectural-level and above and the development of urban community health services and other four major measures, these measures have emphasized the need to increase government financial support (we refer to this as the "government investment" as "questionnaire"). All of these measures emphasize the need for greater government financial support (we will refer to these as the "four measures" with government investment). In other words, the State is now adopting a multi-pronged investment approach to solve the problem of expensive and difficult access to medical care. The author believes that this investment approach to the "four measures" can to a certain extent to alleviate the people's expensive and difficult to see a doctor, but there are obvious drawbacks, mainly manifested in:
1, now taken by the multiple investment approach to the operation of the cost is very high. Because:
The government's multiple investment on the one hand will inevitably increase the difficulty of the government's management of the input funds and management costs; more importantly, it is difficult to avoid the duplication of government funds. China's overall surplus of medical resources, coupled with the distribution of medical resources is extremely unreasonable, the city has a large number of medical resources idle, and due to the current medical institutions in the system and the mechanism of obstacles, the government is difficult to rationally integrate and make full use of the existing medical resources, so there are a lot of local governments have to continue to invest a lot of money, new or rebuilt relief hospitals and community health services, and also to invest a lot of money to maintain Therefore, many local governments are forced to continue to invest large sums of money in building or reconstructing new hospitals and community health service organizations for the poor, and also to invest large sums of money in maintaining the day-to-day operation of these organizations. This will inevitably lead to a further aggravation of the idleness of medical resources on the one hand, and a substantial increase in the government's financial burden on the other, or even lead to the government's financial burden being overwhelmed. For example, if a province prepares to convert three provincial hospitals into relief hospitals on a pilot basis, according to detailed calculations made by the relevant departments, the Government will need to increase its annual investment by four times on top of the existing amount in order to maintain the normal operation of these three hospitals. At this level of investment, if the relief hospitals are spread throughout the province, it may be difficult for the provincial government's financial resources to bear. So the provincial finance department is cautious about the program.
2, now the "four measures" taken by the difficult to achieve the expected effect of solving the expensive and difficult to see the doctor. Because:
First, because of the current nationwide prevalence of hospitals "a la carte" others (the government, employers and patients) "pay the bill" of the operation of the health insurance, the waste and loss of health insurance funds is difficult to effectively control, the health insurance operating costs are too high, coupled with the lack of government investment, the health insurance system has a high operating cost. Coupled with insufficient government investment, the coverage of health insurance is not broad: 66% of the country's residents do not have any health insurance in urban areas, and as high as 80% in rural areas (last year's figures, and the increase this year has not been significant). Although the rural cooperative medical care perhaps with the increase in government investment, the participation of the surface will have a significant expansion, but because of the government's per capita subsidy is too small, there will still be a large number of rural residents can not afford to see the doctor after participation.
Secondly, due to the limited government funding, the scope and strength of the medical aid population is also very limited, only the special hardship group enjoys a very limited amount of medical aid.
The first step is for the government to take a step back in time, and to take a step forward in the future, and to take a step forward in the future, and to take a step forward in the future.
Third, because the hospitals in need of help themselves "order food" and others "pay the bill" and the use of two lines of income and expenditure will not be able to solve the "pot rice" mechanism, the hospital's low efficiency, high medical costs, coupled with the government's investment in the hospital, the hospital's work. The efficiency of hospitals is low, medical costs are high, and the government's investment is limited, so the range of people served by relief hospitals and the strength of their relief efforts are also very limited. At present, the vast majority of relief hospitals are limited to special hardship cases, and the actual situation is that those in need of hospital relief are far from being limited to these special hardship cases; at the same time, because relief hospitals do not have the **** relief function of social insurance, they rely only on appropriate reductions in registration, examination, and diagnostic and treatment fees (the proportion of medication reductions and waivers is generally very small, and all reductions and waivers are generally limited to a maximum of 30% of the total cost of the hospital's services). The problem of the big patients, after enjoying the fee waiver, the total amount of medical expenses borne by the individual is still very large, and it is still difficult to solve the problem of not being able to afford to see a doctor.
Fourth, due to the current community health service organizations and hospitals are generally different interests, due to the mechanism and institutional barriers, it is difficult to rely solely on administrative means to achieve "minor illnesses in the community, major illnesses in the hospital"; at the same time, due to the community health service organizations can only look at minor illnesses, and major illnesses have to be in the large hospitals for treatment, and let the patient economic and mental unbearable is the major illnesses, and the patient's health is the main reason why the community health service organizations can only look at minor illnesses. And make the patient's economic and mental unbearable is the big disease, so the development of community health services can only make the city residents to see a doctor more convenient, but still can not solve the problem of the poor people's heavy burden of major diseases.
Fifth, because of the government's limited financial resources, many places in China, especially in less economically developed areas, to solve the problem of people can not afford to see a doctor, can not afford to eat medicine had to use "grasp the two ends of the loss of the middle" approach: one end of the economic conditions to grasp the better (such as the government's financial allocations to the administrative and public institutions and more efficient enterprises) health insurance expansion work. At one end of the spectrum is the expansion of medical insurance for the better-off (such as government-financed administrative and public institutions and more efficient enterprises); at the other end is the medical assistance for the special hardship case population (including the medical assistance of the civil affairs department, and the relief services of the health department's relief hospitals); and in the middle of the spectrum, only the natural course of events is allowed to take its course. As the Government's financial resources are scattered, coupled with the high operating costs at both ends, it is difficult to narrow the space in the middle. Nowadays, those who cannot afford to see a doctor or take medicine are not only the special hardship case population, but also a large number of the intermediate population. If a large number of people in the middle of the problem of access to health care for a long time without government care, will also seriously affect social harmony. In addition to the complexity of operation, high operating costs, easy to lead to shirking seriously ill patients, and hospitals will be the same by raising the level of disease (such as complications, etc.) and increase the number of hospitalizations (the disease is not fully well so that the patient is discharged, the patient may have to be re-hospitalized) and other ways to increase the hospital's income and increase the burden of patients' costs. In the case of people with medical insurance, the same will make it difficult to effectively control the cost of medical insurance. It is because of these defects lead to the promotion of charge by disease in foreign countries is limited.
Second, the new ideas and methods
So how to use the government's limited funds to achieve a better solution to the effect of expensive and difficult to see the doctor? The author believes that the following measures should be taken:
1. The central government and local governments at all levels should focus more funds on establishing urban and rural medical insurance systems.
Because centralized investment in medical insurance can further expand the coverage of medical insurance and improve the level of medical protection, so that more people, especially the poor people have a medical treatment, and thus can greatly reduce the medical assistance, relief hospitals, the pressure of the work; especially because of the medical insurance has a very strong social **** relief function, it is easier to help solve the problem of the existing medical assistance and relief hospitals and community health services can not solve the problem of the big problem. The community health service can't solve the problem of the big patients who can't afford to see a doctor. In other words, medical insurance in the government investment in the "four measures" can play a role in the outline.
2. Drastically reduce the operating costs of health insurance and improve the efficiency of the use of health insurance funds.
To increase the participation rate of medical insurance and the level of protection only rely on the government to increase investment or not enough, must significantly reduce the cost of medical insurance, improve the efficiency of the use of the fund. To do this, we must fundamentally change the current hospitals to "order" others to "pay the bill" of the operation of the health insurance mechanism, so that the hospitals themselves to "order" themselves to "pay the bill". Let the hospitals themselves "order food" and "pay the bill", so as to consciously control the waste and loss of medical insurance fund. The "4-1-3" health insurance model (hereinafter referred to as the "4-1-3" model) has such a mechanism. It has been proved that the "4-1-3" model can reduce the cost of health insurance by 50-70% on the premise of ensuring the quality of medical services. That is to say, even if the government does not increase its financial input by a single cent, it can still expand and improve the coverage or level of health insurance exponentially. If this is coupled with the fact that the government focuses its capital investment on medical insurance, universal coverage of medical insurance will be realized within a short period of time. If we can realize the early universal coverage of medical insurance, the people, including the poor people can not afford to see the disease (including minor and major diseases) can be fundamentally resolved.
3. To revitalize the existing idle medical resources and improve the efficiency of the utilization of existing medical resources.
China's existing medical resources and patient resources in urban and rural medical institutions and the size of the distribution of medical institutions is extremely unreasonable, resulting in a large number of medical resources idle, and the existing medical institutions of the mechanism and institutional constraints and it is difficult to rationalize the adjustment of health care resources, the reason for this is because of the urban and rural health care institutions and the size of the medical institutions are not a "family". The reason for this is that urban and rural medical institutions and medical institutions of all sizes are not "one family". If the existing medical institutions transformed into more like the Daqing Oilfield General Hospital Group as close hospital groups, medical resources and patient resources to rationalize the adjustment is no longer a difficult task, "minor illnesses in the community, serious illnesses in the hospital" is the hospital group's conscious action, the existing unused medical resources can be fully utilized. Then the government does not need to specialize in investment to build relief hospitals and community health services; if the government to the health insurance fund and preventive health care funds packaged together by the head of the package to the hospital group, and then by the hospital group to arrange for its community service outlets to assume the functions of community health services, then the government does not have to allocate funds to raise community health services alone. In order for the hospital group to keep the community residents healthy and less sick, thus spending less money on the hospital group, the hospital group will consciously require its community health service outlets to actively do a good job in preventive health care.
Perhaps some people will say, the state has long called for the establishment and development of hospital groups, but is not built up. There is no need to worry about this, if you adopt the "four-one-three" model after the situation will be very different. Because the "4-1-3" model requires that each participant can only choose a general hospital or a hospital group, if the quality of medical services is not satisfied, the participant can periodically (generally once a year) to choose another hospital or hospital group. Participants naturally prefer to choose a hospital group with multiple specialized hospitals and a large number of service outlets, which makes it more convenient for them to see a doctor. In the case of wide coverage of health insurance, especially in the future universal coverage, health insurance resources to a great extent determines the survival of hospitals, hospitals in order to their own survival and development, is bound to be more willing to transform themselves into a hospital group.
4. The government should use more money to send charcoal to the poor - to help those who need health insurance more and cannot afford it.
Medical insurance should not only be the icing on the cake, but should also be used to deliver charcoal in the snow. The government must first focus on investing a certain amount of money to help and attract those poor people who are at greater risk of illness to participate in medical insurance. The less economically developed regions can solve the problem of insufficient funds through the "four points" approach: in addition to government funding, employers (or grass-roots organizations in a position to do so) to give a little bit, a little bit out of their own, but also through a certain way to mobilize and encourage the community and friends and relatives to help a little bit. In some cities, the poor people are insured, and after adopting the medical insurance management method of "ordering food" and "paying bills" by the hospitals themselves, the insured people only pay more than 300 yuan of premiums every year (only 1-2 cigarettes and 2-3 coins of white essence), and they can get more than 170,000 yuan of medical insurance at the highest level. Medical insurance. Nowadays, the younger generation has to send cigarettes and alcohol to their elders during New Year festivals, and it is especially fashionable nowadays to "send the elder generation and friends and relatives" with Brain White Essence and Gold Match. The Government can mobilize and encourage people to give their elders medical insurance instead of cigarettes and alcohol, so that more elderly and infirm people can be given medical treatment. If the urban poor residents can also be the same as farmers per person per year by all levels of government to give appropriate subsidies, then the health insurance "to send elders, friends and relatives," the enthusiasm will be higher.
First of all, to help the poor people to participate in the main operational methods of health insurance: First, the beginning of the provincial capitals of the city and a considerable scale of prefecture-level cities (economically developed areas can also be expanded to county-level cities), select a number of medical conditions, but the business is not full (or the strength of the strong and forward-thinking) of the general hospitals or hospitals group for the poor people of the health insurance designated hospitals. The second is to use standard fees that are 40-50% lower than those in the local area to help and attract a large number of poor people who cannot afford to enroll in insurance and pay fees according to the existing standards, but who have some ability to enroll in insurance and pay fees after the fees have dropped considerably, and who have the ability to enroll in insurance and pay fees through their own efforts and with the help of the government, relatives and friends, and to gradually expand the number of people who can enroll in the insurance program to include all ordinary people. Thirdly, the cost of medical insurance and preventive health care for the poor and other public **** costs are paid to these hospitals on a per capita basis (the cost of major illnesses above the cap line may still be co-ordinated by the economic organization of the medical insurance scheme), with the cost overruns not being compensated for, and the balance going to the hospitals, and the hospitals in which the participants are located assuming the corresponding responsibility for medical insurance and preventive health care, in accordance with the agreement. If a participant is dissatisfied with the quality of medical services provided by a designated hospital, he or she may periodically (generally once a year) choose another hospital to be re-designated. When a patient visits a hospital, he or she pays a certain percentage of the cost (this measure reflects the mechanism of the "4-1-3" model, the key role of which is to allow hospitals to order their own food and pay their own bills, and to encourage hospitals to consciously control waste and to pay the bill. The key effect of this is to allow hospitals to "order" and "pay the bill" themselves, prompting hospitals to consciously control waste, and to focus on medical outcomes while actively doing a good job of preventive health care, so that insured people are less likely to get sick). Fourth, as the size of the insured population continues to expand, the existing hospitals that are designated for medical insurance for the poor will be allowed to form hospital groups by merging and purchasing existing specialized hospitals, enterprise employee hospitals and community medical institutions (private capital should be encouraged to participate in the competition). The hospital group will then gradually expand and extend its branches and service outlets to other cities and rural areas. Because the hospital group is mainly oriented to the civilian population, excluding high-income groups, and reflects the "four-one-three" mode of operation mechanism, so we can call the hospital group "four-one-three" civilian hospital group.
The above ideas are summarized as follows: centralized government investment, efficient operation of the health insurance, revitalization of medical resources, and first of all, delivering charcoal in the snow.
The above approach is summarized as follows: establish more "413" civilian hospital groups throughout the country that embody the mechanism of the "413" model and can gradually make it less expensive and less difficult for all civilians to see a doctor.
The purpose of these new ideas and practices is to reduce the cost of operating government funds, improve the efficiency of the use of government funds, and allow the country to solve the problem of expensive and difficult access to health care for the people as soon as possible.