Since June, county-level hospitals across Shandong province have been promoting the policy of seeing a doctor first and paying later
Nationally, more than 10 provinces and 200 medical institutions have already gone to visit
No deposit is needed for admission to the hospital, just leave your medical insurance or New Agricultural Cooperative documents, sign an agreement with the hospital, and settle the out-of-pocket payment when you are discharged from the hospital. If it wasn't for a difficult situation two years ago, Yanzhou Hospital of Traditional Chinese Medicine in Shandong Province would still be an ordinary county-level hospital, and Kong Qingmin's name would not be familiar in the field of health care reform. Today, Yanzhou Hospital is seen as a successful pioneer of the "see first, pay later" service model, and receiving study tours from all over the country has become part of Kong's daily routine.
Currently, this model has been implemented in some hospitals in more than 10 provinces across the country. In June this year, Shandong began in the province's county and county-level hospitals below the full implementation of the end of July in Shandong, only 120 patients to escape fees, accounting for all the "see first, pay later" patients 0.013%, the proportion of the Department of Health of Shandong Province in the view of the not too high.
First to see the doctor and then pay for the process
Outpatient (emergency) clinic to determine whether to be hospitalized. Go to the hospitalization office with the hospitalization notice to register for admission and go through the hospitalization procedure. Provide the medical insurance office with the medical insurance or new rural cooperative card to verify the identity to determine whether it is the scope of medical insurance, new rural cooperative. Provide the Medical Insurance Office with the Medical Insurance or New Agricultural Cooperative Medical Card and a copy of the ID card or household registration book, and sign the "Inpatient Discharge Settlement Agreement" with the Hospitalization Office. Go to the ward with the hospitalization notice and the "Inpatient Discharge Settlement Agreement". When the hospitalization is about to end, the medical staff will inform you of the general expenses incurred during the hospitalization and the approximate expenses to be borne by the individual, so that you can raise funds for the discharge settlement. When you are discharged from the hospital, go to the medical insurance office with the help of the medical staff to go through the procedures for discharge settlement and reimbursement. Go to the hospitalization office to settle the payment and go through the discharge procedures. Discharge. Sign an inpatient installment (deferred) repayment agreement with the hospital for repayment in installments.
A
Director of the breakout
Meeting in Chengdu to see a doctor before paying attracted him, seduced him
Time to go back to 2 years ago. 2010 August, Kong Qingmin was the director of the second hospital in Jining Yanzhou City, when the hospital owed nearly 60 million yuan in debt, the new 13-storey building was empty because of the lack of money to renovate the five floors. The new 13-storey building has been left unfinished for five floors. At this time, Kong received a notice to merge the Yanzhou Second Hospital with the Yanzhou Hospital of Traditional Chinese Medicine.
In October of that year, the merger of the two hospitals was completed. Not only were there 149 employees from the former hospital, but there was also a debt of 10 million yuan, and the new Yanzhou Hospital of Traditional Chinese Medicine had a debt of 70 million yuan. In 2009, Yanzhou's annual revenue was only 29 million dollars.
Recalling the beginning, Kong Qingmin said bluntly that he felt very depressed: "So many medical staff have to eat, right? Pressure, a moment at a loss." At the end of November of the same year, the fourth annual meeting of Chinese hospital directors held in Chengdu, Kong Qingmin to participate. At the meeting, he singled out the grass-roots hospitals on how to adapt to the health care reform forum to listen to, Zhengzhou City, Jinshui District Hospital, the implementation of the poor New Rural Cooperative patients "first to see a doctor, and then pay the money," the installment payment method attracted him.
"See a doctor first, pay later, these six words are too tempting!" Still in the meeting, Kong Qingmin calculated in the hospital to implement, expand the implementation of the surface. Kong Qingmin said that the hospital's situation was: the number of people working, close to 500 people; the establishment of more than 400 beds, but only 200 hospitalized patients, a large number of beds empty. "Anyway, it's all in such a state, break the mold, must change."
B
Reform implementation
Patients who do not have the money to see the doctor can be two-year installments
In early December 2010, Kong Qingmin went to Zhengzhou to visit the implementation of the program. 27 December the hospital held a mobilization meeting, the official start of the implementation of the "first to see the doctor, and then pay".
Prior to the implementation, Kong Qingmin calculated an account, in principle, the hospital will not lose, at best, busy work for nothing. "But if the patients all escape the fee, the society will be too terrible."
The scope of implementation of the "first treatment, then pay" is to participate in the basic medical insurance for urban workers, basic medical insurance for urban residents and the new rural cooperative medical care residents, "three no" patients (no name, no address, no companion), and Patients who are in serious condition and need emergency treatment. Patients injured in traffic accidents, fights and other responsible accidents, and patients who are not enrolled in the medical insurance or the new rural cooperative medicine are not included in the scope of implementation.
Patients will only pay the reimbursed out-of-pocket portion when they are discharged from the hospital. If they can't afford it, they can sign an agreement with the hospital to pay the medical fees in installments or in one lump sum within two years.
Three months later, the sweetness of the "see first, pay later" model is beginning to show. The number of patients hospitalized in Yanzhou City Hospital has reached more than 300, and the number of hospitalized people has remained at about 400 in May. Until now, Kong Qingmin still does not deny that the original intention of the reform is to "attract more patients to see."
In 2010, Yanzhou Municipal Hospital of Traditional Chinese Medicine had an annual business income of 46 million yuan, and in 2011 the figure reached 91 million, almost double the growth. "It's simply incredible growth." Kong Qingmin said he thought there would be changes, but didn't expect them to be so obvious. The service model has been a win-win for both hospitals and patients: not only has it attracted a source of patients, but it has also enabled the hospitals' public interest to be realized.
Up to now, the hospital has more than 24,000 cases of patients "see a doctor first, pay later", accounting for more than 92% of all hospitalized patients, no case of malicious arrears, and no one to implement installment payments.
Kong Qingmin analysis, the hospital average cost of hospitalization is about 3600 yuan, the out-of-pocket part of the original only one or two thousand yuan, the patient has the ability to bear, the risk of escaping small. In addition social integrity improved, "for more than a thousand dollars to evade fees on the blacklist is not worth it."
C
Reform feedback
Jining model ushered in ten provinces to learn from
On July 24, Yanzhou City Hospital of Traditional Chinese Medicine ushered in a delegation from Juno County in Heze, Shandong Province. since 2011, more than 200 medical institutions from more than 10 provinces have come to visit, an effect not unrelated to the promotion of local government departments and media reports.
In Kong Qingmin's opinion, the government's enthusiasm for promotion is beyond imagination. 2011 March, Jining has relevant leaders to visit. May 18, Jining City Health Bureau in Yanzhou Chinese medicine hospitals to open the scene, issued a "on the city's health care institutions to promote the model of first see the doctor and pay after the visit of the guidance," the requirements of the urban areas of various counties by the end of June to select a Chinese medicine hospitals, townships and townships of health hospitals to pilot the second level of above General hospitals and tertiary Chinese medicine hospitals to start the pilot clinical departments.
In February this year, the Jining City Health Bureau issued a document, in the city at all levels and types of medical institutions to fully implement the model. Accepted by the West China Metropolis Daily interview, Jining City Health Bureau of medical administration section chief Zhong Zhanguang said, regardless of Yanzhou hospital reform of the original intention, this model is indeed the implementation of the effect is good, it is worth promoting.
According to the West China Metropolis Daily reporter's incomplete statistics, since May 2011 to April this year less than a year, around the "first to see the doctor, pay later", Jining City, the relevant departments have issued 12 documents covering a number of supporting policies to promote the implementation of the model.
The most popular of these is the adjustment and improvement of the new rural cooperative and health insurance policy. In November last year, the Jining City Health Bureau, Human Resources and Social Security Bureau and Finance Bureau jointly issued a document requiring that, from January this year, the new rural cooperative agencies should be based on the previous year's hospital settlement funds of 15 percent of the proportion of the working capital to be allocated to the implementation of the "first to see the doctor after payment" of the hospitals, health care insurance funds from the original 10 percent of the funds allocated to 15 percent, to alleviate the pressure on hospitals to advance funds. The medical insurance advance fund has been increased from 10% to 15% to ease the pressure on hospitals to advance funds. In April of this year, Jining City has set up a special fund to deal with the operational risks of the "first to see the doctor after payment", adding a double insurance for hospitals.
D
Promotion of the model
Shandong 1256 grass-roots hospitals all first diagnosis and treatment after payment
Implementation of 1 month, only 120 patients maliciously evaded payment, accounting for only 0.013% of patients
According to the Department of Health of Shandong Province statistics, the province's implementation of the province from June 1 to the end of July, Shandong Province, 1,256 grass-roots hospitals carry out "first diagnosis and treatment, pay later", nearly a million people benefited. At present, the country has more than 10 provinces part of the hospital to implement the "first see, pay later" model.
July 26, Shandong Provincial Health Department, a deputy director of the Medical Affairs Division, said in an interview with the West China Metropolis Daily, the implementation of this model, the hospital, enhance the public welfare, triage of patients with common diseases, common diseases, patients choose to grass-roots hospitals, reducing the pressure on hospitals above the county level. For patients, lower the threshold for medical treatment, so that patients can get timely treatment, to achieve a win-win situation for doctors and patients.
January this year, Jining City Health Bureau to participate in the national work of Chinese medicine will be mentioned, "first see the doctor and pay" model will be the health care reform over the past three years in the reform of health care security, primary health care services, zero-differential rate of basic drugs and other aspects of the results directly in front of the residents.
Zang Shujiao is the head nurse of the cardiology department of Yanzhou City Hospital, nursing since 1999, these two years is the two years she feels the most pure. "In the past, you have to be responsible for the collection of accounts, which patient owes money, you have to go to remind." Zang Shujiao said that she used to serve with a smile, but bill-calling would make patients feel that the meaning of the smile was complicated. Now she just concentrates on nursing and spends more time communicating with patients.
Qiu Fei, head nurse of the Breast and Thyroid Surgery Department at Jining First Hospital, has a similar experience to Zang Shujiao. In addition, she believes that "see first, pay later" also puts higher demands on the quality of service. "Post-paid patients may make more demands, and if the quality of service is not good during hospitalization, it will increase the risk of fee evasion."
According to the Shandong Provincial Department of Health statistics, since June 1, the implementation of the province to the end of July, in the province's 1,256 only 120 patients malicious fee evasion, fee evasion amounted to 447,000 yuan, the number of patients evading fees accounted for the total number of patients "see first, pay later," 0.013%, the proportion of the Shandong Provincial Department of Health, which seems to be relatively low.
Patients say hospitals are more humane
In the eyes of patients, "see first, pay later" is not only a more convenient form of medical treatment, but also more humane in terms of emotional experience.
78-year-old Zhang Ji Mei lives in Yanzhou city, due to diabetes, coronary heart disease, etc., every one or two months to Yanzhou City Hospital. The first thing I did was to pay a deposit, and now I'm a "bagman". This time since July 21st hospitalized, to 24th has spent more than 2100 yuan, in addition to the medical insurance reimbursement, out of pocket payment of about three to four hundred yuan.
Every day the medical staff will be the previous day's cost list out, in the one or two days before discharge will also be part of the out-of-pocket payment in advance to inform her. Zhang Jimei's son, Ren Junsheng, said it was a hassle to pay the deposit in advance and then pay only the out-of-pocket portion at the final checkout, which might have to be returned.
July 23, Jining City, Yutai County, Li Ge town, 63-year-old Li Xiuzhen, because of a goiter in the thyroid gland to Jining City, a hospital. She participated in the new rural cooperative, prepared before coming to the examination and surgery costs, but after hospitalization did not pay a penny. "In the future, you don't have to be in a hurry to see a doctor to prepare money first, to see the disease, which is considered the people's hospital for the people."
55-year-old Chen Jing due to breast cancer surgery has cost more than 10,000 yuan, in accordance with a hospital in Jining City, "first to see a doctor, pay later" implementation program, more than 5,000 yuan need to pay part of the cost, but due to the Chen Jing's children temporarily rushed to come, the hospital has not been catalyzed. Chen Jing said, this way doctors and patients trust each other, feel the hospital more humane, "is really a place to save lives and help the injured".
Industry says "first see, pay later" is more suitable for grass-roots hospitals
While Jining has implemented "first see, pay later" in all hospitals across the city, the model is more suitable for grass-roots hospitals in counties and counties below in the view of hospitals and administrations.
Jining City First Hospital is one of the city's two top three hospitals. Wei Zhen, director of the hospital's inpatient department, said frankly that the implementation of "see first, pay later" in the tertiary hospitals, the pressure and risk is greater than the primary hospitals, the implementation of the impetus and benefits are not as direct as the primary hospitals.
First of all, to the tertiary hospital patients with complex medical conditions, higher costs, health insurance and the actual reimbursement rate of the new rural cooperative lower than the primary hospital. The patient's out-of-pocket payment is high, and the risk of evasion is higher. Wei Zhen said, the hospital's average hospitalization fee of about 8,000 yuan, the implementation of the "see first, pay later" before, every year, there are patients to escape.
Because of the complexity of the condition, the three hospitals are more likely to be disputes between doctors and patients, the implementation of the "see first, pay later" on the quality of service, doctor-patient relationship to put forward higher requirements. "Some patients may think, anyway, not yet paid, if the treatment is not satisfactory is it possible to pay less or not pay?
In terms of the implementation of the dynamics, tertiary hospitals unlike primary hospitals there is a situation where beds are empty, primary hospitals to use this model to increase the number of hospitalized, tertiary hospitals do not implement can also ensure that the source of patients. Wei Zhen said the hospital's 2,200 beds have basically reached saturation.
Weizhen said the hospital began implementing "pay-as-you-go" in February this year despite concerns. Last week in the emergency surgery, a new rural cooperative patients hospitalized at a cost of 80,000 to 90,000, due to economic difficulties when discharged from the hospital signed an installment agreement, promising to pay off a year. By the end of July, the hospital currently has about 50% of patients enjoying this model. Some patients are unable to enjoy it because they forgot to bring their medical insurance or new rural cooperative documents, while others have already withdrawn money to see a doctor and took the initiative to pay a deposit, and the hospital respects their opinion.
The relevant person in charge of the Medical Affairs Department of the Shandong Provincial Health Department said that, taking into account the actual situation of the three hospitals, and currently does not do the mandatory requirements for the three hospitals.