One: the current situation of the township health centers
1, the township health centers are lagging behind in the management of outdated equipment, technology is outdated, ineffective, uneven composition of the personnel (formal workers, recruited workers, temporary workers coexist), a variety of operating mechanisms (public ownership, shareholding, contracting coexist)
2, the township health centers because of the high cost of medicine, but also because of the high costs of the market, the market is not the only way to go. Health centers because of expensive medicine, and no technical expertise, is currently in a "small illnesses do not come to see, big illnesses can not see" dilemma, as if the "chicken ribs". Patients with major illnesses to secondary or tertiary hospitals to solve minor illnesses to the village health clinic or illegal medical practice, the township health center is only a medical transfer station to carry out the task of prevention and protection.
3, regardless of whether the hospital is public or private, because at present are self-financing, forced by economic pressure, so most of the township health centers are risking the patient, the double risk to themselves, to carry out some of the "know that can not be for the" medical business. A small number of better efficiency, blind investment, force to catch up with the second level of hospitals, but due to the personnel and technology and other related equipment to keep up with the role can not play a proper role, resulting in the objective of duplication of investment and waste.
4, expensive. Township health centers mostly see some common diseases, common diseases, and the consumption of these diseases is as common as the people's "food basket", the most extensive and sensitive, so the price of how much is also most likely to cause fluctuations in the people's quality of life and mood.
5, because of the economic interests of doctors arbitrarily prescribe large prescriptions and rebates, resulting in mutual distrust between doctors and patients; doctors and doctors to complete the volume of business to compete with each other, attacking, is the current system in the white angels ah moral degradation!
6, the township medical staff's low wages (mostly 70% of the salary, about 700-800 yuan), few benefits, a serious lack of holidays (only a few days off in the Spring Festival, but also scheduling, and no overtime pay), and the teachers and civil servants around them, resulting in a psychological imbalance. In this competitive and low working environment, some of the kind doctors who can't bear to "kill" their patients are overburdened (I am one of them).
7, rural cooperative medical care by the township health centers to control, it is very easy from the obstruction. Where not in the hospital to see the reimbursement of every card pressure, cooperative medical gradually become a tool for the township health center for profit, and farmers get little benefit.
8, my experience: I was assigned in the fall of 1997 in the township health center, to date, through three presidents, three systems, but without exception are deviated from the general purpose of serving the people. The reason, in fact, is very simple, the patient will always be there, but only where to consume it. Why are the benefits of township health centers poor and the number of patients small? Poor efficiency is because the director of corruption, hospital spending; fewer patients because the hospital drug prices are too expensive (especially injection infusion), and health centers and illegal medical practitioners just drill the difference in the price of drugs, so many patients with common diseases, common illnesses, attracted away, which will cause a lot of infusion accidents is not surprising. The government has not really considered the interests of the general public and workers in the health care reform. Take our hospital as an example: in 1997, the implementation of the public system, but in fact for the self-financing enterprise business model, good in the H President of the leadership is good, and the first in the country to implement the model of rural cooperative medical care, the benefits are better, but due to the lack of two lines of supervision and management mechanism, because of the cover of the building and the purchase of a car to prevent insurance and bribery and the evening of the late. S President took over in accordance with the trend of the country's employees engaged in the competition on the post system, but the many reforms in China system, the system of supervision and management. China's many reform system is the development of the staff should be how hard to work, and rarely asked the leadership should be how diligent and honest, do not know, every reform is the key to success is the leadership of the S Dean in office to take advantage of the opportunity to compete for the post to suppress the staff, eating, drinking and having fun, nothing to do, relying on the personal relationship with the Health Bureau squandered national property, although not corrupt, not a huge bribe, but a good hospital to make a good end to the near-bankruptcy. The hospital is on the verge of bankruptcy. After seeing no oil and water can be salvaged, and transferred to another good hospital to continue to spend the day, two years later, fortunately, the local workers have a backbone, quite uproar, S dean had no choice but to retire to the second line, spend their twilight years. The third Z President took over the hospital's mess, has been a struggle, in 2003 and in line with the trend of the county to engage in the so-called employee participation in the joint-stock cooperative system, in my hospital, for example: the President of the 20,000 yuan, Vice President of the 15,000 yuan, 10,000 yuan of employees (later changed to 6,000 yuan due to the employees do not have the money to invest), the investment returns to the hospital, and the beautiful name: the risk of * * * to bear and enhance the motivation of the staff. I don't know this is in line with the leadership of the United States. Most of the county's townships and townships health hospitals invested in the stock fund was basically squandered, the dean of the district of 20,000 yuan of the stock fund what to worry about? Casually through the purchase of equipment and drugs, construction, food and drink, and other daily expenses can be retrieved, and then can not be reassigned, rightly so, will be taken away from the stock. Lamentable majority of employees can not share the dividends, but also can not ask for the return of the shares, is still pending. 2005 hospital has long been a negative growth, although the staff has been working hard for nearly a decade, all the "economic interests" as the center, but still can not fill such a bottomless hole. In the spring of 2005 to respond to the call and took the lead in the implementation of the contracting system (a package of 30 years), changed to private hospitals, the name: recovery of state-owned assets, to get rid of financial burdens. Hospital by the county financial assessment of the valuation (including fixed assets and liabilities), by the dean of the priority purchase (such as the dean of the money is not enough to pull a few employees to participate in the shares), but part of the liabilities can still be burdened, do not have to make a down payment. A township health center so after the operation of the Health Bureau with a down payment of 480,000 yuan price sold out, and later profit that is owned by the contractor. This is not only a low-cost embezzlement of state property, and hospitals carry a large number of employee debt (including arrears of wages, the original share cooperative system when the investment in the share capital, temporary workers and rural doctors mortgage, etc.) can be a penny without having to pay back, unless you walk away from the job. How pathetic restructuring, the only thing left is to go full throttle, reduce all expenses, and try every means to earn more hard-earned money from the people! And the wages and salaries of employees can only rely on the boss's income and face to reward.
Two: the township health center market privatization or public enterprise or cancel the harm
1, aggravate the burden of low-income groups and farmers, even to see some common diseases, common illnesses have to spend a lot of money
2, a part of the township health centers eliminated in the competition, will result in the farmers to see a doctor difficult (inconvenient), such as blood, urine, feces routine, x-ray film and other simple tests need to go to the county, robbing the county town, and the township health center, the township health center, the township health center, the township health center, the township health center and the township health center. Checks need to go to the county town, rescue pesticide poisoning and other emergency patients can be dealt with at the grassroots level is delayed.
3, after the privatization of township health centers, easy to cause the epidemic prevention work is not enough attention, or be used as a tool to earn money, even if the country will be separated from the medical prevention, but it also creates a separation of waste and work to carry out the work of inconvenience (because of the work of the prevention of the need for medical support, such as immunization needle allergic reaction to the rescue of the women's pregnancy and health care and gestation and production and the continuity of the child's insurance is inseparable from the clinical findings of tuberculosis and screening needs chest radiographs, blood tests, blood tests, and screening of the clinical findings. and screening need chest X-ray, blood sedimentation support, etc.)
4, public **** health emergencies (such as SARS and other virulent infectious diseases) of the grass-roots network of treatment, the village health clinic and privately owned hospitals can not be organized, disciplined, and integrity of the completion! Only the public nature of the township health centers have a certain quality of both the business team, but also can be ordered to take on this important task.
5, township hospitals privatized, the same is a unified enrollment allocation of grass-roots medical staff is unfair, they are simply because they are decentralized and thus can not be in the upper level of the hospital fumigation exercise, resulting in outdated technology, so you can not jump to the upper level of the hospital employment, can only be in the township hospitals at the behest of the boss slaughter! The government is also trying to make sure that the government is able to provide the necessary resources for the development of the country's hospitals.
Three: township health center reform program
1, two lines of income and expenditure. All income is turned over, all expenses are required to write an application for approval. (Can put an end to hospital corruption and energy saving)
2, only retain the Personnel Bureau in the program of all employees (such as individual hospitals surplus or shortage such as can be unified deployment), wages (including the director) full pay according to the treatment of civil servants, and like a teacher in the bank to receive. Relevant departments should be networked to save personnel, in case of shortage of personnel, recruitment and temporary workers can be selected through the examination on merit according to the needs of the post, its salary is set separately, still paid by the Treasury. (Strictly prohibited by the hospital to set up another small treasury to pay, otherwise there will be a source of expensive)
3, the appointment of the director can be completely let go of the staff elected by secret ballot, and the provisions of a two-year term, and every year for a performance assessment.
4, the establishment of a perfect supervision and incentive mechanism. a, complaint system: poor service attitude, frequent medical accidents in the leadership of the staff once verified that the yellow card warning, and again the red card dismissal; b, assessment system: the implementation of business skills assessment of the medical staff, such as three times, but then dismissed; the dean of the implementation of integrity performance assessment, do not pass the dismissal. c, the legislative system: all the commission kickbacks according to the crime of bribery The law will be applied to the case.
5, medical defense is not separated. If the township health center to implement the financial allocation, the epidemic prevention work and personnel right into the hospital management, both complementary, but also conducive to better work. (As mentioned earlier)
6, abolition of the doctor's business, the drugs used by the hospital in the cashier's office network can be checked, price transparency, strictly prohibit hospitals from purchasing out of the network of the difference between the price of the drugs, so that the doctor through the way to get kickbacks to sell to the patient.
7, universal health insurance, all legal hospitals (including private, private hospitals) should be given health insurance benefits. With the country's wealth should gradually increase the proportion of health insurance reimbursement, such as all drugs after reimbursement is lower than the ex-factory price, then all do not enjoy the health insurance policy of the illegal pharmaceutical individuals and groups will not be investigated since the extinction of (of course, except for the sale of counterfeit medicines). Nowadays, many measures to lower drug prices are just tinkering with a simplest and most effective solution. For example, in order to reduce drug prices and facilitate the purchase of medicines and the generation of pharmacies, and now in turn if not given its health insurance policy, its survival will be difficult; if only a few large pharmacies are left in the maintenance, that the convenience of purchasing medicines and how can we talk about it? There is also a zero-price markup on medicines, in fact, there is no need, zero-price markup is just a solution to the problem of expensive medicines, but due to the different technical content of the hospitals, then how to provide for the technical charges? Its operational difficulties are too complex! And if only the township health center zero-price increase, will inevitably lead to secondary, tertiary, private hospitals, drug prices are inconsistent, and will give rise to many branches and leaves of the problem.
8, the abolition of the individual part of the health insurance, so that the cultural awareness of the low, the disabled, the elderly and young, homeless and widows, and a large number of poor peasants to enjoy the socialist health and welfare undertakings free of charge.
9, health insurance and hospitals are delinked, should be set up like an insurance company, health insurance center, and the formation of a set of perfect to facilitate the patient-centered reimbursement system. Such as the implementation of a, the patient in the first reimbursement of the establishment of medical insurance card, that is, "with the report with the construction", so that neither in the stipulated time to specialize in manpower and material resources to build a card, but also will not make any one of the sick patients do not have a card. b, the establishment of the invoice network audit system, to prevent fraudulent invoices. c, the provisions of the reimbursement of the maximum time limit for the completion of the establishment of a complaint system to prevent the reimbursement of staff to eat. complaint system to prevent reimbursement staff from taking advantage of the situation. d. If the patient spends a lot of money, segmented reimbursement during the treatment period can be implemented, and it is not necessary to wait for the patient to be discharged from the hospital before giving reimbursement.
10. Abolish the referral system. The decision of referral should be given to the patient, which is both humane and prevents hospitals or doctors from intentionally setting up barriers, and can never take the patient's "private referral" or "overstep referral" as a reason for not being reimbursed (e.g., a patient with a broken finger in a rural area who needs to be referred to a third-level hospital for treatment, and at this time, the patient is not reimbursed). (For example, if a rural patient with a broken finger needs to be immediately referred to a tertiary hospital for treatment, the patient can be reimbursed without a referral certificate from a secondary hospital). However, it is possible to limit the rate of attendance at tertiary hospitals by lowering the reimbursement rate. (It should be stipulated that some of the diseases that need to be treated in tertiary hospitals except such as broken finger reimplantation, heart surgery, etc.)
11, senior doctors in large hospitals should be regularly to the grass-roots level to teach, grass-roots level doctors should be stipulated to a certain title or qualifications must be further training once (for example, it can be stipulated that each obtaining the qualification of licensed medical practitioner, or to obtain higher level of academic qualifications, or obtaining the attending, deputy director of the medical staff and so on must be further training, etc.), so that not only can eliminate corrupt practices, but also to prevent the corruption of the public. This can not only put an end to the corruption of further training, but also the formation of echelon mode of further training to promote the medical staff only to study well, can continue to further training.
12, the village health center according to the population density set up (hardware and software need to be approved and qualified), there is a computerized network of health centers by the hospital on behalf of the purchase of medicines, and shall not be increased in price to enjoy the health insurance policy, self-financing; no computerized network of charges or the idea of temporary adaptation can be purchased by themselves from legitimate channels of medicines, self-financing, do not enjoy the health insurance (in order to prevent fraudulent invoices). Because there are township health centers of fixed price control and reimbursement differential macro-control, as long as the proportion of health insurance reimbursement increased year by year, any village health clinic does not enjoy the health insurance policy will lose the price advantage, so that the automatic demise or transfer to the ranks of health insurance.
13, the state should focus on investment in primary hospitals can carry out emergency rescue equipment, such as gastric lavage machine, oxygen tanks, commonly used testing equipment, x-ray machines, b ultrasound, electrocardiograms and so on. And there is no need to invest in some large medical equipment and advanced equipment. Township health centers need to train should be general practitioners, not only can see some common diseases, common diseases, but also be able to accurately refer and triage patients, try not to do some difficult specialized treatment, so that the patient is responsible for the doctor also reduces the occurrence of medical errors. The entire medical environment should be clearly defined at all three levels.
In short, all reform programs must be systematically eliminated to produce the embers of corruption in order to be successful; all reform programs must be centered on the interests of the general public in order to win the hearts of the people, and long lasting