Insufficient depth of reform. In the national health care system framework, China's county-level health care reform, mainly limited to the internal management of the health care system, the overall basic inheritance of the pattern of the planned economy period. Lack of how to follow the trend, under the conditions of the market economy to actively and effectively promote the health care system, mechanisms and other fundamental reforms of the exploration of the "separation of health care," "separation of medicine," the property rights system reform of public health care institutions, the transformation of administrative functions, etc. The exploration of deep-rooted problems, so the reform is difficult to breakthrough results.
Personnel management mechanism is not active. County medical and health system internal personnel management system reform has been effective, but the employment mechanism is still not flexible enough. The relevant functional departments of the personnel management over the "dead", although the county's public medical institutions named differential funding, the actual basic self-supporting, but the personnel are still by the functional departments of the strict control of the number, strict control. As a result of not being able to independent "horse", "recruiting", some units due to lack of staff, for many years failed to introduce relevant talent, resulting in the technical force, "green and yellow"; some hospitals do not have the right to participate in the The investigation of the personnel into the board, the allocation of some of the quality of the poor, some do not fit the post, the supply and demand disconnect, affecting the construction of the talent team.
Health investment is seriously inadequate. To a district in Chongqing, for example, the county's total investment in 2003, only 3.15 million yuan, per capita 3.91 yuan, much lower than the city's per capita level of 21.39 yuan, and the highest investment of 45.14 yuan, is ten times. 2004 on this basis, there is also a decline in the total investment of 2.74 million yuan, per capita 3.39 yuan. At the same time should be supported by the county financial subsidies for the new rural cooperative medical subsidies are not in place.
Because of the serious lack of input, one of the impact of the public **** health development. At present, most of the public **** health funding by the public health institutions "self-financing". Such as a town health center, engaged in public **** health 7 people, the annual headcount and work expenses of 200,000 yuan, while the financial budget subsidies only 67,000 yuan, and the last four years for various reasons have not been honored. "To make up for the health" to raise money is a drop in the bucket, there is no money to do hospitals have to "medical first after the health", public **** health naturally weakened. County CDC, Maternal and Child Health Center is a public **** health units, but the government has invested very little, in order to self-financing, a lot of energy for the "practice of medicine" to generate income, put the cart before the horse. Secondly, it affects the promotion of new rural cooperative medical care. County financial supporting funds are not in place, the insured farmers benefit from relatively lower than other districts and counties within the city, is not conducive to the expansion of cooperative medical care. Third, it affects the public medical institutions to play the public welfare. According to statistics, from January to June 2005, the total income of the county's public medical institutions, drug income accounted for 52.23%, medical income accounted for 45.62%, and financial allocations accounted for only 1.15% (some of which are not yet in place). In the basic situation of no input, hospitals in order to maintain survival (including retiree support), seeking development, they "fully" use the national "drug for medical" policy space to seek benefits, "profit-seeking "triggered by rising medical costs, doctor-patient conflicts intensified, the role of the public welfare of the hospital is greatly reduced.
Health resources integration, optimization is insufficient. At present, the county's 33 townships all have established health centers, the service radius is too small. Layout is unreasonable, duplication of construction, waste of resources is more prominent. Part of the township health center medical equipment aging, backward technical level, insufficient sources of disease, medical personnel basic treatment is not guaranteed, not to mention their own construction and development. Within a radius of less than 10 kilometers, there are six health centers, "small and comprehensive" caused by personnel and equipment idle, a waste of limited medical resources.
The introduction of social resources to run the health care is not effective. The city and some towns seem to be "individual" clinics, but are hung in the name of public health units set up under the outpatient clinic, a number of medical clinics who are still public health units or workers, still enjoy the policy treatment of public health institutions. Now only Tongren Hospital is a real private hospital, but because of some concepts, policies and hospitals own factors and other constraints, problems and difficulties, at
in an effort to maintain and develop a slow state.
People to see a doctor, the problem of expensive and difficult to see a prominent. According to relevant information, the county in the past eight years, outpatient medical expenses increased by 1.9 times, hospitalization costs increased by 2.3 times, an average annual growth of 18% and 19%, more than the growth of annual income of residents. The people think that it is difficult to see a doctor accounts for 63%, of which 65.9% is because they have no money to see a doctor; 91.3% think that it is expensive to see a doctor. The society reflects strongly on the difficulty of seeing a doctor, see a doctor is expensive, indicating that our county medical services reasonable and fair supply and the people's health needs there is still a big gap.
Suggestions:
Clear understanding. Currently, health care reform has become the focus of social commentary, many of the reform is not successful attributed to the "marketization" of health care. In fact, the whole country, including my county, health care resources, more than 90% of the state-owned, medical market monopoly by the public medical institutions, private capital is difficult to enter the equal competition. On the other hand, the government in order to reduce the financial burden on the heavy burden of public **** health care, investment continues to decline, and to make up for the lack of investment, and the implementation of the "medicine for medicine" policy, that is, to allow hospitals in the degree of permission to float a certain price of drugs. In this kind of resources, the market are controlled by the public medical institutions, but also has the strong support of the national policy of unidirectional interest mechanism tends to, hospitals with public resources for the monopoly of the market-oriented operation, naturally in a strong seller position. Such "marketization" has lost the essence of fairness and impartiality, can only be administrative monopoly under the distortion of "marketization". In addition, medical services are high-tech special commodities, information asymmetry between doctors and patients, the transaction is difficult to equality, "generation buyer" features prominent, the patient is in a weak position.
Under the current health care system, the crux of the problem lies not in the so-called "marketization" but in the high degree of monopoly in the medical market and the government's "failure". Monopoly so that the medical treatment of the loss of fair market competition, insufficient government investment so that the public **** medical care is not guaranteed, the medical side of the survival of self-interest and "profit-oriented", these are ultimately by the people "to pay", "difficult to see a doctor "difficult to see a doctor", "expensive to see a doctor" and therefore not cured for a long time. To this end, it is necessary to deepen the reform, to solve the institutional and institutional problems, from the source to find a way out.
Deepening reform. Medical and health services can be divided into three aspects of public **** health, basic medical and non-basic medical. Public **** health, including immunization, infectious disease control, maternal and child health care, occupational health, environmental health and health education, etc., should be provided by the government to all members of the community free of charge of the public **** products; basic medical care is for the vast majority of common and frequent diseases, etc., led by the government, social participation, medical services for all; non-basic medical care, can be completely socialized, market-oriented, in order to fully meet the The non-essential medical care can be completely socialized and marketized to fully meet the multi-level needs of the society.
To this end, it is recommended that medical and health care be separated. That is, public **** health by the government to assume responsibility for the implementation of full funding, in order to establish a sound public **** health system and emergency response mechanism, to ensure that society's demand for public **** health. Medical services are undertaken by both public and private medical organizations***. Public hospitals, like public schools, are fully organized by the Government, with guaranteed financial inputs, and provide basic medical services for the community as public welfare medical institutions, so that the people can generally enjoy the fruits of reform and opening up and the benefits of economic development. At the same time to encourage and support private capital and public welfare organizations to enter the medical field, the rise of office or operational hospitals, as a supplement to the basic medical care, more mainly for the community to provide non-basic medical services. Through the medical and health public separation, clear government responsibilities, the introduction of market mechanisms, the establishment of a fair and reasonable health care system, and promote the healthy development of medical and health
career.
Separation of medicine. The income of public hospitals and doctors should be based on technical service fees, which can be appropriately increased. All hospital prescriptions are open to the public, and outpatient medications are chosen by the patient and can be purchased at out-of-hospital pharmacies. Hospitalized medicines should be abolished under the "medicines for doctors" policy, supervision should be strengthened, and the use of medicines, prices of medicines, and payment of fees should be made public and transparent, and the operation of the system should be standardized. Thus cutting off the economic ties between hospitals, doctors and drug operators, eliminating inflated drug prices, and ensuring that patients' medication is reasonable and costs are fair. Effectively solve the medical, pharmaceutical "cooperation" for profit, "difficult", "expensive" problem, to protect the people's vital interests.
Actively expanding social medical care. Under the existing system and financial resources, the government is practically incapable of running the hospitals that account for the vast majority of the population, and also incapable of providing all medical services for the whole population. To solve the problem of insufficient medical resources and government financial resources, it is necessary to mobilize the efforts of society. Encourage private capital to participate in the reform of the property rights system of public medical institutions in the county outside the framework of the main body of basic medical services, and take the form of transferring ownership and operation rights, implementing shareholding system, cooperative system, and sole proprietorship to run medical institutions, introducing social resources and expanding social medical institutions. To strengthen support, so that private medical institutions enjoy preferential policies such as taxation and land use in accordance with the law, in the introduction of talent, title evaluation, determine the designated hospitals, the purchase of community health products, the provision of policy and information services on an equal footing with the public medical institutions, in order to create a favorable environment for their development. To strengthen supervision, standardize practice behavior, medical order, to prevent vicious competition, illegal profit-seeking, to guide the private medical institutions in accordance with the law, reasonable profit-making, and healthy development.
Increase investment. Guaranteeing public **** health and basic medical care for the whole society, so that all people can enjoy good health, health care, medical services, is the government's due diligence. Health undertakings, especially public **** health is too much debt, the development is very weak. Through the enlightenment of SARS, avian influenza and other public **** health incidents, we need to change the traditional concept of emphasizing medical care over health care and treatment over prevention, and adhere to the principle of prevention and strengthening public **** health. The development of health care from the protection of people's health, social harmony, the long-term strategy to calculate the big account, and effectively increase investment, change the public **** health manpower, material shortages, the emergency response system is not sound, all the hospitals are completely self-seeking "financial", the loss of public welfare, the status quo of the basic medical care is not guaranteed, the establishment of a comprehensive health care system to meet the needs of the people. The people's needs.
Optimizing resources. Basic hospitals are currently relying on the distribution of townships and townships, the amount of small, small, technical grade is not high. This small and comprehensive layout has a low utilization rate of resources. It is recommended that small township health centers be gradually abolished through restructuring and converted into private or publicly owned medical stations and outpatient clinics, in order to pool resources and concentrate on the construction of central township health centers, as well as to accelerate the construction of community hospitals and to increase the support of village health centers, so as to form a rationally laid out and efficiently improved primary health care network. To promote the county and township hospitals to develop, support and guide the county hospitals to scientific research, technology and other higher areas of progress, and gradually shifted to the prevention and treatment of major diseases, difficult diseases, township hospitals, community hospitals to provide routine, common medical and health care services, so that a reasonable diversion of sources of disease, hospitals, each in its own way, to achieve the optimization and enhancement of limited resources.