Focus on Zhejiang’s new medical reform: Citizens pay less for medical treatment
Difficulty and expensiveness of medical treatment are the two issues that have been criticized most about medical services for many years. The main reasons behind this The reason is the uneven distribution of medical resources: residents in big cities seek medical advice from specialists even if they have a cold, while people in rural areas have to wait for a serious illness because it is too difficult to get a name from a famous doctor in a large hospital in a provincial capital.
In Zhejiang, the new medical reform has taken drastic measures to solve difficult problems. A Qianjiang Evening News reporter recently learned from the Provincial Department of Health’s small-scale briefing on the new medical reform that Zhejiang Province’s new medical reform has “three changes”: it is difficult to see a doctor, and medical resources are sinking, allowing provincial and municipal experts to go to county hospitals and community hospitals to treat everyone; The health service industry has expanded the diversification of medical services, allowing residents to have more choices for medical treatment. Is medical treatment expensive? There is zero price difference for medicines. Buying medicines in hospitals is the same price as buying medicines in affordable pharmacies, or even cheaper.
As for the nationwide medical reform, the Zhejiang phenomenon has begun to take shape.
Mao Qun'an, Director of the Publicity Department of the National Health and Family Planning Commission, spoke highly of Zhejiang's medical reform: "Zhejiang's experience should be said to have given us great confidence in advancing the reform of public hospitals." ?
Mei Junjie, a researcher at the Shanghai Academy of Social Sciences, believes that the current medical reform also plays a role in reducing the cost of medical treatment for patients. ?Nowadays, a large part of the cost of medical treatment is that medicines are relatively expensive. Nowadays, the zero-markup rate on medicines is implemented, and the benefits to patients are obvious. ?
Zhejiang, which is at the forefront of the country, is there really any case to follow? How is the "Zhejiang phenomenon" in the new medical reform done? For Zhejiang people, what impact do these reforms have on our lives? What changes have been brought about by medical treatment? Has medical treatment really become more convenient and cheaper? Qianjiang Evening News will launch a series of reports on "Zhejiang Phenomenon of Medical Reform" to explain in detail the health benefits that Zhejiang's medical reform has brought to the people.
Ease the difficulty of seeing a doctor?
One of the phenomena in Zhejiang: 47 county hospitals have provincial doctors working
Going to the hospital when you get sick is on everyone’s mind My first reaction is always the large hospitals around me.
In large hospitals, overcrowding and scalpers competing for admissions have long been commonplace; in community hospitals, scenes of deserted and empty hospitals are also seen almost every day. While we complain about the long queues in big hospitals and the difficulty in seeing a doctor, we turn a blind eye to the community hospitals around us.
The reason behind this is nothing more than distrust of doctors in community hospitals, and always hope that the most experienced experts can make the most professional diagnosis for themselves.
So where do good doctors come from at home?
At the beginning, Zhejiang began to systematically implement the sinking of high-quality medical resources in cities. By the end of June, there were 28 county-level hospitals in the province that had close cooperation with provincial hospitals, and 19 county-level hospitals that had close cooperation with municipal hospitals.
This means that in 47 county-level hospitals, you can see experts from provincial hospitals and enjoy the medical technology of provincial hospitals. As for the payment of medical expenses, it is much cheaper than going to a large provincial hospital, because the reimbursement ratio for medical treatment in county hospitals is much higher.
A reporter from the Qianjiang Evening News interviewed at the First People's Hospital of Chun'an County. Since July 19 last year, the hospital has added a sign saying "Zhejiang Provincial People's Hospital Chun'an Branch". This is the province's first hospital. The beginning of the trusteeship cooperation between People's Hospital and County Hospital.
The president, vice president and financial section chief of the county hospital are all selected by the Provincial People's Hospital. Last year, 21 people worked here for a long time, including 18 doctors. All have professional titles above deputy senior level.
They cover the county hospital’s general surgery, neurosurgery, thoracic surgery, gynecology, urology, orthopedics, anorectal, otolaryngology, ophthalmology and cardiovascular medicine, intensive care unit, neurology, renal Department of Internal Medicine, Infectious Diseases, Dermatology, Rehabilitation, Radiology, Ultrasound and many other specialties, 11 of whom serve as department directors and heads of departments.
Uncle Li from Chun'an is a patient with chronic kidney disease. In the past, he had to take a two-and-a-half-hour bus ride and queue up for hemodialysis in Hangzhou, but now he stays in the county hospital for treatment. According to his words In other words, it is convenient and reliable.
? In the past, children who did not grow tall had to go to Hangzhou to have their bone age measured. Now, it can be done directly at the county hospital. ?Another Ms. Xu from Qiandaohu Town said.
In addition to outpatient services and surgeries, most patients also stay in the local area. ?The urologist at the Provincial People's Hospital has seen it. Because I am over 70 this year, I need to have surgery as soon as possible, so I have to be prepared for surgery. ?Lao Yu, who has suffered from prostate disease for many years, said that in the past, his family would definitely take him to Hangzhou for surgery, but the doctor in Hangzhou is in Chun'an, which is much more convenient. He does not have to travel far, and his family can take care of him more conveniently. With.
How many local people enjoy high-quality medical care at the county hospital at their doorstep? This set of figures can reflect the problem:
In comparison, the business of county-level hospitals that cooperate with urban hospitals The total revenue increased by 78.69, the number of outpatient and emergency visits increased by 50.35, the number of discharged patients increased by 90.14, and the number of operations increased by 35.23.
With more patients, the hospital's medical service efficiency has also improved: the proportion of medicines has dropped by 29.63, the average hospital bed day has dropped by 6.94, and the balance of revenue and expenditure has increased by 50.45. County hospitals have become stronger, more efficient and have greater potential for development.
Give patients more choices?
Zhejiang Phenomenon 2: Good private hospitals can already compete with large provincial hospitals. By 2020, the total scale of the health service industry will reach 80,000 More than 100 million yuan. ?In October last year, the State Council issued the "Several Opinions on Promoting the Development of the Health Service Industry". Private capital has entered this industry, and private hospitals are a very important link.
Whether it is a private hospital or a public hospital, the service targets are the same: ordinary people who are sick. For ordinary people, whether it is a private hospital or a public hospital, a hospital with convenient medical treatment and good curative effect is their first choice. Also in the medical market, public hospitals seem to have a natural "born orthodox" identity, but such an identity In the development of private hospitals over the years, it has become less and less important.
According to data from the Hangzhou Municipal Health Bureau, as of the end of last year, there were 1,228 private medical institutions in Hangzhou ***, including 132 private hospitals. The private hospitals had 4,764 approved beds, accounting for the city’s total approved beds. The ratio of 13.28 beds is roughly equivalent to the ratio in Zhejiang Province.
Qian Bao reporter learned that in specific professional fields such as traditional Chinese medicine, dentistry, and medical cosmetology, Zhejiang private hospitals are no longer weaker than public hospitals. Compared with the long queues in public hospitals, it is not easy to Fewer people will trust these private hospitals more with specialized features and convenient treatment. At the same time, corresponding departments in public hospitals are also constantly introducing new equipment and new treatments under competitive pressure. Private hospitals and public hospitals are not competing with each other, but promoting each other. Ma Weihang, deputy director of the Provincial Health and Family Planning Commission, said: Wenzhou Kangning Hospital is a private top-level hospital, and Jinhua Guangfu Hospital has a high level of tumor treatment. Many private hospitals are opened by outstanding doctors from public hospitals. The overall level of private hospitals in our province ranks among the top medical standards, which is rare in the country. ?
At the end of May this year, the Provincial General Office issued the "Implementation Opinions of the Zhejiang Provincial People's Government on Promoting the Development of the Health Service Industry". In the opinions, there is such a description: Strict control of individual public hospitals in central urban areas To expand the scale, governments at all levels will in principle no longer establish new urban public general hospitals. ?Encourage enterprises, charities, foundations, commercial insurance institutions and natural persons to establish various medical institutions. ?
It can be seen from this that the development momentum of private hospitals in Zhejiang will be stronger in the future. With the investment in better and better equipment and the participation of personnel, there will be a swarm of patients going to public hospitals for treatment. More diversion. The reform of public hospitals is advancing, so we hope that more private capital will come in to expand the supply of medical services, which will also produce a catfish effect, and some new models will be born. ?A staff member of the Municipal Health Bureau told reporters.
Is it expensive to see a doctor?
Zhejiang Phenomenon No. 3: Fully implement zero price difference for drugs in municipal hospitals in Hangzhou
From April 1 this year, Zhejiang The province-wide elimination of the 15% mark-up on drug sales in public hospitals is the first in the country to break the hospital operating method that has been used for more than half a century. This kind of reform is the first in the country. Such changes have brought benefits to Zhejiang people for nearly five months.
In the outpatient pharmacy of the First Hospital of Zhejiang University, the comparison of Ms. Zhang’s liver disease prescriptions is obvious. In her prescription, there are two boxes of oral lamivudine and two boxes of oral adefovir dipivoxil tablets. It’s 801.74 yuan. She looked through past receipts and found that the price of the medicine dispensed before April 1 was 862.2 yuan. This time, she saved 60.46 yuan on medicine. Zero margin? The hospital is involved in drug price reductions and medical service fee increases, but for patients, the out-of-pocket ratio has actually been reduced. For patients with chronic diseases like Ms. Zhang, the reduction in medical expenses after the reform is obvious. For surgical patients, even if the medical expenses have increased, the proportion of out-of-pocket expenses has actually decreased.
Yesterday, staff from the Finance Department of Provincial Tongde Hospital came to the Orthopedics and Traumatology Ward to make settlements for Aunt Chen, a retired employee. She had an operation due to a broken finger bone and was hospitalized for half a month.
Compared with before the reform on April 1, although her total expenses have increased, Aunt Chen actually paid less.
Qianbao reporter saw this list of discharge expenses. The total cost was 10,391.78 yuan, of which he paid 2,457 yuan and the medical insurance paid 7,934 yuan. If the time had been a few months earlier, the total cost might have been 10,192.3 yuan, but Aunt Chen would have paid 2,559 yuan herself and the medical insurance would have borne 7,633.3 yuan. Obviously, although Aunt Chen's total medical expenses increased by 199.48 yuan, Aunt Chen saved 102 yuan by paying it herself.
Zhejiang’s medical reform makes it more and more convenient to enjoy the treatment of provincial hospitals
Dr. Ye, I will go to your place for surgery next week. ?Ye Ke, the attending physician at the Neurosurgery Department of the First Hospital of Zhejiang University, received another call from the patient Lao Wu to make an appointment the day before yesterday. On March 31 this year, Ye Ke and 15 other colleagues were selected by the First Hospital of Zhejiang University to serve as resident doctors at Sanmen County People's Hospital to treat local people. This county hospital has become the third branch of the First Hospital of Zhejiang University, and Lao Wu was Ye Ke's patient in the third branch.
Now, after completing his four-month residency, Ye Ke returned to the First Hospital of Zhejiang University, and another group of colleagues rushed to the Third Gate. Due to the convenience of the referral system, Lao Wu will go to the First Hospital of Zhejiang University next week. Hospital for skull repair surgery.
For patients like Lao Wu, when provincial medical resources come to county-level hospitals, they can enjoy upgraded medical services at their doorstep. More importantly, he can receive medical services more conveniently than in the past. He was referred to the First Hospital of Zhejiang University.
What is the smoothest referral?
After being filed in the county, he was sent directly to a provincial hospital. Lao Wu suffered a brain injury in a car accident. I performed the surgery, but he suffered from diabetes insipidus after the surgery. situation and irritable mood. In Sanmen Branch, there are relatively few drugs to treat diabetes insipidus. The most ideal way is to transfer to a large hospital. ?Ye Ke told the Qianjiang Evening News reporter that before the sinking of medical resources started, it was not easy for Lao Wu to think of seeing a doctor in the First Hospital of Zhejiang University.
Like any out-of-town patient, first of all, Lao Wu had to take a three-and-a-half-hour drive from Sanmen to Hangzhou. After arriving at a large hospital, he had to register at the outpatient clinic and take his medical records and Relevant instructions and films should be shown to the neurosurgeon. If you need surgery for symptoms like this, you will have to wait for a bed to become available. It will take at least a week. ?
Because of the close medical cooperation between the two hospitals, Lao Wu’s referral does not need to be so troublesome now. ? Lao Wu at least saves the time of queuing for registration, and he can be notified immediately when a bed becomes available. ?Ye Ke said.
At the beginning of the year, the Standing Committee of the Zhejiang Provincial Party Committee studied and made important decisions to promote the "sinking of high-quality medical resources in cities". The results have been obvious after more than a year of implementation. As of the end of June, all province-wide and provincial hospitals There are 28 county-level hospitals that implement close cooperation in running medical services, and 19 county-level hospitals that implement close cooperation with municipal hospitals in running medical services.
The fact that so many large hospitals have opened branches in the county has saved people living in the county a lot of trouble when it comes to medical treatment. People have more trust in county hospitals than in the past. Compared with the same period, the total business revenue of county-level hospitals that cooperated with big city hospitals increased by 78.69%, the number of outpatient and emergency visits increased by 50.35%, the number of discharged patients increased by 90.14%, and the number of operations increased by 35.23%.
The luckiest patient?
Dangerous tumors were treated at the county hospital
If we were to rank the luckiest beneficiaries of the sinking of medical resources, there might be three Wang Shunhe, 55, of Huaqiao Town, Men County.
In June this year, Wang Shunhe encountered a car accident and was rushed to Sanmen County People's Hospital by ambulance 120. Due to the brain injury caused by the collision, the hospital conducted a brain CT examination. Who would have thought that this examination would reveal another big problem. He is in good health and has never had any problems, so he has never had a physical examination before. ?Wang Shunhe’s son said that his father did not take the physical examination seriously due to his good physical condition. However, the CT examination caused by the car accident revealed a shadow on the brain that was very worrying. This patient suffered a traumatic brain injury caused by a car accident. The brain injury caused by the car accident was not serious, but our examination revealed that there was a space in his saddle area. ?The doctor who examined him, Ma Yuehui, was the chief physician of neurosurgery at the First Hospital of Zhejiang University. He was providing technical guidance at Sanmen County People's Hospital for three months at the time.
After consultation at the hospital, Ma Yuehui concluded that the shadow on Wang Shunhe's head was a pituitary tumor. Although it was a benign tumor, due to the long time since its onset, the tumor had become alarmingly large. This mass has reached 1.3 centimeters. If it exceeds one centimeter, it is a large linear tumor, which is close to the optic nerve. ? Ma Yuehui said that if the tumor is not removed, it will further grow in size. By then, the visual field will be damaged, the eyes will not be able to see, and there will be insomnia. ?It will be too late to do surgery by then. ?
If this test had happened one month earlier, Wang Shunhe might not have had such a smooth test and subsequent surgery. Now, not only has a dangerous tumor been discovered, but more importantly, because doctors from the First Hospital of Zhejiang University are present, such an operation can also be completed in the county hospital.
Not long before Wang Shunhe was sent to the hospital, the county hospital had just bought an operating microscope. In the neurosurgery department of the First Hospital of Zhejiang University, the operating microscope is a standard equipment, but Sanmen County Hospital is still the first hospital. One. ?The experienced surgeon Ma Yuehui performed the surgery on Wang Shun. The tumor in his position used to be inserted from above the forehead of the head, and the operation was very slow. Now it is inserted through the nose. This position is very close. The nose goes all the way here, and then the bone is bitten open. This tumor Just dug it up. ?Wang Duanbu, deputy chief physician of Sanmen County People's Hospital, said that he understood that the new equipment and the doctors from the First Hospital of Zhejiang University had brought completely different surgical techniques to the county hospital.
After an hour and 20 minutes of surgery, Wang Shunhe’s brain tumor was removed.
This operation could not be performed in the county hospital in the past, but he received the same operation here as at the First Hospital of Zhejiang University. Ma Yuehui said that within one year after the introduction of instruments and equipment, doctors in the branch were basically able to maturely master the surgical skills of the new equipment. The gap in equipment and technology between county hospitals and provincial hospitals will also become more and more important because of such cooperation. Small.