It is difficult to see a doctor and expensive to see a doctor, which are the two problems that people have criticized most about medical services for many years. The main reason behind this is the uneven distribution of medical resources: residents in big cities look for experts when they catch a cold, while people in rural areas are seriously ill because it is too difficult to hang a famous doctor in a provincial hospital.
In Zhejiang, the new medical reform completely solved this problem. Qianjiang evening news reporter recently learned from a small-scale report of the new medical reform of the Provincial Health Department that there is a new medical reform in Zhejiang Province? Three changes? Is it difficult to see a doctor? Medical resources are sinking, so that provincial and municipal experts can go to county hospitals and community hospitals to see everyone; The health service industry has expanded diversified medical services, giving residents more choices to see a doctor; Expensive to see a doctor? There is no price difference between medicines. Buying medicines in hospitals is the same as buying medicines in cheap pharmacies, or even cheaper.
For the nationwide medical reform, Zhejiang phenomenon? At the beginning of the clue.
Mao Qun An, director of the Propaganda Department of the National Health Planning Commission, spoke highly of the medical reform in Zhejiang. The experience of Zhejiang should be said to give us great confidence in promoting the reform of public hospitals. ?
Mei, a researcher at Shanghai Academy of Social Sciences, believes that medical reform has also played a role in alleviating the high cost of medical treatment for patients. ? At present, seeing a doctor is expensive, and a large part of it is that drugs are more expensive. Now, the zero difference rate of drugs is also obvious to patients. ?
Is there really a case to follow in Zhejiang, which is at the forefront of the country? In the new medical reform? Zhejiang phenomenon? How are you doing? For Zhejiang people, what changes have these reforms brought to our medical care? Is it really more convenient and cheaper to see a doctor? Qianjiang evening news will launch? Zhejiang phenomenon of medical reform? The series of reports will explain in detail the health benefits brought by Zhejiang medical reform to the people.
Alleviate the difficulty of seeing a doctor
One of Zhejiang phenomena: 47 county hospitals have provincial doctors working.
When you go to the hospital when you are sick, the first reaction in your mind is always the big hospital around you.
In large hospitals, overcrowding and scalpers grabbing numbers have long been commonplace; In community hospitals, empty scenes are staged almost every day. While complaining about the long queues in large hospitals and the difficulty in seeing a doctor, they turned a blind eye to the community hospitals around them.
The reason behind this is nothing more than distrust of the level of doctors in community hospitals. I always hope that the most experienced experts can make the most professional diagnosis for themselves.
So where do the good doctors at home come from?
From the beginning, Zhejiang began to implement the sinking action of urban high-quality medical resources step by step. By the end of June, there were 28 county hospitals with close cooperation with provincial hospitals and 9 county hospitals with close cooperation with municipal hospitals/KLOC-0.
This means that in 47 county-level hospitals, you can see experts from provincial hospitals and enjoy medical technology from provincial hospitals. However, the payment of medical expenses is much less than going to provincial hospitals, because the proportion of reimbursement in county hospitals is much higher.
Qianjiang evening news reporter interviewed in the First People's Hospital of Chun 'an County. Since July last year 19, the hospital has added a piece? Chun 'an Branch of Zhejiang Provincial People's Hospital. Brand, this is the beginning of trusteeship cooperation between provincial people's hospital and county hospital.
The dean, vice president and chief of finance of the county hospital are all appointed by the provincial people's hospital. Last year, there were 2 1 people who worked here for a long time, among whom 18 people were doctors with associate senior titles or above.
It covers general surgery, neurosurgery, thoracic surgery, gynecology, urology, orthopedics, anorectum, otolaryngology, ophthalmology and cardiovascular medicine, intensive care unit, neurology, nephrology, infectious diseases, dermatology, rehabilitation, radiology, ultrasound and other specialties in county hospitals, among which 1 1 is the director and head of the department.
Li, a native of Chun 'an, is a patient with chronic kidney disease. In the past, hemodialysis in Hangzhou took two and a half hours by bus and had to wait in line. Now stay in the county hospital for treatment. According to his words, right? Convenient and reassuring. ?
In the past, children had to go to Hangzhou for bone age measurement, but now they can go directly to the county hospital. ? Another Ms. Xu from Qiandao Lake Town said.
In addition to outpatient service and surgery, most patients also stayed in the local area. ? The urologist of the Provincial People's Hospital has seen it. Because I am over 70 years old this year, the operation needs to be done as soon as possible, so I should be prepared for the operation. ? Lao Yu, who has suffered from prostate disease for many years, said that his family would definitely take him to Hangzhou for surgery, but it is much more convenient for doctors in Hangzhou to be in Chun' an. He doesn't have to travel far, and his family can take care of him more conveniently.
How many local people have enjoyed high-quality medical care in the county hospital at their doorstep? This set of figures is very telling:
In contrast, the total business income of county-level hospitals cooperating with municipal 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 surgical visits increased by 35.23%.
With more patients, the efficiency of hospital medical services has also improved: the proportion of drugs decreased by 29.63%, the average length of stay decreased by 6.94%, and the balance of payments increased by 50.45%. County hospitals are more capable, more efficient and have more stamina for development.
Give patients more choices.
The second phenomenon in Zhejiang: Good private hospitals can compete with provincial hospitals.
By 2020, the total scale of health service industry will reach more than 8 trillion yuan. ? From June 5438 to last year 10, the State Council issued "Several Opinions on Promoting the Development of Health Service Industry". Private hospitals are a very important link for private capital to enter this industry.
No matter whether it is a private hospital or a public hospital, the clients are the same, and they are all sick people. For ordinary people, whether private hospitals or public hospitals, hospitals with convenient medical treatment and good curative effect are their first choice. Similarly, in the medical market, public hospitals seem to be natural? Born orthodox? Identity, but this identity has become less and less important in the development of private hospitals over the years.
According to the data of Hangzhou Health Bureau, by the end of last year, there were 1.228 private medical institutions in Hangzhou * * *, including 32 private hospitals1.34 beds, accounting for 1.3.28% of the total approved beds in the city, which is roughly equivalent to that in Zhejiang Province.
Qianbao reporter learned that the strength of Zhejiang private hospitals is not weaker than that of public hospitals in specific professional fields such as traditional Chinese medicine, dentistry and medical beauty. Compared with the long queues in public hospitals, many people will trust these private hospitals with unique professional characteristics and convenient treatment. At the same time, the corresponding departments of public hospitals are constantly introducing new equipment and new therapies under the pressure of competition.
Private hospitals and public hospitals do not compete with each other, but promote each other. ? Ma, deputy director of the Provincial Health Planning Commission, said: Wenzhou Kangning Hospital, a private third-class first-class hospital and Jinhua Guangfu Hospital have a high level of tumor treatment. Many private hospitals are run by excellent doctors in public hospitals. The overall level of private hospitals in our province ranks in the forefront of medical care, which is rare in the country. ?
At the end of May this year, the provincial general office issued the "Implementation Opinions of the People's Government of Zhejiang Province on Promoting the Development of Health Service Industry". Is there such a description in the Opinions? Strictly control the expansion scale of public hospitals in the central city, and governments at all levels will no longer set up new urban public general hospitals in principle. Encourage enterprises, charities, foundations, commercial insurance institutions and natural persons to set up various medical institutions. ?
It can be seen that the development momentum of private hospitals in Zhejiang will be stronger in the future. With better equipment investment and personnel participation, patients who flock to public hospitals will have more diversion.
The reform of public hospitals is advancing, and we hope that more private capital will come in and expand the supply of medical services, which will also produce catfish effect and give birth to some new models. ? A staff member of the Municipal Health Bureau told the reporter.
Relieve the high cost of seeing a doctor
The third phenomenon in Zhejiang: the full implementation of zero price difference for drugs in municipal hospitals in Hangzhou Province
Since April this year, Zhejiang has cancelled the 1 5% mark-up of drug sales in public hospitals in the province, taking the lead in breaking the hospital operation mode that has been used for more than half a century in China. This kind of reform is the first in China. Such changes have enabled Zhejiang people to enjoy the benefits of nearly five months.
In the outpatient pharmacy of the First Hospital of Zhejiang University, you can clearly see the comparison of Ms. Zhang's liver disease prescription before and after. In her prescription, two boxes of oral lamivudine and two boxes of oral adefovir dipivoxil tablets are 80 1.74 yuan. She checked the previous documents, and the prescription price before April 1 was 862.2 yuan, which saved 60.46 yuan this time.
Zero error rate? Hospitals involve lowering drug prices and increasing medical service fees, but for patients, the proportion of out-of-pocket expenses has decreased. For patients with chronic diseases like Ms. Zhang, the reduction of medical expenses after the reform is obvious, while for surgical patients, even if the medical expenses are increased, the proportion of self-funded expenses is also reduced.
Yesterday, the staff of the Finance Department of Tongde Hospital came to the orthopedic ward to settle the bill for a retired worker, Aunt Chen. She had an operation and was hospitalized for half a month because of a broken finger and phalanx.
Compared with April 1 before the reform, although her total expenses have increased, Aunt Chen actually paid less.
Qianbao reporter saw this list of discharge expenses, and the total cost was 1039 1.78 yuan, of which 2,457 yuan was paid by himself and 7,934 yuan was borne by medical insurance. If it had been a few months earlier, the total cost might have been 10 192.3 yuan, but Aunt Chen paid 2559 yuan herself and the medical insurance paid 7633.3 yuan. Obviously, although the total medical expenses of Aunt Chen increased by 199.48 yuan, Aunt Chen saved 102 yuan through out-of-pocket payment.
It is more and more convenient for Zhejiang medical reform to enjoy the treatment of provincial hospitals.
Dr. Ye, I'm going to have surgery with you next week. ? Attending surgeon Ye Ke, a neurologist in the First Hospital of Zhejiang University, received a telephone appointment from the patient Lao Wu the day before yesterday. On March 3, this year, Ye Ke and another 15 colleagues were selected by the First Hospital of Zhejiang University to be residents in Sanmen County People's Hospital to treat local people. This county hospital has become a three-door branch of the First Hospital of Zhejiang University, and Lao Wu is a Yeke patient in Sanmen.
Now, after staying for four months, Ye Ke returned to the First Hospital of Zhejiang University, and another group of colleagues rushed to Sanmen. Because the referral system is convenient, Lao Wu will go to the First Hospital of Zhejiang University for skull repair surgery next week.
For patients like Lao Wu, provincial medical resources come to the county hospital and they can enjoy an upgraded medical service at home. More importantly, it can be referred to the First Hospital of Zhejiang University more conveniently than in the past.
The most unobstructed referral
After the county file is filed, it will be sent directly to the provincial hospital.
Lao Wu was injured in a car accident, and I did the operation. But postoperative diabetes insipidus, upset. In Sanmen Branch, there are few drugs to treat diabetes insipidus, and the most ideal way is to refer it to a big hospital. ? Ye Ke told qianjiang evening news that it was not easy for Lao Wu to see a doctor in the First Hospital of Zhejiang University before the sinking of medical resources began.
Like any patient from other places, first of all, Lao Wu has to take a bus for three and a half hours from Sanmen to Hangzhou. When he arrived at the big hospital, he had to register at the outpatient clinic and show his case, relevant instructions and films to the neurosurgeon. If he wants to have an operation on this symptom, he must wait for a bed. It will take at least a week. ?
Because of the close medical cooperation between the two hospitals, it is not so troublesome to refer Lao Wu now. Lao Wu at least saved the time of queuing for registration, and he could inform him as soon as there was a bed. ? Yeke said.
Did the Standing Committee of Zhejiang Provincial Party Committee make progress in its research? Urban quality medical resources sink? By the end of June, there were 28 county hospitals with close cooperation with provincial hospitals and 9 county hospitals with close cooperation with municipal hospitals/KLOC-0.
So many large hospitals have opened branches in the county town, which saves a lot of trouble for people living in the county town to see a doctor. People trust county hospitals more than in the past. Compared with Belgium, the total business income of county hospitals cooperating with big city hospitals increased by 78.69%, the number of outpatient and emergency departments increased by 50.35%, the number of discharged patients increased by 90. 14%, and the number of operating tables increased by 35.23%.
The luckiest patient
The dangerous tumor was treated in the county hospital.
If we evaluate the luckiest beneficiary of the sinking of medical resources, it may be 55-year-old Wang Shunhe from huaqiao town, Sanmen County.
In June this year, Wang Shunhe suffered a car accident and was rushed to Sanmen County People's Hospital by 120 ambulance. Because the brain was injured by impact, the hospital conducted a brain CT examination. Who would have thought that this investigation actually found another big problem?
He is in good health and has no problems, so he hasn't had a physical examination before. ? Wang Shunhe's son said that his father didn't take the physical examination seriously because of his good health, and the CT examination caused by this car accident found that there was a shadow in his brain, which was very worrying.
The patient was injured in a car accident. The brain damage caused by the car accident was not serious, but we found that he occupied a space in the saddle area. ? Dr. Ma, who examined him, is the chief physician of neurosurgery in the First Hospital of Zhejiang University. At that time, he was doing technical guidance for three months in Sanmen County People's Hospital.
After consultation in the hospital, Ma concluded that Wang Shun and the shadow on his head were pituitary tumors. Although it is a benign tumor, it is surprisingly large because of its long onset time.
This lump has reached 1.3 cm, and if it exceeds 1 cm, it is a huge linear tumor, which is close to the optic nerve. ? Ma Yuehui said that if the tumor is not removed, it will become bigger and bigger. At that time, my eyesight will be impaired, I can't see anything, and I will lose sleep. ? It will be too late to operate then. ?
If this test had happened a month earlier, Wang Shunhe might not have had such a smooth test and subsequent surgery. Now not only dangerous tumors have been found, but more importantly, such operations can also be completed in county hospitals, because doctors from the First Hospital of Zhejiang University are present.
Shortly before Wang Shunhe was taken to the hospital, the county hospital just bought an operating microscope. In the neurosurgery department of the First Hospital of Zhejiang University, the operating microscope is standard, but Sanmen County Hospital is the first one. ? The experienced horse operated on Wang Shun.
In the past, the tumor in his position was done from above the forehead, and the operation was very slow. Now it's through the nose, very close. Stick your nose here, then bite the bone open and dig out the tumor. ? Wang Duanbu, deputy chief physician of Sanmen County People's Hospital, said that he learned that the new equipment and doctors from the First Hospital of Zhejiang University brought completely different surgical procedures to the county hospital.
After 1 hour and 20 minutes of surgery, Wang Shunhe's brain tumor was removed by the way.
This operation could not be done in the county hospital in the past, but he received the same operation here as the First Hospital of Zhejiang University. Ma said that in one year after the introduction of instruments and equipment, doctors in the branch can basically master the surgical skills of new equipment, and the gap between county hospitals and provincial hospitals in equipment and technology will become smaller and smaller because of such cooperation.