Take up a job as a doctor for 25 years, she prescribed the average form one does not exceed 80 yuan, a minimum one has 2 mao and 7 fen only; Her friendly service of seeing, touching, asking, listening to etc., has cured countless difficult and complicated cases. She, Wuhan money bridge community's doctor and king of Hankow contend in beauty. On September 25 of 2009, through the secret ballot of more than 30,000 citizens, she wins from more than 20,000 doctors, elected Wuhan " Good doctor in my mind " . The deed that Wang contends in beauty caused the strong response in the society, several hundred newspapers, websites were successively reported, reprinted, tens of thousands of netizens discuss with the card warmly. She is liked being called by the masses " Small prescription doctor " . The health is all-round developing foundations of people, concern the huge numbers of families happily. The commendation that people contended in beauty to the king, it is not merely to her admiration of consummate medical skill and noble medical ethics, have reflected it to further solving the earnest hope of the difficult problem of seeing the doctor even more. Where is the difficult difficulty of seeing the doctor? In July of 2009, Beijing Municipal Health Bureau organizes a special experience activity, invites the president of 19 large famous hospitals to go to the large other hospital to " work as a patient for one day " respectively ,It is how to personally experience ordinary masses to see the doctor. Among them a president is from lining up to register to leave the hospital for nearly 7 hours, but really only see the doctor for 20 minutes, line up to wait for accounting for 95.1% that go to a doctor for time entirely. The president " diagnoses the illness " Experience,what has been is it difficult to see the doctor to reflect to a certain extent at presented reality. Party and country have always paid close attention to health problems of people. Since reform and opening-up, the medical hygiene industry of our country has made the prominent achievement. Especially cover disease of the urban and rural areas is prevented and cotrolled and the medical treatment system of meeting an urgent need is basically built up in recent years, basic medical treatment ensures the institutional improvement to move forward continuously, the service system construction pace of health care at the basic level in urban and rural areas is obviously accelerated, production of medicines, circulation, supervisory system are being improved constantly. At present, the expectation life-span of per person of our country has already been up to 73 years old, is far higher than the average level (63 years old) of developing countries ,Close to the average level (75 years old) of the developed country ,Multiple resident's health indexes such as pregnant and parturient women's mortality, infant and pre-school children's mortality occupy developing country's forefront too. See, with socio-economic development, the people are higher and higher to life quality and physically and mentally healthy requirement at the same time, a lot of new health problems are appearing constantly, the masses are still relatively strong to the reflection difficult to see the doctor. The fourth national hygiene serve investigation, reveal, have 41.2% resident serve, unsatisfied with to the clinic according to 2008, 44.2% of the residents are unsatisfied with serving in hospital. It is difficult to see the doctor, but the generalizations of all sorts of places unsatisfied where people seek medical advice in seeing the doctor and meet in the course, careful analysis is main and " difficult " In four following respects: It is difficult to see the doctor to get to the large hospital. Enter the large hospital, the most ocular feeling is " unexcepted misfortune " --Register, wait, take long time of medicine; The intersection of doctor and inquiries test, check time to be short. A lot of patients reflect, go to the large hospital to see a disease, how many teams it is arranged that very difficult statistics appear, how much fee is paid. See, toss about more than half time for day by one disease, but used for seeing the doctor time ten come minute only really. Not only this not merely lets the ordinary patient feel physical and psychological weariness, but also to patients such as old man, child, disabled person, pregnant woman,etc., suffer unspeakably especially. It is more difficult to hang expert's number. Because does not understand the doctor's detailed conditions, many people's all one's life diseases, no matter serious disease and small disease, always think that lets an expert have a look, steady and more sure in the heart. And the big expert's number of the large hospital is very limited, so has caused expert's number one " number " Situation difficult to ask. In order to hang up an expert's number, the general mobilization of the whole family of some patients, lining up to register in turn, some line up all night, patients mobilize all resources and look for the relation to register even more. Combine with from " The number source " The number dealer's problem initiated intensely can never be solved completely, has made some hot expert's number fried to several hundred yuan even thousands of yuan. The medical expense burden is heavy. 2009, of our country time, out patient of hospital, medical expenses 160, the intersection of impatient and the intersection of per person and medical the intersection of expenses and 5952. The once cost of hospitalization is equivalent to 1/3 of annual per capita income for urban residents, it is 1.12 times that of annual per capita income of peasants! Clinic once of national hospital of 2008 and the expenses will be 12.5 times and 10.1 times of 1991 respectively in hospital, average annual growth rate is 16.0% and 14.5% respectively, it is higher by more than 10 percentage points than resident's consumer goods price index growth rate. The elderly and chronic disease patient who will often see the doctor, the medical expenses are born and not merely pressed so that they are breathless, still involve to the whole family. Those have participating in medical insurance masses, feel more burden to be heavy especially. In different social groups, rural resident diagnose the illness most difficult. The vast rural area especially former revolutionary base areas, not merely medical resources are insufficient, technology is weak, and it is extremely inconvenient to see the doctor and seek medical advice. A lot of peasants want to scale mountains and ford streams in order to diagnose the illness, go on more than ten, dozens of kilometers of ways. Some peasants suffering from difficult and complicated cases, in order to make a definite diagnosis of the condition or look for the hope, get outside the county, outside the province, even go to the large hospital of the big city of Beijing, Shanghai,etc. to seek medical advice, not only this has not merely increased the difficulty of seeking medical advice, but also heavier financial burden. Some difficult outstanding behaviours that the ones that enumerate only see the doctor above. Should see, with the progress of medical technology, what we meet now is difficult to see the doctor, already been different to some extent in initial stage with reform and opening-up, in a situation that the total amount of medical resource has already increase been rapidlied, a present one see the doctor difficult to behave, serve for accepting high-level medical treatment difficult more, Hi-Tech medicines, rare medicines and high-grade, precision and advanced apparatus are checked costlily, a lot of expenses are that the medical resource structure is unreasonable, dispose efficiency non- high and using bringing extravagantly and unreasonably. With effort, these problems should be able to solve too. Where is the difficult reason of seeing the doctor? Cure the disease, should first find cause of disease is kind to suit the remedy to the case. Solve the difficult problem of seeing the doctor, the same. Only analyze the forming reason of difficult problem of seeing the doctor conscientiously, could " suit the remedy to the case " . Then, the difficult " old complaint " of seeing the doctor Where on earth? It is relatively insufficient that the government puts into. Though the government increased the input into health care industry in recent years, still insufficient generally. The population of our country accounts for 20% of the world, but the all-inclusive cost of the hygiene only accounts for 3% of the total value of the world. Government's input will account for 24.7% in the all-inclusive cost of the hygiene in 2009, not merely well below the level of developed country (on average for about 75%) ,Also lower than a lot of levels of developing country (on average for about 55%) . In a situation that it is insufficient to put into the government, the health care expenses are mainly undertaken by the family, the hospitalization cost lacks the sharing system; This is forming the hospital objectively too " Work eating by oneself " Income structure,last medicines, not last income machine that be tied to doctor's income Make, the rising of the expenses plays a very big role. Medical resource maldistribution. The overall hygiene resources of our country are insufficient at present, it is unreasonable to dispose, it should be " the Pyramid " The health care system of the structure? Does �� rush and manage Hu's roast meat �� of dark mushroom of �� to kill and anchor at Xuan night of ��? About 0% of hygiene resources are in the city, new and high technology, outstanding hygiene talent centre in the large hospital of the big city, only there are about 30% of hygiene resources in the vast countryside. Some large hospitals excessively develop, and not merely apparatus and condition are bad in medical health organs of basic unit such as countryside and urban community,etc., and generally lack the qualified complete doctor, often distrust the medical organization at the basic level after causing the masses to be ill, pour into the large hospital of big city one after another. The public hospital trends towards the profit. At present, 71% of the hospitals in our country are the public hospital, the service amount born accounts for the national hospital and serves more than 80% of quantity. Because the government puts into for a long time insufficiently, the public beneficial desalinization of public hospital, form " mend medicine with medicine " Mode,not last hospital and medical worker is basic without being ignored medicine and application of technologies suitable, incline to make the great prescription, fall over each other to use the heavy-duty equipment, has increased by a lot of unnecessary expenses, cause the hospitalization cost to soar by a large margin, has also damaged the patient's health seriously. The proportion of caesarean birth of our country is far higher than the normal level, it is very serious that antibiotic abuses the situation, the consequence that this kind of mechanism brings. In addition some hospitals seek medical advice the procedure lacks humanization to design, a few medical worker attitude exists " coldly, hard, carry, drag, push away " ,can't share, be worsened whether that patient sought medical advice to experience inspection on between hospital result, have strengthened a patient to the feeling difficult to diagnose the illness. The medical insurance ensures low competence. By the end of 2009, medical insurance and new rural cooperation medical treatment system of basic medical insurance, urban residents of urban worker of our country,etc. have already covered more than 1,200 million people, but more than 100 million people do not have basic medical insurance of any kind. And the guarantee level of basic medical insurance and new rural cooperative medical service of urban residents is still on the low side, individual pays about half that the proportion still accounts for the all-inclusive cost for itself. In addition, system and commercial medical insurance of medical rescue in urban and rural areas of our country relatively start late, cover population and ensure efforts not big. So, a lot of masses still need to seek medical advice at one's own expense, is bearing the physiology, psychology and economy treble pressure. The price of medicines is empty and high. My traditional Chinese medicines enterprises are in large quantity, in small scale, the masses say jokingly " what has been sold medicines is even more than ones that take medicine " . Because the market competition is fierce, in addition supervision is uncomplete, medicines and medical apparatus are produced and circulated disorderly, some manufacturers are possessed with a lust for gain, adopt the means in violation of rules and regulations to falsify the cost, raise the price etc. wantonly seriously. It is insufficient to combine with the motive force of the cost of hospital active control medicine, a lot of medicine enterprises adopt improper competitive methods such as covert payment commission,etc. to enter the hospital. The country in recent years though 20 reduce the medicine price many times continuously, but a lot of enterprises take the method of transferring to names, transferring to and packing, changing into and dividing the proportion, examining and approving again etc. to avoid the restraint on a price reduction of the country, the masses still feel that has not received due material benefit. In addition, because the constant improvement of the scientific and technological level of medicine, various new medicine, new technology are appearing constantly, add the influence in factors such as aging population, transition of disease mode,etc., the service cost of the hygiene increases quickly; Some people lack the knowledge of basic medical treatment and health knowledge, no matter serious disease and small disease head direct for the large hospital, some patients even require the doctor to offer thorough examination, prescribe more costly medicines voluntarily, all these have aggravated the difficult problem of seeing the doctor to a certain extent. Knowledge is clicked " mend medicine with medicine " For a long time, the input proportion to the public hospital of the government is reduced gradually, in order to maintain its normal operation, solve problems such as the medical worker salary bonus,etc., 15%- 20% of addition, as compensation while allowing the public hospital to sell medicines, this is " Mend medicine with medicine " Origin. As a compensation policy, " mend medicine with medicine " The mode has once served development in promoting the health care to play the positive role, but encourage the hospital to create income, belong to ownly incomes, control by oneself, has encouraged trending towards the profit of the hospital objectively, have brought a lot of questions. 2008 statistics show, in three kinds of sources of a large hospital of incomes in Shanghai, the medicines addition income accounts for 57.3%. For realizing it is so expenses for medicine income when it is high proportion,will incline hospital and doctor to turn on patient by prescriptions large, by high price medicine, if you can't make, check,etc. more. " mend medicine with medicine " It causes the difficult, expensive important factor of expenses for medicine of seeing the doctor to already become. At present, the medical reform scheme proposes needing to carry on the public hospital reform, change " mend medicine with medicine " progressively Mode. In order to solve medical and health domain some profound systematic, mechanisms and structural problems, in March of 2009, the central authorities make the great decision of deepening the system reform of the medical and health, have set up goal and task of the basic health care system of covering urban and rural residents clearly, it is difficult to point out the direction in order to relieve the masses effectively to see the doctor. How to let the masses see the doctor more conveniently? Aunt Zhang living in one community of Yuhang of Hangzhou, seeing the doctor will take the bus for half an hour to go to the large hospital in the past, because the ability to move around is inconvenient recently, have to go to the community health station of the home gate. "Always made and talked in whispers in the heart in the past, is afraid that will cause delay to see the not good disease here. Has never expected that has looked without registering directly, and doctor's attitude is pretty good, the level is very high too. It is really too convenient! " A few words of aunt Zhang, say the medical organization at the basic level in urban and rural areas is relieving the masses and seeing the doctor on the important function of the difficult respect. The medical organization at the basic level in urban and rural areas is generally set up in the urban and rural residents life range, and quantity is numerous, widespread, community's doctor is the resident's neighbours, friends, improve convenience, accessibility of medical care and control medical cost, improve the intersection of relationship between doctors and patients and, have advantage which loud hospitals can't compare. Meanwhile, medical health organs in the basic unit generally use basic medicines, suitable technology, develop the activity of health education, prevention and health care,etc. extensively, start with putting prevention first, improving resident's health level, difficult to relieve and see the doctor by letting residents fall ill few. So, difficult to relieve and see the doctor conscientiously, a focal point is to " protect the basic, strong basic unit, build the mechanism " according to the General Secretary Hu Jintao Requirement,promoting the development of medical organization at the basic level in urban and rural areas, if you can't let it not lasted masses, accept convenient to seek medical advice by not choosing first of service, thus lighten the pressure of the large hospital effectively. In recent years, the construction of medical organization at the basic level in urban and rural areas is being strengthened constantly, the medical condition is being obviously improved, the ability of prevention and cure of disease is strengthened notably. Have medical the intersection of resource and shortage, the intersection of service and indifferent, the intersection of masses and the intersection of trust and problem such as being high still, many rural medical organizations at the basic level still stay in the sphygmomanometer, stethoscope, thermometer " Third kind " Level; Meet community hygiene medical talent required to serve enough; Basically medical organization in the community of medicine yet Used in an all-round way; The patient of the large hospital has not fully assigned and run to the basic unit yet. So necessary one " The strong basic unit " As deepening the focal point of the reform of the medical and health system, put forth effort to improve the medical service system of basic unit in urban and rural areas, accelerate forming the large hospital and health organ at the basic level's dividing the work the pattern of seeking medical advice hierarchically of cooperation, offer safe, effective, convenience, cheap medical care to the masses of urban and rural residents. Accelerate the construction of medical health organ of basic unit of countryside. Want sound with hospital at county level as the locomotive, health clinics in towns and townships and village clinic as the rural health care service network on foundation. Continue devoting more efforts to investing, make each of villages and towns of the whole country have a commune hospital at least, there should be a clinic which governments held in each administrative village, and allocate indispensable medical apparatus facilities, improve and seek medical advice condition and environment. Advance the village to integrate and manage actively, rational planning and disposing rural hygiene resources, standardize the service act, improve service ability, realize " small disease does not go out of the village, serious disease does not go out of the county " . Accelerate the construction of urban community medical organization. Throw urban hygiene into, turn the intersection of community and hygiene to, serve construction especially, improve with the intersection of community and hygiene serving for new urban the intersection of health care and service system of foundation. The overall arrangement of service organization of community's hygiene of rational planning, adjust and dispose resources rationally, should make the transition or transform a batch of existing small hospitals as the hygiene service organization of the community, and also lead social forces to set up the hygiene service organization of the community. Strengthen the technological staff training of hygiene at the basic level. The complete medical service system of basic unit not merely needs " The hardware " Development,even more leave "software " --Improvement of talent's quality and ability. Strengthen the building of contingent of health care at the basic level in urban and rural areas especially, and make the preferential policy, encourage outstanding the intersection of hygiene and talent get in urban and rural areas basic unit serve, on the job to claim promote, treatment policy,etc. pay slope appropriately. Meanwhile, should encourage the large hospital through coordinated cooperation, staff training,etc. too, help the medical organization at the basic level in urban and rural areas to improve medical level and service ability. In a word, should construct a medical health organ of basic unit in urban and rural areas with the division of labor and coordination of work of the large hospital, support with each other, coordinate the orderly operation mechanism. At present, 80% of the portfolio of large hospital can be solved in the basic unit. On average, see same disease, tertiary hospital 30% with high costs hospital than second have. Want science to define the functional demand of the hospitals at all levels, the medical health organ in the basic unit offers basic medical treatment and public health service for masses, the municipal or district hospital at county level puts forth effort to improve the clinical comprehensive advantage, integral level and training service as the medical centre in the area, at country and provincial hospital use energy for promoting medical technology, strengthening discipline to build, strengthen medical innovation ability, solve the serious of difficulty to make a diagnosis and give treatment mainly. Through reducing the expenses standard, raising comprehensive measures such as the proportion,etc. of submitting an expense account in the basic unit, realize progressively the community examines, grades medical treatment and changes the place of examination bidirectionally, lead the masses to form " the small disease is solved in the basic unit " for the first time, serious disease changes the place of examination in the large hospital " If you can't seek medical advice, used to,is it at the basic level without being made medical organization let's bear really daily life the people" the gatekeepers " healthy Duty. How to lighten masses' medical expense burden conscientiously? The fourth national hygiene serve investigation, reveal doctor diagnose need, in hospital and patient the proportion in hospital has been up to 25.1% according to 2008, the main reason among them " Financial difficulties " Account for 70.3%. It is obvious, it is difficult to relieve and see the doctor, should let the masses see the doctor more conveniently, should lower burden of the medical fee of the masses hard too. The former involves the accessibility of medical care, the latter involves the validity of medical care, the latter is even more important in a sense. Generally speaking, the medical expenses are afforded to mainly depend on the medical insurance that the masses participate in ensures competence, medicines expenses and level of the medical care expenses. Medical treatment ensures the system to reflect the society helps each other and helps spirit together, it is significant for individual to resist the disease risk, lighten the medical expense burden; The price level of medicine mainly raises the price with pricing standard, link of circulating the range, hospital addition policy are correlated with; Medical care expenses depend on whom hospital adopt make a diagnosis behavior, expenses standard, mode of charging mainly. So, must ensure system, medicines to produce circulating since medical treatment several respects such as system and medical service system are set about at the same time, it is left together, make great efforts to " modulate " that multicell A clothes lightens masses' medical expense burden " Compound medicine " . First, ensure construction through medical treatment " Lighten the burden " . Further consolidate and improve the new rural cooperation medical treatment system in the countryside, it is steady in the high position to guarantee to join and shut the number of people; Improve the standard of raising funds, the government subsidizes competence and reaches 120 yuan for each person every year this year; Raise, compensate proportion, strive, make policy expenses wipe out proportion up to 60% about in hospital in the range. Further improve urban worker's medical insurance and medical insurance of urban residents in the cities and towns, accelerate covering employed population and old man, disabled person and children; The government of the medical insurance of urban residents should improve to subsidize competence by 120 yuan for each person every year too this year. Improve the basic medical treatment in urban and rural areas and ensure serving, simplify and submit an expense account the procedure, make the basic medical insurance relation and shift and continue the method. Do the medical insurance of urban worker's medical insurance, urban residents, new agricultural shutting, connecting the work between every system of medical rescue in urban and rural areas well. Second, pass the basic medicine system " Lighten the burden " . Will set up national basic medicine system, the basic medicine needed to curing the disease preferably is managed as a whole, guarantee stability and accessibility of its price from system. The medical organization at the basic level held in all governments sells a difference rate of price of medicines, through bidding and purchasing publicly, provide and deliver in unison, make the masses use the security, rest assured about and cheap medicines. The national basic medicine catalogue has already been released at present, establish 307 kinds of basic medicines; Make a lot of local basic medicine prices reduce by 25%- 50% through the pilot project, and all include in the medical insurance and submit an expense account in the range. Third, pass and advance the reform of public hospital " Lighten the burden " . The public hospital is bearing it for the important duty of the health service of the broad masses as the main body of the medical service organization of our country, must adhere to the public beneficial direction. Further deepen reform, form the normal and rational government and invest the mechanism, guarantee the public hospital is really surnamed " Common" . Reform " mend medicine with medicine " Mechanism, cancel the intersection of medicines and addition progressively, cut off interests roller chain during hospital and medicines sell, change to depend on the situation that the income from sales of medicines keeps on the go unduly. Adjust the medical service price appropriately, reduce " great prescription " With excessively checking, further reduce medicines, medical consumptive material and heavy-duty equipment and check prices. Public hospital therefore reduced income or loss that form replenish, set up the intersection of medicine and the intersection of thing and the intersection of service charge,etc. and route, solve through increase government, the medicine thing service charge includes in the medical insurance and submits an expense account in the range. Fourth, supervise through strengthening the norm " Lighten the burden " . Strengthen supervision to the non- national basic medicine, rigorously enforce market access and medicine Taste and register and examine and approve, energetical norm and rectification produce the order of circulating, the promotion medicines production, integration of enterprise in circulation, build up high efficiency, low cost, medicines which accords with the national conditions characteristic and circulate and supply the security system as soon as possible. Strengthen the supervision of production-supply-marketing every link, stop old medicine " appearing again at high price " . Fully give play to the role of administrative supervision, technical supervision and social supervision, manage the trader in the buying and selling of medicine firmly? Pray and float
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