China sees the doctor the expensive phenomenon of ugly disease lasts Probe into the excessively medical origin

China sees the doctor the expensive phenomenon of ugly disease lasts Probe into the excessively medical origin
Recently, 26 doctors, experts of Shanghai East China hospital come to the river bridge town to volunteer medical consultation for villagers, welcomed warmly, is surrounded ring upon ring by 5 kilometers of villagers in Pat Heung. On the same day, East China hospital and the river bridge community health Center signs and agrees on, the experts will often go to the countryside and serve the people, local villagers will not go to the large hospital of urban area and can enjoy high-quality medical care too. Zhang HaiFeng can cure the disease at the gate of home when taking a photograph of, this is the ordinary people's wish. But in most countrysides and community's hospitals, are generally in the state that can't take a fancy to the disease, see the not good disease, common people can only run to the large hospital of the big city. The medical care that and the large hospital offers is miscellaneous and expensive, often exceed the patient's basic demand, cause " the difficulty and high cost of getting medical treatment " The phenomenon lasts for a long time. " twelve five " The planning outline proposes, strengthen the construction of medical service system in urban and rural areas, meet basic health care demands of masses preferably. What is the basic medical care? How to meet the basic medical demand preferably, let common people cure the disease at the gate of home? The reporter has interviewed. The national patients all run to the large hospital of Beijing - -Medical care " Pour the trigonometry " ,The basic unit crosses the training, the more comprehensive the hospital the of higher more level is. If the medical organization at the basic level can not keep patients, practical experience is little, the medical skill level can not be improved for a long time, the patient distrusts the basic unit even more, form the vicious circle At the end of March, 59 -year-old native of Shanxi Da Tong Li Xiuming went to Beijing to see the doctor again under the son's company. They have gone to the hotel by the hospital to book a room first, 120 yuan per day. The condition is not very good, but there are rooms to live it is satisfied very much that Li Xiuming has thought, she has known that there are too many people that the large hospital sees the doctor to run, the hotel room is very hard-to-get. It was cataract that saw this time. Because there is glycosuria medical history in 14 years, the doctor of the large hospital of Beijing proposes, control good blood glucose levels first and then carry on the operation. Li Xiuming has to get back to the hotel, begins to monitor blood glucose, can not always control well. By the 12th day, reduced to 4.8 at last, is qualified to perform the operation. On April 6, Li Xiuming carried on the clinic operation, spent more than 5900 yuan, in addition, the hotel, expenses having a meal, it cost about 20,000 yuan together. "Certainly a little expensive, but the technology here is good. " Li Xiuming lives in the county town, according to her introduction, they locals would all like to go to Beijing to see the doctor, the reason is worrying the level of the hospital of county, do not rest assured about the market hospital, provincial hospital very much either, "believe Beijing most, besides, the journey is not far. " Da Tong reach Beijing have 350 more than, according to current the intersection of medical insurance and system, strange land can only wipe out to see the doctor very much partially little. Li Xiuming says, then can only admit, reach the treatment of Beijing to rest assured about some. One ward mate of Li Xiuming come from the intersection of Jilin and Yanbian, accompany, go Beijing make the intersection of cataract and surgery in child too. This ward mate says, oneself is misdiagnosed, has spent 20,000 yuan doing the operation in a hospital of Yanbian, eyes but it has been never good, made a definite diagnosis of cataract after checking in Beijing. Listening to this words, Li Xiuming strengthens one's own idea even more: The medical organization at the basic level really can't let people rest assured. Auntie Shi from Xianghe of Hebei holds this kind of view too. She says, even if just catch a cold to go to Beijing to look, though is costly - -Cold takes two 300 yuan too, but the thinking value of auntie Shi. She says: "The level of BJ Hospital is not a little better than in the locality, but so better! Make it steady and sure in the heart. " According to the whole country, the high-quality medical resource allocation of our country is uneven, more than 80% medical resource centre in the big city, among them high-quality medical resources all centre in the large hospital of the big city. The total amount of resource distribution of the hygiene does not meet the health care service demand that urban and rural residents increase day by day, the disparity of basic medical care between town and country is enormous. Zheng Gongcheng, Professor of the People's University of China, has offered a group of figures: In view of facility, there are nearly 10% of the administrative villages in the whole country there is no clinic, it is 3.31 that the berth of medical organizations of a thousand people of every the whole society is counted, and every a thousand the intersection of agricultural population and the intersection of health clinics in towns and townships and berth it counts to be 1.06 only; In view of doctor's quantity, the urban community health Center has 3.2 medical practitioners on average, the clinic is only 0.12 in the village; In the community health Center of the cities and towns, it is non-profit-making to exceed 95%, but in the rural clinic, only 67% are non-profit-making. The medical organization at the basic level can not keep patients, medical personnel's practical experience is little, the medical skill level can not be improved for a long time, the patient distrusts the basic unit even more, form the vicious circle so. "At present, lack continuity and harmony between the medical organizations of different levels of our country, have not formed a system of examining, grading medical treatment, changing the place of examination bidirectionally yet and arranged, the medical service mode demonstrates ' pours the trigonometry ', the more go to the basic unit to cross the training, it is the more comprehensive to reach the hospital of higher level. You can see, even large than supermarket in that large hospital diagnose the illness person in every day. " Rao KeQin, secretary of Chinese Medical Association, says. It make while checking size on piece all over,turn on medicines a lot of - -Information asymmetry, backward means of payment, doctor's self-protection,etc. are the root cause of excessive medical care, also deviate from the aim of basic medical care, demand the reform urgently At the end of March, find a little blood silk in the urine when grandson gaudy China working in Tongzhou of Beijing urinates. Because of from Chengde of Hebei, she diagnose the illness unable to submit an expense account in Beijing, must own to foot a bill. 23 -year-old Sun YanHua thinks oneself young, in addition, without other symptoms, determine not to see the doctor until having a holiday. On April 2, Sun YanHua comes to a second hospital of adjacent place to see the doctor, doctors held three inspections such as urine routine, gynaecology, rectum, check for quite a while, prescribed some gynecological medicines to let her go home for her finally. Came back home, the grandson had regretted taking so many medicines in gaudy China: "What I saw is the question of the urinary system, but the doctor prescribes gynecological medicine for me, can this be affective? ! " Sun YanHua worries, she went to hospital of a the first, second and third again the next day, the doctor let the urine that she made a urinary system check the project. In the morning of April 7, Sun YanHua got to the hospital, fetched the inspection result, is writing " the shape is normal " above . Show kidney physician, the doctor wants her to change into the number of the urological department. In the urological department, doctors had not heard from her two sentences yet, had looked at the inspection result, opened an color ultra list at 120 yuan for her. After finishing paying the fee, become the doctor checking to tell her, must wait until that could it's her turn half past 2 in the afternoon. Sun YanHua at this moment is a little discouraged: "Why does not the doctor tell me what reason on earth cause? Can only I go to the most authoritative Peking Union Medical College Hospital to find the result? Always open one pile to check singly once coming up, ignore my feeling too. " To this, in fact grandson gaudy China has psychological preparation early, but connect a bit Can not stand. From large downstairs of the hospital, already over 11 o'clock. The grandson has eaten yet by oneself in order to prevent checking the blood of empty stomach in gaudy China? Beautiful to park ��, have jurisdiction over the intersection of Shou and the intersection of Nai and sauce, lick the intersection of �� and Zhu Yuan the intersection of horsefly and angry ��, mould of reason, hurry the intersection of contraction and Gun, imitate thin several broadleaf plants two? Two hospitals run in 3 days, checked, bought a pile of medicines after doing multiply, Sun YanHua finds, the very costly, fee energy of seeing the doctor, the cost is very high! According to statistic of Ministry of Public Health, 2009, time, out patient of general hospital, medical expense up to 159.5 yuan, having nearly doubled more than the statistical data in 2000, among them, it was nearly 3 times of 2000 to check and treat the fee. As to this, Vice President of Zhengzhou University second affiliated hospital Yang LiXia thinks, the medical health organ is under the drive of interests at present, expand scale burning, apparatus among them important one the intersection of contest and content. For example, among short 10 years, a lot of large hospitals eliminated 16 rows of CT and even 64 rows of CT, instead of most advanced 320 rows of CT in the world. These high-grade, precision and advanced apparatuses often excessively use, their cost is added on patient. Because the Chaoyang District Cai Gui more than 50 years old of Beijing celery has medical insurance, seems not to be afraid it is " excessive " Serve. Not long ago, Cai GuiQin felt the waist pained, went to hospital of a the first, second and third to see the doctor, the doctor without demur, let her shoot the film first, after the film comes out, writes a prescription without a break, amounts to more than 600 yuan, and tell her to be only quantity for two weeks. Though Cai the Guangxi Zhuang Autonomous Region's celery only needs to cost more than 90 yuan, " great prescription " The ones that were wasted are public medical resources. Originally worry the level of the medical organization at the basic level, go to the large hospital to see the doctor, but the large hospital does not distinguish the patient's demand, no matter serious disease and small disease, the ones that can be involved check the projects and must all be checked once. The patient has to sigh with deep feeling: It is really too difficult to want to spend less money! Why can't cure the desease, reduce and check on the disease well in the large hospital? Forgive gram hardworkingly to explain, this is because of ordinary people and information asymmetry between the doctors, the policymaker is not but the patient but a doctor. Inspection and medicines patient that the doctor opened can only accept passively. He says: "How many medicines get in touch if the doctor's income and makes more or less checking, prescribing, it is impossible to avoid inducing the demand, form excessive medical treatment. Meanwhile, paying according to the project and medicines addition, it is the comparatively backward means of payment in the world, need reform. " In addition, in the medical dispute, the ones that put to the proof and invert are guilty to infer the principle, make some doctors have to hold and check to protect oneself more for the patient too. All this kind, make the patient's burden heavier and heavier. The reporter finds from the statistical report which Ministry of Public Health announces, though in the hygiene all-inclusive cost in recent years, taking dropping than year by year of ordinary people's personal hygiene expenditure, but absolute number is still rising, if is 509,870 million yuan in 2007, it will be 657,080 million yuan in 2009. It is " small and ill " to give , " serious disease " Have a bank - -Strengthen the ability construction of medical organization at the basic level, train the complete doctor in the basic unit, " small disease " Solve in the basic unit, could relieve the excessive concentration of high-quality medical resources effectively, reduce financial burden that excessive medical care cause to common people and the society who want, have an optimistic view of disease at the gate of home? Who wants to run to see the doctor far away, must toss about for quite a while? The medical service system of a country, primary one is to reflect equally, meet generally most basic demands the most of people. Such basic demand can be got at the gate of home, that is to say the medical organization at the basic level can offer corresponding basic medical treatment service. If really need to go to the large hospital that treats serious disease of difficulty to go to a doctor, can to the large hospital to see the doctor as required via the route of changing the place of examination of the norm. However, reality is that the majority run to the large hospital, the middle has lacked a differentiation " serious disease " , " small disease " Bank. Having lacked this bank, the upper strata of the structure of medical care seem too too fat and clumsy to move, even can't bear bearing. The helplessness of Li Xiuming and Sun YanHua has reflected the defect of the medical service system of our country to a certain extent, it can not well meet the most general basic demands of seeing the doctor of people. Why can turn into like this? Rao KeQin's characteristic analysis from basic medical care. He says, what basic medical care is emphasized is accessibility, refers to suitable talents (such as complete doctor and rural doctor) Clinical diagnosis using suitable technology, basic medicine to launch and treats and serving. Here " Basically " It is a economics, dynamic course, intension changes with disease structure, level of economic development. He says, the countryside of the seventies of last century, the barefoot doctor had only " third one " (the stethoscope, sphygmomanometer, thermometer) With a medical kit, the daily medicine of clinic is fewer than 30 kinds, but should have been already enough to infective, infective diseases such as common cold, diarrhoea,etc.. Now, the urban community, rural common diseases and frequently-occurring diseases of our country have already changed into chronic diseases such as hypertension, diabetes, heart cerebrovascular diseases, depression,etc., these diseases mostly need treating all the life. But reality is, the talents of medical organization at the basic level, technological means can't adapt to the changing fast of this kind of disease, can't meet masses' demands, can only run to the large hospital. As to this, Qinghai Province Ulan county is indebted to chrysanthemum safflower of hospital Vice President to rather approve. She says: "The hospital of our health clinics in towns and townships, county can not meet most resident's common diseases, basic demands of the frequently-occurring disease at present, the apparatus, medicine can not all catch up with, a lot of people go to Xining to see the doctor. " Meet basic the intersection of health care and demand of people preferably, must give " the light disease " , " serious disease " Have a bank, distinguish the cause of disease of number, put into different categories and suit the remedy to the case. The design of this bank will come by the system completely, will let the basic unit become strong, make the medical service level in urban and rural areas reach unanimity, reflect the justice. How does the medical organization at the basic level become strong? Forgive gram hardworkingly to think, strengthen the medical institutional capability construction of the basic unit, especially the ability of the hospital at county level is particularly important in construction. Meanwhile, the system, mutual coordination relation that the ones that establish the hospital and medical organization at the basic level change the place of examination. Launch tele-medicine, the basic unit passes the result inquired, checked to the hospital of higher level directly, the hospital of higher level helps to diagnose and propose the healing solution, let serious disease not go out of the county without going out of the province, small disease, leave the patient in the basic unit. "The phenomenon that the large hospital sees the little disease is very general at present, this is actually wasteful use of resources. The intersection of patient and little disease large to watch, cost more money, result in, see the doctor expensive unsatisfied with moring. " Rao KeQin says. Forgive gram hardworkingly to point out, the key of strengthening the construction of medical organization at the basic level is to train the qualified doctor at the basic level, the doctor at the basic level should have the ability to distinguish " Serious disease " , " small disease " ,And " small disease " once Solve in the basic unit, a pair of " serious disease " Assign to and run to the large hospital. Train the complete doctor in the basic unit as training the large hospital resident, the creation condition is them after being qualified Would like to serve the community medical organizations, rural clinics of the basic unit. Meanwhile, the hospital where the hospital of higher level should take the initiative with the basic unit keeps good cooperation, get up " gatekeeper " Function,in this way could realize "it is be basic to protect, basic units strong, building by mechanisming " Medical reform goal. " twelve five " In the planning outline, the content about strengthening the medical service system in urban and rural areas and building, advancing the reform of public hospital actively and reliably, emphasize the integration of urban and rural areas, equal basic medical service system construction that melted, just in order to meet the basic medical demands of masses in urban and rural areas to the maximum extent, relieve the excessive concentration of high-quality medical resources, reduce the financial burden that excessive medical care causes to common people and the society. (reporter Li HongMei)

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