Beijing Public hospital nurses ' nursing fee is up 10 times times the controversy

Public hospital reform: Beware of "looking critically ill" "China Economic weekly" intern reporter Euna Lee | Beijing reported recently, a "Beijing public hospital nursing costs up to 10 times times" The news, once again sparked public debate on the new health reform.　　It is reported that the Beijing Municipal Health Bureau has submitted to the municipal government Nursing Service price adjustment program, for example, three-level hospital, the current one, tertiary care fees for 9 yuan/day, 7 yuan/day, 5 yuan/day, the proposed adjustment of the standard is 90 yuan/day, 70 yuan/day, 50 yuan/day. "I really do not know how to reform the reform of China, the more expensive, it is sad." "It should be borne by the State and the hospital rather than passed on to the patient," he said.　　"Many people are dissatisfied with this, that health reform should not be" more and more expensive, increase the burden of medical care for the people. According to the industry, in 2009, the Beijing Municipal Health Bureau, the Finance Bureau of Beijing 8 Hospitals carried out public hospital medical cost accounting.　　The current standards of nursing fee and treatment fee are too low, which has become one of the reasons of the loss of public hospitals, which leads to the decrease of the working enthusiasm of the medical staff and the insufficiency of nurses ' allocation. In order to break the vicious circle of the Medical Service project, the Beijing Municipal Health Bureau proposed to adjust the price of nursing service.　　At the same time, the Beijing Municipal Health Bureau said the cost will be as far as possible through the health care solution, without increasing the burden on patients. "The problem with the new medical reform is that the system has not been straightened out and the subsidy has not been implemented, and 6 million of medical personnel have not been mobilized." "National Consultative Committee members, famous orthopaedic experts, China Academy of Chinese Medicine, Wang Jing Hospital orthopaedic director Wen Jianmin said, can not sacrifice the interests of hospitals, health care workers to obtain the" success "of health reform.　　Otherwise this "success" is unreliable, will also lead to "see critically ill" phenomenon, the ultimate victim of the patient.　　"The increase in nursing fees is not in place, too weak," China Economic Weekly: You are "nursing fee standard to be raised 10 times times" How to see? Wen Jianmin: Of course it's good news.　　Over the years, the shortage of nurses has seriously affected the normal operation and service standards of public hospitals. Why are there more and more nurses in the hospital? As the nurses are getting less and more, a nurse is responsible for two or three wards. Therefore, the nurse is only responsible for medication, injection, surgical arrangements, emergency treatment, can no longer take into account the patient's day-to-day care. Patients are not given the care they deserve and only have their own caregivers. But the nurses are generally managed by the company, their medical knowledge and service level are uneven, even with the nanny. For example, how should a patient with cholecystitis, hypotension and hemiplegia be taken care of?　　They are not aware of dietary taboos, massage techniques and methods of care that can easily cause accidents.　　China Economic Weekly: So do you think the rise in nursing costs can solve the current situation of the shortage of nurses?　　Wen Jianmin: This is the affirmation of the labor force paid by the nurses, is a kind of comfort, but I think the intensity is not enough, can not reach the effect of expanding the nurse team. The nurse's wages are still low., such as advanced care, they are generally bachelor degree or above, provide 24-hour care, according to the standard, a day of care costs of 90 yuan, the hospital to deduct a part of their hands, pay is not high. So the hike is not in place, and it's still a lower charge. This increase is too weak, too one-sided, from the mobilization of the enthusiasm of the medical staff is far from the difference. Nurses are only a part of the medical staff, even a small part.　　And a lot of doctors, it's a bigger team. The inadequacy of hospital establishment is the key.　　The hospital continues to expand, the increase in the number of patients, and the establishment of the hospital has been very small, not even allocated to doctors, so the nurses are basically the appointment system, there is no formal preparation, they are not only low treatment, the work is not stable, therefore, the adjustment of medical staff, so that it is the most important to match A great deal of determination and action is required to mobilize the enthusiasm of all medical personnel.　　I think that the recent reform of public hospitals is not a cure, it is difficult to achieve a good "curative effect", for example, the government subsidy which is regarded as a "life pill" in public hospitals is likely to become formalistic, and public hospital reform still fails to find a "cure". Government subsidies are hard to put into place. China Economic Weekly: Many people have high hopes for government subsidies to public hospitals, even as a measure to improve hospital operating conditions and the income level of medical staff.　　What do you think?　　Wen Jianmin: First of all, to determine the level of medical staff income is the source of income problem, first of all, to be clear in the end is the "drug-raising" or "technology to raise medicine"? I think it is reasonable to "foster medicine by Technology". To encourage doctors to delve into medical skills, to improve the technical level, to form the level of technology as the basis of the level of fees to reflect the technical value of health personnel. I think it is also possible to increase the fees for pharmaceutical services, that is, to provide a fixed fee for prescribing a drug, and it must be unrelated to the amount of medication prescribed, to reflect the value of the Doctor's knowledge.　　This also can avoid the doctor to open "big prescription" problem.　　Of course, the reversal of the source of income is a problem of institutional reform, which takes a long time, and the availability of subsidies is the key to public hospital reform.　　China Economic Weekly: Do you think government subsidy can be put in place?　　Wen Jianmin: I think it's hard to get subsidies in place. The background of the mechanism of "taking medicine and Nourishing medicine" is that in the 50 's, the state subsidized hospitals by adding drugs to solve the shortage of financial investment.　　There are some difficulties in government subsidy. First, the medical financial investment is insufficient, the history debt is too many. According to the data released by the Ministry of Finance, 2003-2007, education investment of 2.43 trillion yuan, and health care only 631.1 billion yuan, nearly 4 times times; 2008, education invested 901.021 billion yuan, medical investment 275.704 billion yuan.　　The loophole created by the chronic shortage of medical input is huge and it is difficult to fill it up. Second, taking Beijing as an example, it is possible to calculate how much money the government will need to subsidize the public hospitals in full. Beijing has more than 60 three-level hospitals, a three-level hospital has hundreds of millions of to a billion ofYuan of water, of which at least 40% of the drug income, we have an average of 1 billion yuan to calculate, that is, 400 million yuan, multiplied by 15% of the drug, a three-level hospital's drug income has 60 million yuan. If you want to maintain the status quo, light Beijing subsidized level three hospitals need at least 3.6 billion yuan, have so much financial resources?　　The national subsidy public hospital, also need how huge amount! If this number is not achieved, the hospital income is not enough, but it can not save medical expenses, it can not stop the hospital construction, it can not reduce the number of patients, then the only way is to reduce the income of medical staff. Therefore, I said, we can not sacrifice the interests of hospitals, health care workers to obtain the "success" of health reform.　　This "success" is unreliable.　　China Economics Weekly: Is this your concern about the future, or is it a firsthand experience of the status quo? Wen Jianmin: This has happened, most notably in the primary care sector. After the implementation of the 0 difference in drug sales, there will be village doctors reaction can not be done. They use their homes to open clinics to serve local villagers, and they need a driver to go far to buy medicine back. Drug addition is their main source of income, this addition to the village doctors level only 5%~10%. Now, these income has been stopped, but the financial subsidy can not be timely, fully in place, village doctors will not do, the villagers will not be convenient to see a doctor, to the township doctor also increased economic burden.　　The bottom of the medical network is critical, sudden public events, natural disasters, epidemic prevention, family planning, chronic disease prevention and treatment must rely on these "guardian God" efforts. The problem with the new medical reform is that the system has not been straightened out and the financial subsidy has not been implemented, and 6 million of medical personnel have not been mobilized.　　In particular, public hospital reform, it involves a wide range, difficulty, water depth, financial subsidies are not in place will be prone to trouble, can not use administrative orders to solve the problem.　　"Looking critically ill": The Future to "import" good doctors "China Economic Weekly": The Doctor's enthusiasm can not be mobilized what will happen? Wen Jianmin: There will be "see critically ill" phenomenon.　　"Crisis" refers to the lack of good technology, no good doctors, the ultimate victims of the majority of patients. I engaged in Chinese medicine research for many years, the most heartache is that a lot of Chinese medicine treasures were slowly lost. For example, wrist fracture reduction, manual reduction and small splint can be completed treatment, not only cheap, but also reduce the patient's pain. But now the universal method is tens of thousands of dollars of surgery, why?　　Chinese medicine treatment only 80 yuan, do not make money, who still do? Outside thought the doctor income is very high, in fact, the Beijing three Armour Hospital department chief physician The monthly income insufficient million people, the health reform reform is not good will have the doctor to change careers. Medicine is an empirical science, which requires the accumulation of years of medical experience. I'm worried that our country needs to "import" good Doctors in the future.　　I have students who are good prospects, but because the doctor's income can not repay his student loans, to protect the basic life, the result of selling medicine, it is very sad. China Economics Weekly: What advice do you have for health reform?？　　Wen Jianmin: First, the government should increase investment, system and finance to support, can not cancel the hospital's drug income, and can not be fully subsidized in time, otherwise, the hospital folder in which there will be problems.　　Second, the use of commercial insurance supplementary medical insurance, that is, between the patient and the hospital, a third party, balancing the interests of hospitals and patients, to curb the phenomenon of "medical trouble". Third, resume the original appearance of the Doctor Freelancer. China is the practice of fixed place diagnosis and treatment, out of the hospital's diagnosis and treatment are illegal. Foreign countries are licensed to be able to flow across the country or the province, doctors can open their own clinics. Government regulation and industry self-discipline are two ways to control the medical staff by controlling the license.　　Not only give doctors a full space for development, but also ensure social benefits, so that doctors contribute to the country. The hospital managers should be management experts, not medical experts.　　The more the better doctors are now, the more they are being held hostage by chores, and the scientific work is hard to break through. Charities and philanthropists can fund hospitals, or directly fund hospitals, and implement government-led, charitable-funded public hospitals.