How long will it take for the reform to meet the "cotton wall" and the new medical reform

Source: on March 10, 2015, compared with many rapid reforms in other fields, medical reform is experiencing a period of hesitation after entering the deep water area The representatives who are attending the two sessions of the National People's Congress describe the difficulty of reform in this field with "climbing the hill and climbing the ridge" In April 2009, "opinions on deepening the reform of medical and health system" was released, focusing on solving the problem of "difficult and expensive medical treatment" reflected by the masses, which became the highlight of the new medical reform plan Seven years later, the public's voice and even complaints about deepening the reform of the medical system are still strong The representative of Zhong Nanshan frankly admitted that the problem of "difficult and expensive medical treatment" has not been significantly alleviated, and more significant breakthroughs are needed in medical reform Reality dilemma: reform hit "cotton wall" hard "To be honest, this kind of pilot time is too long!" Guo Shuqin, the president of Baoding first central hospital, said that he was disappointed in the slow progress of medical reform "The pilot project of public hospitals, which took three years first, then three years, has yet to produce results Doctors at the grassroots level are looking forward to it They think it's a little slow now " Improving the basic medical security system, consolidating and improving the basic drug system, and reforming public hospitals are the main tasks to be promoted in the 12th Five Year Plan of medical reform According to Guo Shuqin, the reform of public hospitals is the hardest thing to crack "It cannot be said that the national level does not attach importance But facing the world-class problem of medical reform, it is much more difficult than we think " A number of Representatives interviewed by reporters acknowledged that the medical reform has huge funds, many departments and complex interests Its accelerated progress needs strong departments to coordinate the implementation The reporter noted that in the list of 36 members of the medical reform expert advisory committee of the State Council, it not only includes important figures from various departments such as health, medical insurance, finance, staffing, publicity, but also includes well-known scholars and experts from Taiwan, the United States and other places in China The person in charge of the State Council's medical reform office gathered opinions at the group meeting just after the opening of this people's Congress In the past few years, with clear reform path and strong reform measures, the decision-makers of medical reform have directly promoted the initial realization of full coverage of medical insurance, and greatly improved the accessibility and convenience of medical treatment However, the fortress of public hospital reform is difficult to break through How to break the existing revenue generating mechanism of public hospitals? Up to now, there is a lack of authoritative and feasible top-level design In the past six years, most of the pilot projects have been optional There is no doubt that the reform hit the "cotton wall" A comparison of figures shows that the new medical reform needs to improve efficiency: from 2007 to 2013, the total cost of national health rose from 1.12 trillion yuan to 3.2 trillion yuan In six years, the cost of health has nearly tripled, far faster than the growth rate of residents' income However, the actual reimbursement proportion of urban employees, urban residents and new rural cooperative medical insurance in China is only 53.8%, 44.9% and 38.0% respectively, which is still lower than the level of effective risk sharing Sun Zhigang, deputy director of the national health and Family Planning Commission and vice chairman of the leading group of medical reform of the State Council and director of the medical reform office, said at the panel discussion that he would like to hear the suggestions of the members, but in the discussion, he should make clear which problems are the original ones and which are caused by the reform For example, many problems in the system and management of urban public hospitals mentioned by you are not actually medical problems Because the reform of urban public hospitals has not really begun On the opening day of the Guangdong delegation, Zhong Nanshan once again pointed to the topic of medical reform: "public hospitals should return to their public welfare, which is the bull's nose of the new medical reform." Tracing back to the source: the lack of consensus, the interweaving of interests from the reform of public hospitals, hierarchical diagnosis and treatment to the separation of medicine, from the running of medicine by social capital, drug bidding to the reform of drug price, which are almost old-fashioned issues, are still the hot spots reflected by the representatives of the two sessions The difference is that these problems are more and more linked to the new health care reform According to Hou Jianming, Professor of Fujian Medical University, "the slow progress of the new medical reform is the result of the potential complex interest game." In fact, although the direction of government led and public welfare health reform has been clear, there is still a lack of enough consensus in the process of promotion The debate on the direction of government led, public welfare, market-oriented and diversified has continued in various ways under the macro background of the government's decentralization of profits and the slowdown of economic growth It can be proved that in the panel discussion of the medical and health circles at this CPPCC conference, the views of "market school" and "public welfare school" had a fierce collision Behind the lack of consensus is that the income of hospitals and medical staff is still inseparable from the market Han Yaling, vice president of the General Hospital of Shenyang Military Region and director of cardiovascular medicine, said with her own experience: "the outpatient doctors in our hospital pay 3 yuan for a visit to the park, and the tickets cost dozens of yuan; the first-class nursing inspects the patients every 15 minutes, caring for more than 100 times a day, earning 297 yuan a month, and employing a nanny at least 5000 yuan a month Is the health care workforce too cheap? " Interestingly, after leaving their posts, many representatives of former government officials began to converge with Zhong Nanshan Their voices echoed each other and directly pointed to the stubborn disease of medical reform Wang Longde, academician of the Chinese Academy of engineering and former Vice Minister of health, said: "when patients go to the hospital for treatment, doctors should be linked with economic benefits How can they trust each other? Whether the next step of medical reform is successful or not depends on the fact that the Department Director and the doctor no longer calculate the economic accounts.. " Huang Jiefu, former Vice Minister of health, criticized and said: "I said one thing, there is actually no public hospital in China at present, which is realistic In today's hospitals, 93% of the money is earned by themselves, while only 7% is invested by the government Therefore, the whole structure of the hospital is profit-seeking " At the same time, the implementation of the new medical reform will inevitably touch the chain of vested interests The representative from Fujian confirmed that although the reform of Sanming District's "self-contained dry food" public hospitals had a significant effect, drug costs dropped significantly, patients' burden reduced, and medical staff's income increased, some groups that benefited from the "potential rules" of drug circulation also spread the negative waves through wechat and other new media Some drug supply and marketing enterprises even intend to bypass Sanming market, so that some drugs can not be matched The government's money: spend enough, spend accurately, spend efficiently the more difficult it is, the more we need to move forward quickly "Medical reform is an important guarantee for building a well-off society in an all-round way," said Zhang Shaochun, director of Anhui Provincial Development and Reform Commission "Deepening the reform of medical and health system is directly related to the most basic interests of the people It is not allowed to wait, not slow." The biggest difficulty of the new medical reform is that we are still not clear about the concept of "basic security" Xu Yong, Dean of the second hospital of Tianjin Medical University, said that "the public welfare of medical reform, in the final analysis, is reflected in government expenditure." He suggested that the government's money in health care should be spent fully, accurately and in place In a speech to the CPPCC National Committee, the Central Committee of the rural labor party quoted the figures of the level of national health investment - in 2013, the proportion of China's total health expenditure to GDP was only 5.57% Among them, the government's health expenditure is 952.14 billion yuan (30.1%), which is lower than the level of 30.7% in 2011; the personal health expenditure is 1072.68 billion yuan (33.9%), which has not reached the target of reducing the proportion to 30% in the 12th Five Year Plan The reporter noted that in the budget report submitted to the National People's Congress for deliberation, in 2014, only 96.5% of the budget for medical and health care and family planning was completed by the central government The main reasons for this problem are the decrease of medical insurance expenditure settled according to the facts and the reform expenditure of public hospitals arranged according to the work of medical reform Zheng Xincong, deputy secretary of Quanzhou Municipal Party committee, proposed to pay attention to health like education "Every year, education funds are hard invested 4% of GDP, with obvious effect There is no such input mechanism for health funds How can we ensure the input of the central government to the grass-roots health undertakings? " To adhere to the public welfare road of medical reform, we should not only spend enough money, but also spend accurate money, and even spend in place The representatives noted that in 2012, the average input value of financial subsidies to each hospital at all levels was 165.839 million yuan for the central general hospital and 7.159 million yuan for the county general hospital, almost a fraction of the former Most of the limited funds have been invested in large hospitals It is difficult to solve the urgent needs of the grass-roots level, and it can not alleviate the income generating impulse of large hospitals The consequences can be imagined How the reform principles of public hospitals meet the actual needs is testing today's reformers The representative of Zheng Xincong found that Quanzhou is the place where the floating population flows in, and the medical and health investment can't meet the needs of the actual living population all the time, "there is a lot of pressure" He said frankly: "Quanzhou per capita bed, if calculated according to the household registration population, it is in the forefront of Fujian Province But according to the living population, it is the lowest in the province " He hoped that in the future, the country's transfer payments to local governments would take the factor of migrant population into account Zheng Xincong's suggestion was recognized and supported by many representatives on the spot "The orientation of national health investment should be highlighted At present, the focus is on villages and communities, which are the weakest areas of the foundation, and on population inflow areas, which are the most prominent and concentrated areas of conflict A lot of things are urgent "