It is not only necessary but also feasible to allow residents to have the freedom of choice to sign a contract with the medical community

Abstract: only by adopting the new method of "allowing residents to have the freedom to sign a contract with the medical community and other relevant supporting measures", can the medical community of our country go further and better! In recent years, since the pilot of "medical group + medical insurance pay per head" mode in Luohu of Shenzhen and Tianchang medical community of Anhui has achieved great success, the mode has been highly valued by the State Council and its relevant departments, and has been comprehensively promoted in the country At present, more than 3000 county-level medical communities have been established in China If we add the 567 that the national health and Health Commission will focus on this year, there should be nearly 4000 medical communities in China In this way, in more than 2000 counties (districts, cities) in the country, there is at least one medical community in each county Although there are some disputes about whether to build a medical community or not in the country, the medical community has been popularized all over the country, and there is no way back What's more important for us now is how to build these built and to be built medical communities How to build these medical communities? The most important thing is to change the practice that the medical community in China generally does not allow residents to choose to sign a contract freely The author has been paying attention to the construction of medical community in China for many years, and has seen many typical cases of national famous medical community, but has never found that there is a case in which residents can choose the free signing of medical community The author can not see the implementation plan of more than 3000 medical communities in China, but it should be confirmed that it is a common practice in all parts of the country that residents do not choose the freedom of signing medical communities The author thinks that in the place where the medical community has been established, the local government requires all residents to sign a contract with the medical community, but as for which medical community to sign a contract with, residents should have freedom of choice Otherwise, it will bring different degrees of harm to urban and rural residents, medical community itself and local government This is reflected in: First of all, the service quality of residents cannot be guaranteed Because which medical community the residents sign with is determined by the administrative region designated by the local government, and the residents cannot help themselves Even if the residents are no longer satisfied with the service quality provided by the signed medical community, they have no choice but to bear it year after year, so the residents' sense of medical and health security can be imagined When the communication industry was completely monopolized by the government post and Telecommunications Department, I spent several thousand yuan to install a telephone line and waited for more than a month On the day when the telephone was installed, the workers who installed the telephone not only needed to pick him up in a special car, but also gave him two packs of famous brand cigarettes, otherwise they would not come to the door for various reasons But now there is a broadband in the house As long as there is a phone, there will be workers coming to the house immediately, and they will not even drink water Is this the thinking and moral standard of workers now higher than before? Obviously not The only difference is that it is not exclusive monopoly but fierce competition among many enterprises, which forces enterprises and workers to improve work efficiency and service quality The same is true for the healthcare industry Secondly, it hinders the healthy development of medical community Because the residents have no freedom to choose the medical community to sign a contract, each medical community will have a fixed number of people signing a contract and a fixed lump sum fund for medical insurance every year, regardless of the quality of their work Although the government has a variety of performance appraisal measures for the medical community every year, due to the bureaucratic style, equalitarianism and "big pot rice" mechanism that are hard to overcome by the government departments, the majority of the appraisal results are the same with more work and less work, good work and bad work This kind of "big pot rice" mechanism will make the excellent medical community can not get further development, and the backward medical community can not be eliminated Without the survival of the fittest, the medical community has neither external survival pressure nor internal driving force As a result, it can only force more medical communities to "muddle along" In this way, although the medical community of our country can develop rapidly through the administrative power of "running horse and encircling the land", the service quality cannot keep up with it, and it will not go far in the end In particular, the medical community in some places is still "one and only one" Although a few places have taken some special measures under the special background, some obvious phased results have been achieved in the near future However, if the monopoly continues, there will be no development power brought by market competition pressure, and only administrative intervention will inevitably lack the sustainable development momentum, and its final outcome can be imagined Third, social medical communities will be shut out forever As the saying goes: "there is no grass under the big tree." The existing county medical communities are basically public All the contracted residents are assigned to the public medical communities by the local government according to the administrative areas Naturally, the medical insurance funds of these residents are also allocated to the public medical communities according to their heads In this way, not only the social forces run ordinary medical institutions will be greatly affected, but also the social forces run medical communities will be seriously restricted Because the social forces run the medical community, the residents must first sign the contract, and in order to obtain the contracted residents, it is necessary to host a number of township health centers or community health service centers where the residents live But it is extremely difficult to trust these basic public medical institutions If it can't be trusted, the local government can't approve social forces to run the medical community Some people compare this to the new "glass door" and "spring door" in front of the medical community run by social forces If these two doors are not dismantled, the documents issued by the ten ministries and commissions of the State Council or the recent leading group of health reform of the State Council to encourage and pay the social forces to lead the medical community may be empty If these two doors are not removed, it is only as early as possible for the public hospitals to close their doors and "run for horses and enclosure" Fourth, it brings unnecessary troubles to local party and government leaders If it is up to the government, not the residents themselves, to decide which medical communities the residents sign up with If the non-public medical communities are to be developed in the future, which areas of residents should be allocated by the government to these medical communities? What are the methods and standards of distribution? This will make it difficult for local leaders, especially the main leaders In the political environment of the central government's high-pressure anti-corruption, government officials can neither "do nothing" nor "act in disorder" However, there is neither a reasonable distribution method nor a clear distribution standard, so how to achieve "correct action" If the leaders of relevant government departments can't decide, they can only put a "hot potato" in the hands of local party and government leaders, or even major leaders In order to get more "cakes", maybe some people will use improper means of public relations, and there will be more corruption cases in the medical field Objectively, it also adds unnecessary trouble to local leaders If the medical community signs up to let residents "vote with their feet", the troubles of local leaders will disappear It should be noted here that although some places allow residents to choose the practice of local medical institutions outside the contracted medical community, which can make residents more convenient to see a doctor to some extent, the practice can not avoid the adverse consequences of the above four aspects To sum up, if the contracted residents of the medical community do not have the right to choose, they will not be able to form a competitive mechanism of survival of the fittest If they continue to rely only on administrative intervention, they will not be able to give full play to the advantages of the medical community, but may also abandon the achievements of the medical community, or even go astray It may be said that if the local government allows residents to have the freedom to choose the signing of the medical community, is it operable? I think the answer is yes According to the basic practice of "four in one" medical community mode, the author puts forward the following specific operation methods: 1、 If it is a county with a large population and a strong service ability of county-level hospitals (including districts, the same below), two or more county-level medical communities must be established (since it is called medical community, it must be close); if some of the population is small and the service ability of county-level hospitals is weak, it can be led by the relevant departments of the local municipal government to integrate the medical services of neighboring counties Resources and contracted population resources, establish a number of medical communities with real independent legal personality, and implement the unified management of people and property At the same time, the grass-roots service outlets of each medical community can be set up on their own according to their own needs, just like the banking industry and the communication industry, not limited by administrative regions The same urban and rural community can have multiple primary service outlets of medical community The purpose of this approach: first, it is to establish multiple medical communities, which can break the exclusive monopoly situation of medical communities; second, it is convenient for residents to select a medical community's grass-roots network nearby their residence to sign a contract, and enjoy all the services of the medical community 2、 Referring to the practice of UK residents choosing any private clinic nearby for registration (i.e signing a contract), China should also allow residents to choose a medical community with Grass-roots Service outlets nearby for signing a contract As long as the residents can pay the premium (personal part) according to the regulations, any medical community shall not refuse any local residents to sign a contract The contract period shall be at least one year, and it can be renewed after the contract period expires, or other medical communities can be selected to sign And the implementation of medical insurance "money with people", that is, which medical community the residents signed a contract with, the residents' health (i.e prevention and treatment of disease) insurance government subsidies and individual premiums paid by the government medical insurance fund management agency to which medical community regularly allocated If the fund is over used, it will not be supplemented, and the savings will be returned to the medical community At the same time, the residents and the medical community settle the expenses according to (i.e disease diagnosis related groups) The purpose of doing this: first, the residents have the freedom to choose the signing of the medical community, which urges the medical community to use high-quality and cheap medical and health services to retain and attract more signing residents, instead of relying on the local government to distribute the long-term fixed signing population according to the administrative region; second, the government and the medical community are to implement the head based settlement of health insurance costs, so as to promote the medical community to consciously control The third is that the patients and the medical community settle the expenses according to DRG, so that the contracted residents can get more standardized treatment and pay more reasonable expenses 3、 Social forces can independently form non-public medical communities with leading hospitals and community service outlets, or form non-public medical communities by trusteeship of local community public medical institutions Whether it is a public medical community or a non-public medical community, it is up to the residents to choose who to sign the contract with If it is a non-profit medical community, it can get the same fair financial subsidy as the public medical community It should be the social medical institutions or private enterprises (such as Internet giants) with real strength and good social reputation to undertake the non-medical community The purpose of this is to change the monopoly situation of the public medical community, and promote the public medical community to improve work efficiency and service quality through the role of catfish effect 4、 All member units of the medical community (including public county hospitals, township hospitals and community health service centers) will no longer undertake the task of raising funds for the medical community from the local county government, neighborhood office and township government, and the local financial and tax departments will subsidize such funds to each contracted resident through appropriate ways, so as to improve the premium subsidy standard of all residents