Behind the sky-high funeral expenses of the Three Hospitals of Beijing Medical College: The chaos in the morgue is frequent, and it is time to cancel it?

The "sky-high" funeral expenses reappeared, and the three hospitals of Beijing Medical College were caught in the storm.

Half a month ago, the media exposed that "the third hospital of Beijing Medical College collects sky-high funeral fees". In February, a body temporarily stored in the morgue of the Third Hospital of Beijing Medical University, 3 days later, the family was charged 38570 yuan in funeral fees in the hospital, of which 5990 yuan was bathing SPA, 3990 yuan was liturgical services, and 600 yuan was provided for meal services...

The bill was issued in the morgue of the Third Hospital of Beijing Medical College, but the bill was addressed to a company called Beijing Paradise Xianghe Funeral Service Co., Ltd.

Subsequently, behind the outsourcing of the morgue of public hospitals, it was also made public.

In fact, because there is no explicit regulation prohibiting it, the "mortuary outsourcing model" of major public hospitals in Beijing is not uncommon.

In addition to the Third Hospital of Beijing Medical University, the funeral company involved in this case has also provided services for many large public hospitals such as Peking University Shougang Hospital and Tsinghua Changgeng Hospital.

However, these mortuary outsourcing companies have caused a lot of trouble for the hospital over the years, and even frequently have a huge negative impact on the hospital's reputation.

Outsourcing companies often take advantage of the "no bargaining" rule in hospitals to "sneak up" on the families of the deceased and charge high funeral service fees in the hospital. In past reports, it has appeared repeatedly. As early as 10 years ago, there was the former Second Hospital of Chaoyang District of Beijing, because of the "sky-high price" funeral expenses of the outsourcing company, which was constantly negative, and eventually collapsed and smashed the brand.

However, for hospitals, operating morgues is facing difficulties such as difficult to hire, cost of consumption, and management burdens, and outsourcing not only saves trouble but also collects money, which has almost become an inertial choice for hospitals.

On April 17, the "sky-high" funeral fee incident made new progress, and the Beijing Health Commission called for strengthening the management of hospital morgues in the city, prohibiting any for-profit funeral services in the hospital morgue area, and carrying out relevant work in accordance with laws and regulations. Some commentators said: In the future, will the morgue of the hospital not be outsourced?

Why is the outsourcing management of hospital morgues chaotic? How much responsibility does the hospital have? If the "sky-high" funeral expenses are repeatedly prohibited, will the morgue in the hospital be cancelled? Who can protect the rights and interests of life's "last journey"?

The dilemma of mortuary outsourcing

For the families of the deceased, the grief, strangeness and chaos in the morgue are the first steps to their exploitation.

At this time, a bill with an obviously inflated price and fraudulent is placed in front of the family, who often signs it directly out of trust and inertia in the hospital.

Wang Fangfang, a professor at Peking University's School of Medical Humanities and a member of the Social Affairs Expert Committee of the Ministry of Civil Affairs, told Eight Points Jianwen that the funeral agency company took advantage of the negotiation advantages of the hospital premises and the grief of the deceased's family members.

"A project of several thousand yuan will be easily rejected in the normal business game, but it will be tacitly acquiesced in the specific time of the death of a loved one. Merchants take advantage of the reluctance of their distressed families to bargain and frantically offer prices. He said that the unspoken rule of "no two prices for doctors" in the hospital has also been used by merchants, "Drugs and surgeries in the hospital are not bargained, and the outsourcing company uses the hospital's life and death separation time node and the hospital's space and occasion atmosphere." ”

The so-called sky-high projects were not implemented and completed in the morgue, but non-inclusive projects completed in the funeral home, which were brought to the morgue in advance for negotiation. If you talk about these projects in the funeral home, you will not be easily accepted by the family. Time and space are changing, and the emotions of the family members have recovered.

For example, "flower beds, petals, ceremonies, etc., these are the costs incurred in the funeral home, and the outsourcing company maximizes the use of the negotiation occasion and collects the fee in advance, which is obviously suspected of commercial fraud." Wang Fang explained.

Once the family of the deceased arrives at the funeral home, they will find that there are actually many options here, and the "sky-high" funeral project is not a must. In Beijing, for example, the Civil Affairs Bureau will have thousands of yuan of funeral subsidies for the death of beijing residents. If it is a public official, the death has a large funeral fee, the public welfare funeral home has also launched a number of inclusive packages, according to the relevant departments of the Babaoshan Funeral Home, the minimum fee of the inclusive package (including farewell, cremation, urn) only needs a thousand yuan.

By all angles, morgues are not a place of "high consumption" to accumulate wealth, but a place of transition from hospitals to funeral homes. But precisely because of the characteristics of "transition", the function and positioning of the morgue are blurred and chaotic all year round, and they are also very easy to deform.

This also creates a dilemma after mortuary outsourcing.

In terms of administrative management, the funeral home is under the management of the civil affairs department, and the hospital is under the supervision of the Health Commission, "The funeral (morgue) in the hospital is not managed." A senior funeral industry practitioner told Eight Point Jianwen that after the morgue was outsourced, the charges "did not matter on both sides", and the morgue directly became a hotbed for breeding chaos in the funeral market.

For hospitals, morgues are marginal. It is understood that the entrusted management rate of the morgue of Beijing Secondary Hospital is more than 90%.

On the one hand, the outsourced morgue is neglected, but on the other hand, the outsourcing costs of hundreds of thousands or nearly one million are also the reasons why some hospitals do not supervise outsourcing companies too much.

According to a person familiar with the matter, the outsourcing cost of the morgue of the Third Hospital of Beijing Medical University is about 1 million yuan. "Funeral service companies are equivalent to spending nearly a million to rent the brand and place of the hospital in the hospital, and they definitely want to earn back this part of the investment." A person familiar with the matter revealed.

Can the morgue in the hospital be cancelled?

Since it is easy to get into trouble in the cracks of the "two regardless of", why is the morgue in the hospital not canceled?

In the early years, a number of morgues in hospitals were cancelled across the country – in many cities, morgues in hospitals disappeared one after another.

Shenyang, Changchun and Zhengzhou announced the gradual cancellation of hospital morgues as early as 2001, 2003 and 2004 respectively; Wuhan also cancelled a number of hospital morgues after 2005, and by 2015, 80% of wuhan hospital morgues had been closed.

In 2018, the Ministry of Civil Affairs and 16 other departments jointly issued a document, which clearly stipulated: "Strengthen the management of hospital morgues, and strictly prohibit for-profit funeral services in morgues." "This cuts off the compliance of morgue marketization and further accelerates the pace of canceling hospital morgues everywhere."

Although the abolition of morgues is considered a general trend, progress has been mixed everywhere. Especially for megacities, it is not easy to cancel morgues.

In 2012, Beijing municipality formulated the "Morgue Funeral Service Specification for Medical Institutions", until 2021, Beijing Daxing District took the lead in canceling the hospital morgue in the district, with the purpose of "cutting off the source of funeral service profits", within one year, daxing district funeral homes directly transferred more than 1500 bodies from medical institutions, no costs incurred between funeral homes and medical institutions, and the funeral expenses of residents dropped from 20,000 to 30,000 to 3,000 or 4,000.

Some people believe that the pace of Reform in Beijing is slow because the city is larger and more populous, the number and capacity of funeral homes are insufficient, and hospital morgues need to assume part of the temporary storage function of remains. This demand is especially pronounced at a time when the COVID-19 pandemic is more tense. According to eight points of health, due to the city's road closures and insufficient transportation capacity during the epidemic period, some cities cancelled the hospital of the morgue and had to restore the morgue.

However, in contrast, the population and number of funeral homes in Shanghai and Beijing are almost the same, but the connection between funeral homes and hospitals in Shanghai is quite good, and private funeral companies have almost no living space in hospital morgues.

Professor Wang Guohua, deputy director of the Expert Committee of the China Funeral Association of the Ministry of Civil Affairs and director of the Institute of Cultural and Creative Industries of Beijing University of Technology, told Eight Points that the number of funeral homes in mainland cities is planned according to the local natural mortality rate. There are more than a dozen funeral homes in Beijing distributed in various urban areas, and from the perspective of operational history, the funeral services of funeral homes are "completely sufficient", and the problem lies in the management level and efficiency. Improving the level and service skills of the entire funeral service industry is a top priority for the funeral industry.

That is to say, whether the hospital morgue can be cancelled has an absolute relationship with the service capacity of the local funeral system.

A vice president of a third-class hospital in a small coastal town told Eight Point Jianwen that many years ago, due to the improvement of a number of funeral parlors in the local area, the civil affairs department and the health department coordinated to abolish the morgue in the hospital. Since then, there has been no separate morgue in the newly built local hospital.

There are also deans who are happy to see the cancellation of the morgue.

A county hospital president in the southeast region told Eight Points That the morgue is like a "hot potato" for small hospitals, and it is a window for doctor-patient conflicts to occur.

"Many family members will use the morgue to make trouble with the hospital. In the current domestic environment, the dean is not able to cope. The deceased is sent to the funeral home earlier, and the disputes and contradictions in it will be reduced and alleviated a lot. He said.

There are senior practitioners in the funeral industry to eight points of Health to calculate an account, according to the mortality rate of 7 ‰, the population of large cities of tens of millions, funeral homes less than 20 to calculate, each funeral home in the city has to serve dozens to hundreds of deceased people every day, queued up, the ceremony is often calculated by the hour. This is far from the standard of one funeral home per 10,000 people in developed countries, behind which mainland residents are taboo about death and the limited choice of funeral home addresses.

"Endure grief, be busy, be at a loss, and then say goodbye to your loved ones without even a little time, 45 minutes to the end, three turns gone." Mare said that the haste of farewell may leave the family with regrets that are difficult to resolve, "Chinese there is no death, only death is not good." ”

This is not just Beijing, but a phenomenon that is common throughout the country. This is also the reason why some experts and practitioners recommend keeping the hospital morgue, they believe that the relevant market behavior is "better than loose", in addition to the crowded and busy funeral home, there should be a corner, there are more alternative ways, allowing the living and the deceased to get along for a while.

Who will guarantee our last journey?

If according to the latest requirements, it is forbidden to carry out any for-profit funeral services in the hospital morgue area, and instead extend the services of the funeral home to the hospital, and send a car to pick up and transport at the first time, forming a "closed loop of life and death". What are the difficulties in doing so?

"Lacking self-confidence and initiative, funeral homes have no incentive to extend their services forward." Lin Futong, a funeral professional teacher at Fujian Civil Affairs School, summed it up this way. A number of experts have shown that the nature of funeral homes in the mainland is mostly state-owned, and profits are decoupled from the wages of employees, and there is a lack of initiative in work. Moreover, the talent team of the funeral team is small, and the level of talents needs to be improved urgently, which has a direct impact on the deployment strength, cultural level and richness of funeral services.

If one link of the funeral home is temporarily difficult to open, at the other end, the hospital's initiative to provide services is also a way. A palliative care doctor told Eight O'Clock Jianwen that when he was practicing in a public hospital in Wuhan, the department took the initiative to provide services such as grooming and wearing birthday clothes for the deceased, and the fee was the same as in the funeral home. On the one hand, this can add some additional income to the low-income palliative care department, and on the other hand, the funeral service provided by the doctor who finally treats the deceased can provide great comfort to the bereaved family.

The department also chose to cooperate with suitable folk "one-stop services" (providing birthday clothes, bathing, dressing, spiritual hall arrangement, wreaths, contact cremation, etc.), but the palliative care doctor said that the department doctors were deeply involved, and there was an assessment and family return visit to the "one-stop", as long as the family was not satisfied, it would be replaced. The service content and price point are agreed by the family and the "one-stop", and the fee is reasonable. There have been no cases of dissatisfaction among family members in the past few years. But this is a luxury for most public hospitals, which are either busy with daily operations or do not have hospice units.

"The living belong to the hospital / health management, the deceased to the funeral home / civil affairs management", under such a mindset, both sides are unwilling to take the initiative to take a step, the connection between the hospital and the funeral home, the belt between life and death, the civil forces work for it, and chaos also arises.

Many experts have shown that in the case of unclear powers and responsibilities and limited motivation of all parties, it is particularly important to support laws and regulations and coordinate management - whether it is a funeral home or a hospital, it is necessary to "be famous", at least not to let it risk arrogance, but to act in the morgue with confidence.

However, Eight Points found that in 2018, the Ministry of Civil Affairs and other 16 departments jointly issued the "Guiding Opinions on Further Promoting Funeral Reform and Promoting the Development of funeral Undertakings", but there was no health commission in the issuing department.

Wang Guohua said that after the founding of the People's Republic of China, the mainland's "Funeral Law" has not been promulgated for a long time, which at least reflects the shortcomings of the competent government departments in the legal management of the funeral industry, indicating that the government's attention to funerals, which is a major event related to the national economy and people's livelihood, needs to be improved. As a public service space, hospital morgues should not become a space for institutional profits. Similar to the management of hospital morgues, it is necessary for government departments to issue management rules to strengthen the management of various types of "paid services".

In Wang's view, in the face of the death incident, there is now the embarrassment of the "railway police", the near-death rescue in the hospital, the supervision in the health commission, and the clinical death is handed over to the funeral institution, under the supervision of civil affairs, how to open up this "joint department", the ideal way of cooperation should be the funeral home in the hospital to set up a station, equipment, personnel provided by the funeral home, responsible for refrigerating the remains, providing body cooking services in accordance with funeral industry standards, basic services into the inclusive project management, special services special consultation; the hospital provides a morgue site, Rent can apply for financial assistance, while promising to provide humanistic care, such as assisting in the care of the remains, and sending the deceased on their last journey. As for other items such as flower beds and urns, you can go to the funeral home to negotiate again and negotiate on an equal footing.

Wang Fangfang has been advocating "medical funeral integration" for many years, he recalled, last year's Peking University Qingming Forum also discussed this topic, but only the appeal of the academic community can not solve this problem, the Health Commission and the civil affairs department to hold a special consultation meeting, on the pain points of the people's concerns to communicate and dialogue, and jointly optimize the hospital morgue management.

"Being overwhelmed is not a reason." Wang Fang stressed that death is divided into four periods, near-death, clinical death, biological death, social death, hospital services can not be limited to the near-death period, should be extended to clinical death, biological death period, this part in addition to the placement of the body, clean to maintain dignity, but also to the deceased family grief counseling, which is the ICU, emergency room, hospice ward should be responsible. How to connect with the funeral home, there should be a plan for this. The absolute cost of these services is not high, and there is a gap that justifies applying to the financial sector for subsidies. "Beijing is a medical highland, there are more than a hundred tertiary hospitals, there are many people from other places to see a doctor in Beijing, and the connection between hospitals and funeral parlors in Beijing should also become a model of medical humanistic care in the last journey of life, and the people of the whole country should not be allowed to see jokes or even criticize."

Li Lin, Wei Xiaoning, Yan Yucheng | wrote

This article was first published on the WeChat public account "Eight Points Health" (ID: HealthInsight)

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