Guide
Personally, I think that public hospitals should be changed to two lines of revenue and expenditure like some government departments, so as to change the unreasonableness that the amount of revenue determines the amount of doctors' income, which may save medical insurance funds to a certain extent.
April 20, @烧伤超人阿宝应邀参加了国家医保局组织的医保支付方式改革座谈会.
At that meeting, only 20 medical staff from all over the country were invited, and only Po was a pure clinician. Zhang Ke, director of the National Health Insurance Bureau, Li Tao, and Yan Qinghui, deputy directors of the National Health Insurance Bureau, all attended the meeting, which shows the high level.
At the meeting, Po said four points:
1. Don't let doctors become the backstabbers of unreasonable regulations.
When it comes to health insurance, doctors are a back-stabber. For example, the price of the same drug can be reimbursed if the price difference is several times or even dozens of times. However, in order to ensure the proportion of prescriptions for centralized procurement of drugs, the ball was kicked to the doctors, requiring the doctors to prescribe the centralized collection of drugs, and not to transfer the contradiction to the medical insurance department, and not to refuse to prescribe the original drugs on the grounds that the medical insurance has regulations. This caused a lot of trouble for the doctor and led to a lot of disputes. This practice is very unreasonable and very unfair to doctors.
2. Find out the reason behind the doctor's discharge from the hospital after 15 days.
It is true that the medical insurance department does not explicitly stipulate that "the hospitalization expenses of medical insurance patients cannot exceed 20,000 yuan" and "the hospitalization time cannot exceed two weeks". However, since this phenomenon exists, there must be an intrinsic reason. It can't be a doctor who deliberately tosses the patient for no reason. It is not wrong for the medical insurance department to refuse to bear this pot, but it is necessary to admit the existence of this phenomenon, and actively find out the deep reasons behind this phenomenon and solve it from the root. It's not enough to just "don't take the blame", and it can't.
3. The classification and payment standards of DRG diseases are obviously and seriously detached from clinical practice.
For example, it is too extensive to divide the burn area into groups above 30% and below 30%.
The classification and payment standards for DRG diseases should be extremely hierarchical and detailed, and must be best accomplished by professional associations and medical insurance departments.
4. Do not repeat inspections and punishments.
Some unannounced inspections do not stop until problems are found, and if they do not work once, they will do so twice until the problems are found. And there are duplicate penalties. For the same mistake, under the condition that the hospital has been actively rectified, the city, province, and national flight inspection teams will each punish the hospital once in turn.
Bao revealed that the leaders of the Medical Insurance Bureau have made careful records of these problems and said that they will study them carefully. Director Zhang Ke said: The relationship between the staff of the medical insurance department and the front-line medical personnel is a comrade-in-arms, not a hostile relationship, and the contradiction between the two sides is a contradiction among the people. As a developing country, the country's financial resources are limited. In order to maximize the benefits of the people's life-saving money, the national medical insurance department, as the largest representative of China's medical services, will inevitably adopt various strict control measures to standardize the diagnosis and treatment behavior of doctors and avoid the abuse and waste of medical insurance funds. Whether it is DRG or DIP, it is part of this control and constraint measures. The purpose and intent of these controls is not to interfere with the treatment of physicians or harm the interests of patients. On the contrary, the introduction of these control measures is for doctors and hospitals to better serve patients and better play the role of medical insurance fundsTherefore, in response to the reform of payment models such as DRG and DIP, front-line medical staff should have a correct mentality and actively cooperate to ensure the smooth implementation of the reform measures.
Why the meeting?
It's about solving specific problems.
Small things open a meeting, big things hold a small meeting.
Who will be invited to the meeting?
People who are helpful and insightful in solving problems.
How do you prove that you are a person of insight?
In normal times, it is necessary to express more opinions, do more things, and solve more specific problems, not only to prove ability, but also to solve sincerity. Then, wait to be summoned by the strong and screened. There is always a pair of eyes that are silently watching you.
To be honest, the National Health Insurance Bureau can invite Bao's "stinky mouth" to the discussion, which has already shown the sincerity of its attitude. It shows that they really want to solve the problem, not to solve the person who raised the problem, to really want to do practical things, not to engage in formalism, and to really want to get out of the dream of winning money in the three mahjong games and solve real problems.
However, listen to the Chinese, do not listen to what he says, listen to what he does not say. What he didn't talk about was his interest appeal and his suffering. An obedient person can always hear what others have not said, and then begin to communicate silently. Analysis always falls on paper, and decision-making always falls on paper. Analysis is to put those reasons that can be said on the table, and decision-making is to consider all the reasons that cannot be spoken, and then make a decision.
In fact, the issue of medical insurance, in the final analysis, is still a medical issue.
If you want to manage medical insurance funds well, you must manage the hospital gate.
In social life, as long as the interests of all people are involved, any seemingly trivial problem cannot be solved by an appeal or an order. Abandoning wish-making thinking and returning to the logic of cost and benefit is the thinking literacy that adults need to have.
Personally, I think that public hospitals should be changed to two lines of revenue and expenditure like some government departments, so as to change the unreasonableness that the amount of revenue determines the amount of doctors' income, which may save medical insurance funds to a certain extent.
In addition, in the case of such a shortage of medical resources, it is really necessary to greatly increase the medical fee standard in some aspects and raise the medical insurance reimbursement threshold. For example, if you visit a doctor during non-normal working hours, the fee will be increased by 20% and the reimbursement rate will be reduced by 20%.
In particular, in the emergency department where medical resources are tight, can the reimbursement ratio be greatly reduced or even not reimbursed for non-critical patients, so as to avoid a slight cough or even simply prescribe drugs to crowd out emergency resources.
Resources are always limited, and good steel should be used on the cutting edge. Some people say that having money is not a problem, but I don't think that's too comprehensive. Just like the U.S. military spending, which remains high and continues to rise, and then the 90,000 U.S. dollar to buy a bag of Pinduoduo for 9 yuan bushings has been happening.
Open source and reduce expenditure are very important, clinical and administrative, need to be granular. Otherwise, it is no wonder that a township health center has 30 beds, more than 100 inpatients per day, and not a single patient is in the hospital at night, and the medical insurance funds are not exceeded.
There is also the fact that so many people spend tens of thousands of dollars on commercial medical insurance every year, and in the end, the national basic medical insurance reimburses the majority, and the huge charge of commercial insurance only reimburses the small head, and the most outrageous is the basic medical insurance, which has been effective no matter what, and the commercial insurance is out of danger, and the insurance will be stopped. Is it possible to include all commercial medical insurance in the national medical insurance?
Even if our basic medical insurance is limited, why do we insist on unlimited liability?
Reform must have someone to pay the price, and it will definitely touch the interests of some people, so we need more patience and tenacity, and any reform needs the iron shovel of time to stir up the turbidity and clear up.
Finally, I want to say that I hope that our society will respect and tolerate those doctors who are still willing to grit their teeth and persevere, have dreams, and never forget their original intentions in the midst of embarrassment and constraints, and that there are doctors who do not want to lie down and are willing to practice their ideals, which is the hope and cornerstone of our healthy China.
Source | Lao Ye said medicine