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"Ms. Chen, I heard that you have been treated unfairly in the hospital recently?" As a community volunteer, I visit some of the residents' homes every week to learn about their lives. Today I visited Aunt Chen.
Aunt Chen is a retired teacher, has no children, and lives alone in the community. Last month, she had to be admitted to a local tertiary hospital for treatment because of worsening osteoporosis in the elderly of her legs.
"Hey, it really breaks my heart." Aunt Chen looked at the fruit I handed her, and said helplessly, "You know, my legs and feet are not very neat, and it is usually difficult to go out." So this hospitalization was very important to me. But..."
Looking at Aunt Chen's expression of wanting to speak and stopping, I couldn't help but ask curiously, "What's wrong, Auntie?" What's going on?"
Aunt Chen took a deep breath and seemed to be organizing words: "On the 13th day of admission, the attending doctor suddenly told me that I had to be discharged on the same day, otherwise their hospital would face punishment!" How can you make the patient accept this?"
"What?!" I couldn't help but exclaim, "Why should the hospital force the patient to be discharged?" That's ridiculous, isn't it?"
"I was also puzzled." Aunt Chen shook her head, "I quickly asked the doctor what the reason is." The doctor was hesitant, and later said that it was because 'the National Health Insurance Administration stipulates that a single hospital stay cannot exceed 15 days'. "Do you have to be discharged after 15 days in the hospital? I've never heard of such a rule, have I?" I felt that there was a lot of suspicion about the matter, so I immediately searched for relevant policies and regulations, but found nothing. At this time, I had in my mind a situation from the recent press conference of the National Health Insurance Administration...
(Note: The suspense is set here, and it is not clear what happened for the time being, which arouses the curiosity of readers)
At the press conference of the National Health Insurance Administration, the host is introducing the operation of the medical security fund in 2023.
"In the six years since the establishment of the National Health Insurance Administration, the management of the medical insurance drug catalogue has been continuously optimized, and the number of Western and Chinese patent medicines in the catalogue has increased from 2,535 in 2017 to 3,088 now, especially the varieties and efficacy of drugs for common diseases such as tumors, hypertension and diabetes have been greatly improved."
When it came to the reform of medical insurance payment, the words of Director Huang Xinyu, the person in charge, attracted the attention of the audience: "We are implementing the DRG/DIP payment reform, with the purpose of guiding medical institutions to treat diseases reasonably through the medical insurance payment lever, and avoid improper examinations and indiscriminate prescription of drugs, rather than simply controlling costs......"
Director Huang Xinyu's letter
The words of the oath undoubtedly gave the reporters on the scene great confidence. However, just as he finished speaking, a small episode appeared: "Director Huang, I have a question." A reporter stood up and said, "Recently, many netizens have reported that some hospitals have forced patients to be discharged within 15 days on the grounds of 'exceeding the medical insurance payment limit', what is going on?"
As soon as the words fell, the audience was silent. Director Huang pondered for a moment before he slowly spoke: "On this point, let me reiterate: the national medical insurance department has never issued restrictive regulations such as 'a single hospitalization does not exceed 15 days'!"
"Then why is this happening?" Another reporter asked.
"Indeed, some medical institutions have taken the 'average length of hospital stay' in the DRG/DIP payment standard as a hard indicator, and forced discharge on the grounds of 'medical insurance quota has arrived', which is a huge violation and we firmly oppose it!" Director Huang's tone was firm.
"So how will the NHSA respond to these violations? As a result, many patients are unable to go through the discharge procedures and have difficulty in referral. "We're going to take it seriously! The general public is welcome to report directly to the medical insurance department. (Note: By restoring the real scene of the press conference, the readers' doubts are eliminated and the reasons for Aunt Chen's encounter are drawn)
I figured it out suddenly! It turned out that the hospital management was chaotic, and the DRG/DIP payment reform was understood as a mandatory rule that "must be discharged after 15 days of hospitalization", and the reasonable demands of patients were ignored, which led to the unfair treatment of Aunt Chen.
I hurriedly told Aunt Chen this information, and she was finally relieved: "So that's the case, fortunately, the National Health Insurance Bureau has made a clear statement on this kind of behavior, otherwise it would be worse for us patients." "Yes, Auntie, medical institutions should be patient-centric, not blindly pursue cutting patients for the purpose of saving money." I am sincerely relieved for Aunt Chen.
"But then again, there is nothing wrong with the DRG/DIP payment reform, which aims to scientifically guide medical behavior and reduce unnecessary examinations and treatments." I added, "It does contribute in controlling unreasonable spending." In the past, some hospitals prescribed large-scale prescriptions to patients and indiscriminately examined and treated patients, but now there is a change. "
"Yes, when many of my friends were hospitalized, the doctor's medication and examination items were greatly streamlined." Aunt Chen nodded in agreement. "Therefore, the DRG/DIP reform is a good thing, but the premise is that it must be operated scientifically and must not be out of shape." I said, "By using the 'average length of hospital stay' as a limit, medical institutions are misinterpreting the original intent of the policy. We can fully complain to the Health Insurance Bureau, hoping that they will strengthen supervision and put an end to such violations. "
Aunt Chen listened to my analysis and was deeply touched: "Now that society is developing so fast, many new things need everyone to learn and supervise each other. As ordinary people, we should also pay more attention to these and safeguard our legitimate rights and interests. I nodded, heartily agreeing with Aunt Chen's words. As ordinary citizens, we do not have the power to make decisions and manage, but it is also our duty to pay attention to and supervise the implementation of policies and to speak for the legitimate rights and interests of ourselves and others.
As the saying goes, "knowledge is power". I hope that through this experience, everyone can understand more about the original intention of the national medical insurance policy, and understand that the DRG/DIP payment reform is not simply to control fees or limit the number of days of hospitalization, but to guide the rational use of medical resources. At the same time, we should also actively reflect the management loopholes existing in the front line, arouse the attention of relevant departments, standardize medical behavior, and ensure that the legitimate rights and interests of patients are not violated.
Take Aunt Chen's experience as an example, although the National Health Insurance Bureau has made a clear statement, similar violations do exist at the grassroots level. For example, not long ago, a news that "a woman was forced to be discharged from the hospital after 9 days of hospitalization" was widely circulated on the Internet, and the hospital's reason was still "more than the average length of hospital stay".
I think the key to solving this problem is to strengthen supervision. On the one hand, for those hospitals that stubbornly violate the rules, the medical insurance department must take serious measures to deal with them; On the other hand, it is necessary to increase the interpretation of the DRG/DIP policy, so that every front-line medical staff can understand its true purpose and avoid "generalizing from one side to the other".
In addition, it is also important to improve supporting measures. For example, for those special diseases or cases that do require more than the average length of hospital stay, can they be individually assessed and appropriately adjusted? For another example, for special groups such as the poor and seriously ill patients, can they be appropriately discounted in terms of reimbursement? In short, the implementation of policies needs to be tailored to local conditions and vary from person to person, and it is imperative to avoid a rigid and simple "one size fits all".
More importantly, we should attach great importance to patients' right to know. Nowadays, people's requirements for health rights are getting higher and higher, and there are more and more medical disputes. Therefore, when implementing the new policy, medical institutions must fully explain the content and purpose of the policy to patients, so that they can understand their rights and obligations, so that everyone can form an understanding and recognition.
At the end of the day, DRG/DIP is just a payment method, and its quality depends on the execution effect. I hope that in the future, medical resources will no longer be a "one-shot deal", but can truly be allocated according to demand and scientifically managed. Patients like Auntie Chen deserve adequate hospital stay and proper treatment, rather than being dismissed hastily. Safeguarding the health rights and interests of the broad masses of the people is the ultimate goal of the policy.
In this way, a conversation with Aunt Chen gave me a deeper understanding of the national medical insurance policy. I hope that through this experience, the general public can join us in actively paying attention to and monitoring the implementation of relevant policies, and make unremitting efforts to work together for a better life where patients can be treated and children can be nurtured!
(At the end, we call on everyone to pay attention to and supervise the implementation of the policy, protect their own rights and interests, and look forward to readers leaving comments) #国家医保局: There have never been restrictive regulations such as "a single hospitalization does not exceed 15 days". #