Minister of Health responds to six major issues such as “difficult to see a doctor for expensive medical treatment”

On the 18th, Minister of Health Chen Jie analyzed and responded to the six major problems of “difficulty in seeing a doctor and expensive doctor” when he made a report on deepening the reform of the medical and health system.

Where is the difficulty in seeing a doctor?

Chen Hao believes that "difficult to see a doctor" can be divided into two types. The first is the "absolute" difficulty in seeing a doctor. It is due to the fact that medical resources are absolutely inadequate to meet the basic medical and health service needs. This often occurs in remote rural areas where the economy is backward, traffic is inconvenient, and the population is sparsely populated in the central and western regions of China. .

The second is the "relativeness" of the difficulty in seeing a doctor. It refers to the "difficulties" of patients going to large hospitals to see experts due to the lack of quality medical resources relative to residents' needs. Outstanding performance is that many people see small injury and minor illness also flock to large hospitals, large hospitals are overcrowded. This is the main manifestation and characteristics of the current "difficult to see a doctor."

Chen Hao pointed out that there are also several kinds of “expensive to see a doctor”: the first is “expensiveness” of personal subjective feelings. Patients think that the money spent on medical treatment exceeds their expectations, or that the medical expenses spent are not “value for money”. The second is “expensive” that households cannot afford to pay for, that is, the total cost of seeking medical treatment exceeds the family’s ability to pay, causing “due to illness and returning to poverty because of illness”. The essence of this is that the economic burden of the disease is excessive and there is no effective society. Medical security issues. The third is "expensive" that society cannot afford. From the point of view of social development, the overall level of medical expenses in the whole society has a tendency of continuous growth and high growth rate, but if it cannot be effectively controlled, when it exceeds the affordability of the entire society, it will affect the economic and social Continuous development.

What causes "difficult and expensive"? The contradiction between institutional mechanisms is the main cause

Chen Hao analysis pointed out that "difficult to see a doctor, expensive to see a doctor" mainly has the following multiple causes:

As the price index rose for a long time, people felt that medical expenses rose too fast. Medical expenses are also affected by the price index. If the price index factor is removed, people's feelings about the increase in medical expenses will be less intense.

The medical costs brought about by the advancement of medical technology have increased. The new medical equipment will consume more material resources and be provided by highly skilled medical personnel. This will result in a rapid and substantial increase in the cost of medical services. This is an unavoidable and reasonable increase.

The change in disease patterns has led to an increase in medical costs. With the accelerating process of industrialization, urbanization, and aging of the population, our residents face the double burden of infectious diseases and chronic diseases. Chronic diseases mean long-term treatment, medication for life, and high costs.

Policy "double-edged sword." For example, the establishment of a basic medical insurance system will greatly reduce the people’s burden of disease, but it is undeniable that it will also stimulate the participants to take more medicines, eat expensive medicines, and treat minor illnesses and major diseases, thus increasing the total cost of social medical care rather than cut back.

The medical and health service consumption of patients is passive, and it is easy to generate complaints that “the doctor is difficult to see a doctor”.

The medical service system, the security system and the drug production guarantee system are not perfect. The long-standing system, mechanism and structural contradictions, as well as the management deficiencies and past mistakes, are the main reasons for people's medical treatment. If the total amount of medical and health resources is insufficient and the allocation is unreasonable, the grassroots health service system is weak, the medical security system is incomplete, the nature of public welfare of public hospitals is weakened, and the production and circulation of medicines and medical equipment are disorderly in order and the prices are high.

How to ease the "expensive"? Deepen Medical Reform and Reduce People's Medical Expenditure

Chen Hao pointed out that by accelerating the construction of the basic medical security system, the individual burden on the people will be reduced. From a nationwide perspective, as the government continues to increase the health investment and the basic health insurance system, the proportion of government and social health expenditures in total health expenditure has increased from 40% in 2001 to 61.8%. Personal health expenditure accounts for the total cost. The proportion has dropped from 60% in 2001 to 38.2% in 2009. The problem of the overwhelming personal burden of the people's medical treatment is being alleviated.

At the same time, the state's essential medicine system has steadily advanced at the grassroots level. In regions where the basic drug system is implemented, the zero sales of essential drugs have caused drug prices to drop by an average of about 30%. In some places, implementation of the basic drug system has been the starting point, and the comprehensive reform of primary health care facilities has been promoted. There has been a welcome increase in outpatient and hospitalization costs, outpatient visits and hospitalization.

Chen Hao said that in the “Twelfth Five-Year Plan”, the coverage and protection level of the basic medical insurance system should be improved, the gap between urban and rural medical security should be reduced, and the proportion of personally sponsored medical expenses should be reduced to less than 30% by the end of the “Twelfth Five-Year Plan” period.

How to solve the "difficult to see a doctor"? Cultivate a group of local health "gatekeepers"

Chen Hao said that through the establishment of a relatively complete grass-roots medical and health service system, the masses of people can enjoy convenient and effective services without going out of their communities and villages.

He said that since 2009, China's investment in infrastructure at county-level hospitals, township health centers, and community health service centers has been unprecedented. The central government has allocated 40 billion yuan to support 1877 county-level hospitals, 5169 center township hospitals, 2382 urban community health service centers, and 11,000 village clinics in remote areas. The Ministry of Finance has also allocated more than 13 billion yuan for the construction of village clinics. Rural and tertiary medical and health institutions purchase equipment.

At the same time, in order to solve the bottleneck of the lack of general practitioners, which restricts the quality of primary care services, a grassroots medical health team construction plan focusing on general practitioners has been introduced, and the grassroots will be trained in a variety of ways through transfer training and order orientation within three years. 60,000 general practitioners. At present, 5,000 medical students who are oriented toward the orderly cultivation of township hospitals in the central and western regions have enrolled for one semester. They support the recruitment of more than 20,000 practicing doctors at township hospitals, and 3.77 million in the training of township health centers, village clinics, and community health service agencies. People times.

In 2011, we will also adopt order-oriented free training for medical students, recruitment of practicing physicians, standardized training for general practitioners, regular job training for primary health workers, counterpart support, encouragement of retired physicians in large hospitals to practice at the grass-roots level, construction of revolutionary housing for employees, and improvement of grassroots technologies. The measures for backbone treatment and the promotion of preferential policies for promotion of titles are focused on cultivating a group of locally available talents at the grass-roots level and fulfilling the responsibilities of the “gatekeeper” of the residents’ health.

How to realize the effectiveness of cracking the “difficult to see a doctor?” Public hospital reform is the key

Chen Hao said that the reform of public hospitals has always been a “hurdle” that cannot bypass the past and is a key point to ease the “difficult to see a doctor”.

Since the pilot reform of public hospitals started in February 2010, pilot cities have all established and improved their leadership and working mechanisms; successively introduced public hospital reform pilot implementation programs and a number of supporting policies and measures; closely focused on solving people's problems The problem of "difficult to see the disease is expensive", and efforts are made to promote direct and convenient measures to benefit the people; and to actively explore major institutional and institutional reforms.

However, Chen Hao said frankly that the reform of public hospitals has not completely broken the topic. With the continuous deepening of medical reform, the reform of public hospitals is limited to only a few pilot cities and it is difficult to adapt to the new expectations of the people. This year, we must identify a number of well-seen and effective public hospital reform policies and measures to promote it across the country and strive to achieve breakthroughs in the three areas of convenience for the people, relief of “difficult to see a doctor” and encouraging medical staff. .

He said that the health department will accelerate the deepening of reforms in public hospitals and strive to explore the basic path of a public hospital reform as soon as possible. This year has the following main tasks: First, the establishment of public hospitals and development plans, adjust the layout of public hospitals, and promote the reform and development of public TCM (including ethnic medicine) hospitals. The second is to give priority to the construction of county hospitals. The third is to establish a division of labor and cooperation mechanism between public hospitals and urban and rural primary health care institutions. The fourth is to accelerate the construction of hospital informationization with the focus on the construction of electronic medical records and hospital management. The fifth is to implement measures to benefit citizens, such as general appointment of out-patient services. Sixth, implement the policy of encouraging and guiding social capital to organize medical institutions, promote the sustained and healthy development of non-public medical institutions, and accelerate the formation of a diversified medical service structure.

How to make people "less sick"?

Chen Hao said that since 2009, the government has provided free access to 9 types of basic public health services, including health records management, for urban and rural residents. Currently, 48.7% of urban residents and 38.1% of rural residents have health records and 35.538 million yuan respectively. Blood pressure patients, 9.189 million diabetics, and 1.70 million severe mental illnesses were included in the chronic disease management program, and health checkups were conducted for 84.49 million elderly people over the age of 65.

In addition, major public health services such as hepatitis B vaccine reseeding, free cervical cancer for rural women, and breast cancer screening have been implemented. These major public health services are provided free of charge to the public and are also important for alleviating the “expensiveness” of the public.

He disclosed that in order to ensure the development of various services, a basic public health service fund guarantee mechanism was established. Starting in 2009, funds were allocated at a rate of not less than 15 yuan per person. The national average reached 17.5 yuan in 2010, and will increase to 2011. 25 yuan.

Chen Hao said that after the increase in basic public health funding, it is necessary to expand and deepen basic public health services, expand service population, improve service standards, improve service standards, and increase service programs so that the public will benefit more.