How can such a "killer weapon" guide patients to stay in the county for medical treatment?

Xu Yucai

Recently, the media reported that the Anhui County Medical Community guided patients to seek medical treatment in the county, and made it clear that its "killer weapon" was that the new rural cooperative medical care payment was made on a per capita basis.

According to the report, Anhui Province two thousand and fifteen According to the annual monitoring data of new rural cooperative medical system, fifteen The number of inpatients outside the counties of participating farmers in pilot counties accounted for 29.52% , compared with that in pilot counties 32.14% low two point six two Percentage points; The proportion of new rural cooperative medical fund in pilot counties used for compensation outside the county 54.46% , compared with that in pilot counties 55.70% low one point two four Percentage points. Based on this, the situation of participating farmers flocking to big cities for medical treatment began to reverse.

Their approach is to two thousand and fifteen Beginning in, select fifteen County level medical service community construction was carried out in counties. County level hospitals and township health centers will establish a county level medical community with shared interests. People, finance and materials in the community will be managed and allocated in a unified way, and the new rural cooperative medical fund will be managed according to the total population budget. The specific measures are as follows: after deduction of risk funds and reserved funds, the "capitation" budget of the new rural cooperative medical fund is allocated to the medical community, which is fully responsible for the direct provision of outpatient and inpatient services, necessary referral and reimbursement of expenses specified in the medical insurance compensation scheme for residents in the area under its jurisdiction in the current year, and the reimbursement of inpatients outside the county (including those enjoying serious disease insurance) is also paid from the general budget, Overexpenditure shall not be supplemented in principle, and the balance shall be retained.

They believe that this will transform the compensation fees received by the county hospital from the new rural cooperative medical fund from the current "hospital income" to "hospital cost", forcing the county medical community to control unreasonable medical expenses, control the transferred patients, and try its best to reduce the residents' illness, thus saving medical expenses.

In order to form a "standard" for hierarchical diagnosis and treatment, they also selected fifty As the list of diseases diagnosed and treated by health centers, about kinds of common diseases must be diagnosed and treated in health centers in non emergency situations, and cannot be transferred to county-level hospitals or even hospitals outside the county; County level hospitals also select according to their own diagnosis and treatment capabilities one hundred It is not allowed to transfer the disease types around.

As a medical staff and manager who used to work in county hospitals and township hospitals, the author, in addition to sighing for this very mathematical formula design, is full of worries about its implementation and effect.

First, whether the service capacity of township hospitals is equal? If there is a big gap, how can we guarantee the unified provisions fifty To provide safe, effective, convenient and inexpensive medical services for various diseases? Are the masses relieved?

Second, how can people's right to medical treatment be guaranteed? People should have the right to choose where to go to see a doctor freely. If we set up a medical community on an artificial basis, will it deprive patients of their right to choose a doctor? Moreover, according to general knowledge, the business scope and expertise of county-level hospitals (generally including county people's hospitals, traditional Chinese medicine hospitals, and maternal and child health care hospitals) should also have their own priorities. Can this artificial method of delineating service institutions for patients be recognized by patients? What is the meaning of this circle if the patients do not accept it, or they choose any hospital at the county level freely? What's more, how can private hospitals deal with such demarcation?

Third, worry about the implementation effect of this "killer mace". From the reported data, the effect is not obvious, and there is no "statistical" significance, not to mention a chi square test. Moreover, I feel that this approach is suspected of "lazy politics", that is, to directly hand over the new rural cooperative medical fund that the government should focus on managing well to the medical community. In essence, it is a county-level public medical institution. The author is also worried about whether this will lead to improper policy implementation, increased self payment by the masses, less service and so on?

In short, medical reform is difficult and needs to be explored. But if we can't grasp the most basic options, such as strengthening the grassroots, maintaining the basic level, and building mechanisms, to do things in a down-to-earth manner and always play tricks, we may end up spending money to do good things. It's just like the proportion of drugs. Serious diseases can't leave the county, 90% It is meaningless for patients to be hospitalized in the county.

（ This article was published in the ten day issue of Physician Online two thousand and sixteen The fourteen stage ）