When "Red envelope" meets the hospital
Xu Yucai
The "red envelope" should be a happy thing for everyone to love. Send and receive red envelopes Yes country People's traditional customs for a long time ， It comes from a kind of normal interpersonal relationship in which the Chinese people still exchange courtesies, reflecting the friendly complex of harmonious coexistence. The meaning of giving red envelopes is more common. First, it is a kind of care for younger generations. New Year's money and birthday wishes all contain the meaning of peace and auspiciousness; The second is the etiquette of wedding celebration, as well as the expression of the first meeting of relatives and friends, gathering and giving wishes to each other; The other is the reward that comes from the heart. It should be said that the culture of red envelopes not only reflects the Chinese people's emphasis on reciprocity, but also the people who receive benefits and do not forget to give, and also have the mentality of not being ungrateful. From here aspect Look, “ Red envelopes ” It doesn't seem to be anything evil.
However, at present, Chinese hospitals seem to be full of more "Strange gas", even the popular red envelope has changed its taste and become less pure. Otherwise, why should the state ban it?
September 2012 ， The former Ministry of Health and the State Administration of Traditional Chinese Medicine jointly issued《 Guiding Opinions on Strengthening the Prevention and Control of Integrity Risks in Public Medical Institutions 》, where enclosure two 《 Rules for the Prevention and Control of Integrity Risks in Medical Services of Public Medical Institutions 》It is pointed out in, Implement the system of signing agreement between doctors and patients. When the patient is admitted to the hospital, the doctor will not accept it "Red envelope" and patients will not send "red envelope" for two-way signature, and the agreement will be included in medical record management.
In December 2013, the newly established National Health and Family Planning Commission and the State Administration of Traditional Chinese Medicine jointly issued the Notice of "Nine Prohibitions" on Strengthening the Construction of Medical and Health Profession , which stipulates Do not accept patients "Red envelope" 。 The specific requirements are: Medical and health personnel shall abide by medical ethics and be strictly self disciplined. It is strictly prohibited to ask for or receive cash, negotiable securities, payment vouchers and valuable gifts from patients and their relatives and friends. there "Red envelope" refers to“ Cash, securities, payment vouchers and valuable gifts ”The source is“ Patients and their relatives and friends ”, the way of collection is“ To ask for or receive ”。
In January 2014, General Office of National Health and Family Planning Commission Then it was distributed 《 On the implementation of non acceptance and non delivery signed by both doctors and patients Notice of "Red Packet" Agreement Work 》, specify the requirements, since Since May 1, 2014, medical institutions and inpatients have signed the Agreement on Not Receiving or Sending "Red Packets" between Doctors and Patients And stipulate that the time for signing the agreement is Patient admission Within 24 hours, hospitals above the second level (including maternity and child health care hospitals with inpatient beds, specialized disease prevention and treatment hospitals, etc.) must carry out, and other medical institutions can refer to it. specific Provided by the treating physician to the patient or the patient's representative 《 agreement 》 And carefully answer their questions ， The physician in charge or the attending physician in the ward is responsible for communicating with the patients and their families, and signing the Agreement on behalf of the medical party. In order to reflect the responsibility of the hospital's legal representative, the name of the legal representative can be printed in the signature column of the medical party. The patient shall be signed by the patient or his family. So far, this governance The system design of "red envelope" is basically completed.
Eliminate "Red envelope" is not ideal
Although a series of documents have been issued to put an end to the phenomenon of red envelopes, the implementation of the system has not been as smooth and beautiful as expected, and both in form and effect are unsatisfactory.
Formally, it was generally opposed by the medical staff at the beginning: the signing of the agreement of "no receipt, no bonus" was to establish On the basis of the "presumption of guilt", treating most medical personnel as "suspects" who received red envelopes is an insult to medical personnel. In fact, it is also easy to cause misunderstanding among patients, which seems to mean "reminding" patients and "sending red envelopes".
Academician Zhong Nanshan, Academician of the Chinese Academy of Engineering and Honorary Director of Guangzhou Institute of Respiratory Diseases It was clearly stated in one report that, They didn't recognize the red envelope agreement and didn't sign it themselves, because they had already made an oath when they were studying medicine, and asking doctors to sign a red envelope rejection agreement would make the public think that doctors are a group that generally accept red envelopes.
On November 9, 2016, happen to Department of Pediatrics, Bozhou District People's Hospital, Zunyi City Of A medical accident It is this misunderstanding that causes 。 The course of the event is, eleven month eight On January 1, a child was hospitalized. After communicating with the family members of the child, the medical staff signed the Agreement on Doctor patient Rejection of Red Packet according to the procedure. Because the family members of the child had difficulty communicating with the doctor, they mistakenly thought that the doctor was asking for the red packet. such Misunderstandings accumulate in the chest. second Day, because The hospitalized children in this department are seventy Yu Ming, the doctor wants successively Ward round ， Child mother Thought it was because "Red envelope" problem, doctor deliberately Delayed diagnosis and treatment, temporary Uncontrolled emotion collided with the tube bed physician and scratched three doctors and nurses, leading to a brief conflict between doctors and patients , both sides hurt each other 。 However, it is unbelievable that the matter has not ended here. matter Later, the mother of the child visited many government departments to complain, and family members drove to block the door two Hours. eleven month thirteen The mother of the child came to the hospital to plead. eleven month sixteen The result of the treatment was announced on March 1. The hospital compensated 8000 yuan, and each of the three doctors and nurses was fined 1000 yuan. The whole hospital circulated a notice of criticism. On the Internet, on the one hand, people do not understand the hospital's loss of money and the punishment of injured medical staff, on the other hand, they do not understand the "Sign the red envelope agreement" and then complain.
From the perspective of implementation effect, the acceptance of red packets has not been eliminated because of the signing of the agreement. Otherwise, no further steps will be taken The necessity of "measures", such as Fujian Province.
two thousand and sixteen year ten month ten Day, Printed and distributed by Fujian Provincial Health and Family Planning Commission Has Special Renovation of Medical Institutions in Fujian Province Notice of "Red Packet" and Rebate Work Plan (hereinafter referred to as the Scheme). Plan The clue source, concept and governance method of "red packet" are detailed. The definition of "red envelope" in this Plan is much more than that of the National Health and Family Planning Commission. At the same time, in terms of governance methods, it not only enriches educational reminder means such as warning education, public commitment, regular interview reminder, but also proposes to improve the return visit system, unblock complaint channels, strengthen case investigation and handling and other supervision means, and finally provides accountability and punishment measures.
The Scheme continues to retain the much criticized signing of the agreement of "no receipt, no bonus". but For those that cannot be rejected at the moment "Red envelope", Specify “ Should be on twenty-four Submit to the designated department of the hospital within hours, or pay medical fees for patients, and inform patients in a timely manner ”。 It is worth recalling that the time when the Plan was issued was nearly 2 years after the National Health and Family Planning Commission required the signing of the agreement The first sentence of the "general requirements" of the Plan is“ Implement the provincial party committee's inspection and rectification opinions ”。
government "Red envelope" is divided into four steps
So, this has changed its flavor How to manage the "red envelope"?
First, distinguish The nature of "red envelope". In real life, "red envelope" can be divided into three Class: No one class It is the patient who recovers satisfactorily or enjoys more than expected After "satisfactory" medical service, "thank you" to medical staff out of gratitude ； Category II Is a patient expect get medical staff more patient to take care of . Provide more convenience Or hearsay "Hidden rules" ， "Follow the crowd" For relevant medical staff Benefits , neither voluntary gratitude nor coercion, which is now the mainstream of red envelopes. Category III In a special period and Intentional violation of medical principles under critical circumstances, such as deliberately no Timely arrangement operation Use unnecessary expensive drugs and materials Etc., or implying or explicitly claiming benefits 。 Generally, the first is human nature two We should do more kind reminders, Strive to eliminate, The second is public Those that are abhorrent should be condemned by conscience 、 Moral punishment Legal sanctions 。
Second, give A clear definition of "red envelope". If you give money as a red envelope, give a shopping card as a red envelope, thank the medical staff for a meal then Whether food counts or not, take a bag made at home Peanuts potato Send to the doctor Does it count. FLOWER one thousand How to define red envelopes is actually a very complicated problem.
The third is to cancel the inappropriate way of signing the agreement. From the perspective of actual implementation《 Both doctors and patients refuse to accept or send "Red packet" agreement 》It has not played a very good role in both form and effect, so it is suggested to abolish this formalism.
Fourth, speed up medical reform, promote the rational flow of medical resources, establish a salary system that conforms to the characteristics of the medical and health industry, and let medical personnel live with dignity. As we all know, the reception and delivery currently exist in medical institutions The phenomenon of "red envelope" is mainly concentrated in large hospitals, and rarely seen at the grass-roots level. It objectively reflects the imbalance of high-quality medical resources, and to a certain extent, it also reflects that the income and payment of medical personnel are extremely inconsistent. Therefore, to thoroughly solve the "red envelope" problem, the most fundamental thing is to accelerate medical reform, actively promote free practice, establish a salary system that conforms to the characteristics of the medical industry, and make medical life dignified. This may be the root cause of "red envelope". (This article was published in the Chinese Hospital Dean Issue 22, 2016 ）
