Abstract: With the rapid development of China's economy and the reform and development of medical system, it is the most prominent problem in current medical and health services that it is difficult and expensive to see a doctor, which has become a hot issue of general concern throughout the country. Difficult and expensive medical treatment is not only a livelihood issue, but also a comprehensive and institutional social issue. This paper focuses on the main contradiction of difficult and expensive medical treatment, analyzes its causes and reveals the countermeasures to solve it.
Keywords: medical system reform; Medical and health care; medical insurance
1 analysis of the causes of the problem of difficult and expensive medical treatment.
With the rapid development of various fields in the country, it is more and more obvious that it is difficult and expensive to see a doctor. This problem can be analyzed from several aspects:
The first is to analyze from the patient's perspective. The vast majority of patients without medical insurance in China are farmers, accounting for about 37%. Because of this, I think they lack laws and regulations on medical insurance and have no correct understanding and foresight on medical insurance. So when they go to the hospital, they always find it difficult and expensive to see a doctor. Those patients were frightened by this fact and had a mental breakdown because of this expensive medical expense. So things like this are still happening.
Secondly, from a national perspective, there are not only policy reasons, but also the reasons why the state and the government are not strict enough in market supervision and lack of financial investment. In terms of policy, there are still many defects in China's medical legislation, such as imperfect legislation and imperfect legal supervision. Therefore, when patients go to the hospital for treatment, they can only feel that the price is high and cannot be guaranteed by law. Moreover, hospitals and some health centers or clinics belong to public institutions and are profitable, so patients are more likely to be deceived. At the same time, the state's supervision of the medical market is not strict, and it has not really been implemented on everyone, so this has greatly opened up the bad situation of difficult and expensive medical treatment. In terms of financial input, in 2007, China's financial input in medical assistance at all levels reached 765.438+0.2 billion yuan, of which the central government subsidized local urban and rural medical assistance funds of 3.34 billion yuan, an increase of 654.38+0.4 billion yuan over 2006, and local financial budgets at all levels arranged urban and rural medical assistance funds of 3.78 billion yuan, an increase of 2.7 billion yuan over 2006. Among them, local governments in Jiangxi, Shanghai, Liaoning, Zhejiang, Jiangsu and other places invested more than 200 million yuan in urban and rural medical assistance, and provincial governments in Jiangxi, Shanghai and Henan invested more than 6,543.8+billion yuan. The financial input of Guangxi, Anhui, Chongqing and other places has more than tripled this year compared with 2006. We can see that this is still not enough. Such a big country has invested so little, which not only makes it difficult for our people to see a doctor, but also can't solve their practical problems. In addition, China's medical and health investment accounts for only 2% of the world's total population, while China's total population accounts for about 22% of the world's total population. Using 2% medical expenses to solve the health problems of 22% population will definitely find it difficult and expensive to see a doctor. According to the data of the statistics department a few years ago, about 49.2% people in China were sick and didn't go to see a doctor. This figure is really surprising. Faced with this pressure, I think the state and the government should attach great importance to it and not let this situation continue to develop.
With regard to medical insurance, the coverage of medical insurance in China is particularly narrow at present. Structurally, the basic medical insurance mainly covers the staff of government agencies and institutions. Farmers, urban informal employees and vulnerable groups (low-income or laid-off workers) are not covered by the insurance system, and the fairness and superiority of the medical insurance system are not fully reflected. In some rural areas, we can obviously see many phenomena of returning to poverty due to illness, and the new rural cooperative medical system has not been fully highlighted, so we can often see from the motorcycle screen that migrant workers have no money to treat diseases because of work-related injuries or accidental injuries, even if they are insured, they are still not enough. The main reasons are as follows: First, the rural cooperative medical insurance is short of funds. With the decline of the collective economic strength of grass-roots communities, raising funds from farmers has become an important source of funds for establishing cooperative medical care. However, the difficulty of investing in farmers depends on their satisfaction with medical care. However, the state has invested little in medical care. Then the rural cooperative medical care policy is unstable. Because most countries adopt a laissez-faire attitude towards medical cooperation. However, for the sake of their own interests, the initiative of local government administrators in implementing the policy is greatly reduced, which is not enough to promote the implementation of the cooperative medical care policy. In addition, the state has recently implemented some policies to benefit the people and cancelled cooperative medical care projects, which conflicts with the state policy of supporting the development of rural cooperative medical care and increases the difficulty of the development of national medical policy. Then the rural health system is difficult to adapt to farmers' requirements for health care. The level of economic development in China is extremely unbalanced. Due to the sharp differentiation of rural labor force and large-scale non-agricultural and employee-oriented, farmers have different requirements for medical security, which constitutes an obstacle to the establishment of a unified rural medical security system, that is, the subject, direction and management mode of rural security. Finally, the uneven distribution of medical and health resources makes it difficult to maximize benefits. First, the business of health care outlets set up in rural administrative areas is insufficient. In many places, farmers can basically stay at home for minor illnesses, and go directly to county or township hospitals for serious illnesses. Therefore, the county or township medical layout can not adapt to the new situation. Second, overlapping health institutions and overstaffed personnel have caused great waste of health resources. In addition, the distribution of health workers is very uncoordinated. In short, these are the main reasons for the serious shortage of medical insurance coverage. After the shortage, it is natural for patients to see a doctor difficultly and expensively.
The public welfare of public medical institutions is weakened, which brings troubles to patients. First of all, medical institutions do not fully guarantee that everyone can get basic health services and improve people's living standards. Secondly, the county economy is difficult, especially in many counties in the west, so this may lead to the dilution of the public welfare of public medical care. Then, many underdeveloped areas have limited financial resources and do not have enough funds to invest in medical care and medicines. In this way, some public medical institutions (large hospitals or municipal hospitals) only pay attention to economic benefits to continue their development, while ignoring social benefits, which may lead to the dilution of public welfare of public medical care. Finally, there is a general lack of investment in health care, which is the same thing as the limited financial resources I just said. Because of the lack of investment in health care, including manpower, material resources and financial resources, there will be no professionals to take the lead. The lack of material resources proves that medical institutions do not have enough equipment, instruments, beds, commonly used drugs or first-aid drugs. There is also insufficient financial resources, that is to say, medical institutions do not have enough funds to buy new medical equipment and drugs and attract some particularly famous experts, so they do not invest enough in health. Insufficient health investment, some medical institutions in order to survive and develop, the staff of those hospitals deliberately raise drug prices and medical expenses, making patients feel more and more difficult to see a doctor, and even the phenomenon of not seeing a doctor when they are sick. Therefore, the dilution of the public welfare nature of public medical care is a reason that cannot be ignored.
Finally, from the perspective of economics, the phenomenon of difficult and expensive medical treatment is analyzed. When it comes to the economic benefits of medical services, we can quote the concept of cost-benefit ratio. At the same time, the cost profit rate index shows how much profit can be obtained per unit cost, which reflects the operating results brought by operating expenses. The higher the index, the better the economic benefit of the hospital. The formula is: cost, operating profit rate = operating profit/total cost × 100%. For example, the number of patients in a hospital is 300, and the average cost of each patient is 400 yuan, while the actual cost of treating each patient in the hospital is 150 yuan, but it is said that the higher the medical price, the greater the benefit. In addition, the cost-benefit method can also be used to illustrate its economic benefits. Generally speaking, the project investment invested by the government will last for many years, and the benefits and costs must be added up. The calculation formula is as follows: NSB=PV(B-C), and we can regard NSB as an economic benefit. From this formula, we can clearly see that if the number of B far exceeds that of C by raising the price of B, the economic benefit of the hospital will be greater. Therefore, hospitals blindly pursue economic benefits, such as prescribing large prescriptions for patients or providing unnecessary examinations, which will only increase the burden of patients' medical treatment, thus making it difficult and expensive for patients to see a doctor.
2 Solutions to "Difficult and Expensive Medical Treatment"
The problem of difficult and expensive medical treatment is particularly serious in some economically underdeveloped areas, but in recent years, our country is gradually implementing some policies to solve the problem of difficult and expensive medical treatment for ordinary people.
(1) Adjust the allocation pattern of medical and health resources to make the health resources between the east and the west and between towns and villages more reasonable. Improve the medical and health service system, focus on strengthening the rural three-level health service network and the construction of a new urban health service system based on community health services, and implement funding guarantee measures.
(2) Strengthen the public service function of public hospitals. According to the public welfare nature of health undertakings, governments at all levels and relevant functional departments should take greater responsibility for the construction and development of health undertakings. Strengthen the construction of medical ethics, standardize the management of revenue and expenditure, and correct the tendency of one-sided overcharging. The key is to clarify the government's responsibility, increase the government's investment in medical and health services, implement the management of two lines of revenue and expenditure for public hospitals, and change the current mechanism of public hospitals supporting doctors with medicine and unilaterally generating income.
(3) standardize the medical service behavior of medical institutions. The administrative department of health should adhere to the organic combination of education and supervision, improve the supervision mechanism and standardize the medical service behavior. Supervise and urge medical institutions to adhere to reasonable inspections, strictly implement disease diagnosis and treatment norms, and clarify basic inspections and basic drugs to prevent patients from increasing their burden due to routine drug abuse and unreasonable inspections. The price department should strengthen the special supervision of medical prices, prevent arbitrary charges, repeated charges and excessive charges from the source, and effectively reduce the medical burden of the people.
(4) Establish the national basic drug system and norms, rectify the order of drug production and circulation, and ensure the drug demand of ordinary people. According to the affordability of the state, society and individuals, and in accordance with the principles of safety, effectiveness and low price, a national system of essential drugs will be established to ensure the people's basic drugs. Rectify the order of drug production and circulation, strengthen drug price supervision and hearing, and prohibit any unit from setting drug prices too high in any name.
(five) strict medical institutions, technology access and personnel qualification examination, and guide social funds to set up medical and health institutions according to law. Medical institutions at all levels should strengthen personnel training, so that medical workers can truly understand the needs of the masses, support qualified personnel to start businesses according to law, and facilitate the masses to see a doctor.
(6) Give full play to the strength of all sectors of society and help the disadvantaged groups. Led by the government, civil affairs, the Red Cross and other social assistance departments actively implemented, combined with the construction of social assistance system, raised funds in various ways, and established a fund for the treatment of public health emergencies to ensure that the injured and the "three noes" patients in public health emergencies were treated in time. At the same time, clearly designate medical and health institutions with relatively good medical technology level, exempt laid-off workers and low-income objects from registration fees and medical treatment fees, and reduce bed fees. Effectively reduce the burden of medication for vulnerable groups, and increase investment in holding Huimin hospitals, Huimin clinics, and affordable hospitals. To alleviate the problem that it is difficult and expensive for people to see a doctor. Let the masses truly feel that the hospital is serving the people wholeheartedly.
(7) Establish rural medical and health service network and health service system. At present, it is necessary to establish a system that medical personnel regularly go to the grassroots level, popularize appropriate medical and health technologies, establish a training system for rural health personnel, and carry out various forms of rural mobile medical systems. At the same time, learn from foreign practices, formulate policies that require medical graduates to work in township hospitals for three to five years after graduation, enrich the talent team of township hospitals, improve the level of rural medical and health services, and vigorously develop community health services. We must adhere to the principle of government leading and public welfare, redistribute community health resources and actively build a health service network based on community health service centers.
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