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The near future, national sanitation is healthy appoint, central net letter does, national development is reformed appoint, the Ministry of Public Security, market superintends medical treatment of bureau of medicine of traditional Chinese medical science of total bureau, country, country to ensured medicines and chemical reagents of bureau, country to supervise the 8 ministries and commissions such as management board to combine print and distribute " act about beginning medical treatment chaos to resemble special punish, announced at the same time " medical treatment chaos resembles program of special punish action " (the following abbreviation " plan " ) , arrive since this year March by Feburary 2020, the medical treatment chaos that begins by a definite date 1 year acts like special punish, chaos of medical treatment of 4 big focal points is resembled, endangered people health rights and interests badly, the medical treatment order with disturbed normal, affected industry credit, caused abominable social effect. Cent respect undertakes unscrambling below:
One. Chaos of 4 big medical treatment resembles key task
" plan " point out, chaos of 4 big medical treatment resembles key task but not be confined to the following respects:
It is severe blow of all kinds break the law violate compasses hold trade act. Especially doctor rental, lend, make over " doctor hold industry letter " etc " hang card " behavior, medical establishment buying and selling, make over, rental " medical establishment hold licence of course of study " or " doctor hold industry letter " , without card practise medicine, violate compasses develop immune cell treatment, use " cure is held in the palm " , diagnose phonily wait for means deceit, prevail on, force a patient to accept diagnosis and treatment and consumption, and be gotten illegally and the behavior such as the organ of organ of buying and selling, human body organization such as cornea.
2 it is severe blow medical treatment is cheated defend action. Key blow passes false conduct propaganda, with the items such as check-up ginseng of revulsive, diddle protects personnel be in hospital, keep, pilfer is brushed, risk with ginseng keep card of personnel social security, empty is written down, the action that marks the baleful diddle cure such as charge to keep fund more.
3 it is to investigate the action that releases advertisement of illegal medical treatment and false information gravely. Heavy enumeration place is examined without wholesome and healthy branch and disobey " medical treatment advertisement examines a proof " the regulation releases medical treatment advertisement and build date of website, public to wait oneself in the hospital the action such as information of false medical treatment is released on media oneself.
4 it is to be investigated stoutly non-standard collect fees, collect fees in disorder, revulsive consumption and behavior of excessive diagnosis and treatment. Tear open minute of operation especially or examine examination project, not according to the requirement fair show medicines and chemical reagents, medical material and price of medical treatment service, did not collect fees according to project and valuation basis wait for behavior.
2. Medical treatment chaos acts like special punish the influence to the hospital
01
Severe blow is of all kinds break the law violate compasses hold the influence of trade act
Medical establishment runs way, made clear the postulate of conduction medical establishment, have basic hold doctor of course of study is crucial condition, because the society runs medical service development is rapid, public hospital doctor is free hold course of study is done not have orderly and current, the doctor is strange be short of a state to affect a society badly to do cure to examine and approve, doctor rental, lend, make over " doctor hold industry letter " the market is formed, be called to hang card, need not go to work, the hospital pays the fee that hang card, basically deal with director branch examination.
Examine and approve as a result of medical establishment strict, examine and approve medical establishment construction, examine and approve, buy a profession to take a picture the fee such as cost is big, real assets changes medical establishment license plate to already was become carry out. Once medical establishment is managed bad, appear medical establishment buying and selling, make over, rental " medical establishment hold licence of course of study " or " doctor hold industry letter " phenomenon. If develop activity of diagnosis and treatment strictly according to the limits that register, it is very difficult that medical establishment lives, so, exceed the limits that register to begin phenomenon of activity of diagnosis and treatment very general.
Severe blow is of all kinds break the law violate compasses hold cause phenomenon, the impact is the biggest is, the first, cut off rely on to hang out one's shingle " free hold course of study " of the doctor hang out one's shingle income, a lot of doctors are not renting casually hang out one's shingle, blackmarket hangs list price case to be able to soare. If really examination is strict, a lot of hospitals need close down to rectify because of standard of doctor short of. The 2nd, do not let exceed limits to develop activity of diagnosis and treatment, force the hospital amounts to mark to upgrade classy, extend range of diagnosis and treatment. The 3rd, hairdressing of profitable healthy check-up, medical treatment, reproduction (infecund not Yo) , secrete make water, skin (the gender is pestiferous) , Fu is produced, the society such as tumor, ophthalmology runs medical service active domain and violate compasses begin immune cell cure, dry cell the behavior such as clinical research and cure, the standard shuffles.
02
Severe blow medical treatment cheats the influence that defends action
" plan " clear, begin blow bully bilk to take medical treatment to ensure fund special processing, investigate what medical establishment reachs its public health worker to cheat defend action. Companion is cheated as blow protect strength to increase, the biggest impact and impact are the biggest is civilian battalion hospital, the medical establishment of basic level community that reachs medical treatment to serve ability to be not worth.
03
Who does gravity investigate the action that releases advertisement of illegal medical treatment and false information to affect?
" plan " clear, heavy enumeration place is examined without wholesome and healthy branch and disobey " medical treatment advertisement examines a proof " the regulation releases action of medical treatment advertising. The impact is the biggest is civilian battalion cure medical establishment, medical establishment relies on civilian battalion for the most part advertisement sale hits edge ball, internet interest drive helps strength, let superintend sectional impossible to defend effectively, this impact that is level sex won't be very big, because the patient differentiates ability promotion.
04
Investigate stoutly non-standard collect fees, collect fees in disorder, the influence of revulsive consumption and behavior of excessive diagnosis and treatment
" plan " point out, strengthen pair of medical establishment to collect fees the supervisory examination of behavior, investigate fractionation operation lawfully or examine examination project, not according to the requirement fair show medicines and chemical reagents, medical material and price of medical treatment service, did not collect fees according to project and valuation basis wait for behavior. Groovy to disobeying diagnosis and treatment, revulsive medical treatment and excessive medical treatment, valence is added to wait to violate compasses act badly in art especially, bring into medical establishment undesirable hold trade act billiard-marker and credit system government, announce to the society. Self-evident, the probability prep above that these behavior produce in public hospital civilian battalion medical establishment, investigate bigger to generation of public hospital income impact and effect stoutly.
3. Punish limits covers a range wide grow with time cycle
01
Punish limits covers a range wide
Center punish limits to want to realize the hospital inside area under administration (the hospital in containing and courtyard of health care of women and children) enclothe completely, other type medical establishment enclothes 50% above.
02
Repair time cycle is long
Time of special punish activity is March 2019, Feburary 2020, divide 3 phase to carry out. The 1st phase, be checked oneself and center punish phase (March 2019, in September) ; The 2nd phase, the examination evaluates level (October 2019, in January 2020) , the 3rd phase, summary communication phase (in Feburary 2020) .
Outspread read:
Wang Zhen: How to understand a doctor many a little bit hold of course of study " random elephant " ?
The doctor that already chose in the round in recent years " much dot hold course of study " , it is to liven the big move of medical treatment resource, but do not suffer public hospital deans to wait for see. This is not fathomless, oneself worker handles a part-time job to the competitor, all sorts of interest conflict may produce in the center, break the place with be pulled not clear too much.
Position is different, each are reasonable, but the way that allows a doctor to walk out of public hospital gradually is right. Solve a problem to often want to have the process of a get at the root of the matter. As pure as its push by force with administrative instruction, be inferior to wanting, why doesn't the doctor agree to leave public hospital?
2009 " Ministry of Public Health about doctor much dot hold the announcement of trade concerned problem " , defended the department such as the committee of planning 2015 " be advanced about print and distribute and normative doctor is bit more hold the announcement of a certain number of opinions of course of study " , and defended print and distribute of committee of planning March this year " doctor hold course of study registers administrative measure " , the doctor is bit more hold course of study begins to be pushed in the round, enter drive. The doctor is bit more hold course of study is the major move that our country new medical service changes, be helpful for promoting medical treatment resource reasonable flow, raise medical treatment resource to use efficiency.
But, in doctor much dot hold course of study fulfils executive process in, also appeared a lot of " random elephant " : The brand that making public hospital goes to civilian battalion hospital " carry " patient, making much point hold the brand of course of study, everywhere " open flying knife " , use much site hold course of study does an interest to carry etc. How be known and solve these " random elephant " concerning many a little bit directly hold course of study whether advance smoothly, also concerning the success or failure that public hospital reforms.
Above all, need realises the doctor is bit more hold the reform that backside of course of study is system of management of human affairs of our country institution, it is public hospital doctor from " unit person " trend " social person " the first pace. Next, the doctor is bit more hold in course of study a variety of " random elephant " , its reason is system of original management of institution human affairs and new doctor hold the conflict between industry pattern, it is the phenomenon of sex of a phase, cannot deny accordingly hold course of study. The 3rd, of these level sexes " random elephant " need tries to solve as soon as possible, and should solve these " random elephant " , still need to deepen reform of system of institution human affairs further, unlock a doctor many a little bit hold the space of course of study, compose builds the doctor of socialization to administer a mechanism.
1. from " person depends on " trend equality is contracted
Our country's current public hospital manages system be born out of the institution at the tradition, although also undertook the reform of many sided in recent years, but the main means that the system of human affairs management of hospital of leech on to of traditional institution doctor remains public hospital to manage. In traditional human affairs management the system falls, employer is not only between doctor and hospital - the employ of employee concerns, and or a kind " person depends on " relation: Human relations be subordinate to of the doctor belongs to a hospital, of the doctor bring into play, leave his post to need a hospital approbate; The working arrangement that the hospital still mastered a doctor, title and post welfare of fulfil of rising, firewood; Unless special situation, the hospital cannot be fired, discharge doctor. In this kind of human affairs management the system falls, doctor " the person that be born is a hospital, ghost that is a hospital to death " , serious obstacle the doctor's flow, go against the reasonable configuration of medical treatment resource.
The occurrences in human life that spends in the light of this kind of administration runs a system, new medical service changes put forward a doctor many a little bit hold the reform measure of course of study, aim to drive a physician reasonable flow, the doctor that builds socialization administers new system. doctor much dot hold the is socialization doctor that industry says administers new system, because the doctor is bit more,be hold course of study stipulated doctor and public hospital mix afresh other hold the relation between orgnaization of course of study: With the first hold orgnaization of course of study is signed recruit (labor) contract, rather he hold orgnaization of course of study signs work contract. The distinction of both depends on, the first hold orgnaization of course of study (it is public hospital normally) the unit of human relations management that remains a doctor, and other hold orgnaization of course of study and doctor are the concern that the service offers only. But with traditional human affairs management system photograph is compared, doctor and the first hold of the right of orgnaization of course of study and responsibility differentiate, need is made clear through the contract that signs between both.
From this meaning, although take those who have human affairs government " cap " , but doctor and the first hold the relation between orgnaization of course of study already sadly from " the identity depends on " relation changeover concerns for equal bond. Came on stage 2014 " Ministry of Public Health about doctor much dot hold the announcement of trade concerned problem " in regulation " the doctor is in the first hold the working hours of industry spot medical establishment and workload did not achieve full-time doctor to ask, cannot get full-time firewood reward. " this one regulation indicates much point hold the cent recipe pattern that the doctor of course of study has begun to break through institution personnel. Especially new 2017 " doctor hold trade measure " in " area is registered " regulation, was to break doctor and public medical establishment further more between " person depends on " relation.
2. is bit more hold course of study and system of management of traditional occurrences in human life still have conflict
But, undeniable, in new doctor much feature hold the policy of course of study carries out a process in, system of traditional human affairs management still " wore a tail " , did not undertake thorough reform. This is behaved above all in, the doctor's human relations and institution work out still exist, the doctor still needs to weave through the institution the capacity will obtain position of such as title, learning to wait " advantage " , still need to be finished through public hospital " the profession develops " , hit oneself " brand " . To it relevant couplet, although the doctor is many bits OKer hold course of study, but also should get the first hold orgnaization of course of study (public hospital) a variety of limitation, for instance much dot hold in principle of course of study needs to pass the first hold the approve of orgnaization of course of study, want on working arrangement with the first hold the arrangement of orgnaization of course of study is given priority to etc.
That is to say, although unlocked a doctor many a little bit hold of course of study " cut " , but still stayed very big " tail " . And leave this " tail " , its original intention is understandable: Our country doctor is bit more hold the external environment of course of study is diseased still, doctor from come out many a little bit inside system hold course of study, still face a lot of obstacles; Accordingly, need is nodded for how hold the doctor of course of study " remain a rout of retreat " , be in for them break away from an institution stage by stage " unit person " the trend is bit more hold of course of study " social person " a few safeguard are provided in the process.
But, this " tail " also brought an issue. Although administration changes color,traditional occurrences in human life runs a system grumous, but the logic that also its hold water, that is public hospital enjoys those who include forestall of finance allowance, administration to wait inside a series of use " public natural resources " influence, the worker of public hospital is in theoretic it is a country " service personnel " , because this needs the management that administration turns, put an end to service personnel " with fair seek illicit " . Present doctor is bit more hold course of study, in leave those who administration turns management " tail " while, also withheld one part to use " public natural resources " influence. This is actually use " public natural resources " come " seek expedience " opened a channel.
Current doctor is bit more hold course of study fulfils what appear in the process a variety of " random elephant " can find source from here. For instance wide the doctor of the public hospital that is bad-mouth to oneself " become a shareholder " civilian battalion hospital transfers a patient, for instance the doctor of public hospital is taking the full-time salary of public hospital at the same time, at the same time everywhere " open flying knife " , got this to plant namely " half fair half illicit " flaw, on one hand the identity that they return reservation to have public orgnaization, can obtain from inside public orgnaization " advantage " , nod through how again on the other hand hold the means of course of study, plant this " public natural resources " brought advantage move goes out. From this angle, current doctor is bit more hold of course of study " random elephant " it is traditional rear system of human affairs management and much dot hold the doctor of the new socialization that course of study represents administers the conflict between system.
3. realizes benign development to still need to deepen reform
So, how to know these " random elephant " generation? What need to make clear above all is a doctor many bits hold course of study is the way that our country new medical service changes, be helpful for improving the use efficiency of medical treatment resource, be helpful for realizing the balanced configuration of medical treatment resource. Next, the doctor is bit more hold course of study still needs other a series of policy form a complete set, need the form a complete set of external environment. For instance need unlocks the space that medical treatment serves adequately, break unreasonable medical treatment to serve a program the excessive limitation to installing medical establishment; Need the farther reform of social security system for instance, solve a doctor many a little bit hold the social security problem after course of study; Build danger of perfect malpractice liability and cure to protect doctor system to wait for instance. But current some of these reform of form a complete set were not begun, some was begun but did not fall to real point. This makes a few doctors " not dare " jump to achieve real much point hold course of study. Below such circumstance, through leaving " tail " drive much point hold course of study, it is the price that reform must pay.
But, still need to make clear, these " random elephant " can be level sex only, of provisionality, cannot will normalization. Much dot hold the doctor of course of study, cannot " eating boiler in, look at a bowl in " , cannot of two respects " cheap " earn. If want an institution work out, want public hospital " the identity " , the acceptance with respect to conscientiously the administrative measure of service personnel, the occurrences in human life that accepts an institution runs a system; If want much place hold course of study, be about to abandon the identity of service personnel, abandon career sheet weaving.
Of course, want implementation doctor many a little bit hold the benign development of course of study, still need to deepen reform from each respects, compose is built get used to much dot hold the external environment of course of study, reform of a few form a complete set is necessary:
Above all, come off stage by stage adherent wait in the title assess above institution staff capacity, social security, will socialization, make the worker that the doctor is public hospital without giving thought to bit more still hold the doctor of course of study can win equal treatment. The work out makes a tool that has administrative function only finally, is not the identity those who make is indicative.
Next, build the medical treatment liability accident that gives priority to body with the doctor to be sure, make many a little bit hold the doctor of course of study makes responsibility principal part, cast off the dependence to the unit. In the meantime, the disbursement that cure protects the system also should undertake reform, build maintain doctor system as the medical service that pays a boy or girl friend with the doctor, make cure Baoding dot of the doctor breaks away from an unit, cure protects the disbursement to the doctor not to need to carry an unit.
The 3rd, should unlock a doctor hold the space of course of study, encourage and support the medical establishment of the socialization of a variety of forms, plan and examine and approve what cancel to be installed to unreasonable medical establishment, want progressively instead to put on record make.
Actually, a few afore-mentioned proposals are in 2014 " Ministry of Public Health about doctor much dot hold the announcement of trade concerned problem " in what had summed up is special reached the designated position, want namely " accelerate change government function, relax condition, simplify program, optimize a doctor many a little bit hold trade policy environment. " the doctor is only bit more hold the policy environment of course of study reached the designated position, these policy " tail " ability cancels thoroughly, much dot hold of course of study " random elephant " just also can disappear, achieve much point thereby hold the benign development of course of study.
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