At four o'clock in the morning, at Peking Union Medical College Hospital, more than XNUMX people had lined up in a long line, waiting for registration. Many of them have been queuing from zero.

The key is that you may not be able to register, maybe you will continue to queue up tomorrow.

According to reports, several children's hospitals in Shanghai, including Fudan Children's Hospital, Shanghai Children's Hospital, and Shanghai Children's Medical Center, generally spend more than 3-4 hours in line.

In a slightly larger hospital in Shanghai, see a dentist and register for at least a few days.

People who are healthy and never go to the hospital may never understand how difficult it is, how helpless, and how heartache it is to see a doctor.

Behind these appearances, today I want to talk to readers about domestic doctors and patients.

1. What is most lacking in domestic hospitals?

One sentence answer: conscience!

Bai Yansong once cried and asked on CCTV:

The "anti-cancer vaccine" is a magical and great drug,

Drugs that can kill cancer like cowpox kills smallpox,

Has long been listed in developed countries such as Europe and the United States,

And saved countless lives.

But it was shut out of the country for 11 years.

Now finally listed,

What can be marketed are products that have been eliminated abroad.

Can we not ask? What exactly is this for?

We also have to ask: After so many years, where have the talents cultivated by various medical colleges go? Is the plan not in place, or is there other reasons? I can’t understand and analyze it.

Why do people need to see a doctor on weekends, but the outpatient clinics of the hospital do not go to work? If there are enough medical personnel, the hospital building is there, and the equipment is also there, going to the doctor on weekends can solve many problems. The outpatient clinics of the hospital do not go to work on weekends, which aggravates the difficulty of seeing a doctor.

2. Why is it difficult to see a doctor?

About life-saving medicine:

For example, People's Daily Online reported that there are nearly 10 patients with chronic myelogenous leukemia in China, and about 1.3 new patients are added each year. There is no statistics on patients with gastrointestinal stromal tumors, but the annual incidence rate is about 1/10. 2/10 people, higher than the former.

These patients who were convicted of terminal illness in the past saw the hope of continuation of their lives because of the successful drug Gleevec developed by Novartis.

But a new problem is coming. The cost of taking this drug in China for a month is 23500 yuan. Although Novartis has formulated corresponding preferential measures, the annual cost of 7.2 is still a huge burden for most patients. .

The price of Gleevec in China is the highest in the world, while it only sells for 200 yuan in India. why? This question is too difficult to answer. It is beyond my ability.

However, information shows that this patented drug produced by many multinational companies has often become the most expensive drug in the world when it comes to China.

Vampires are everywhere in the interest transmission chain of price. When the price is low, they have no interest.

About drug approval:

The current medical order is very chaotic. Not only is everyone fighting for the market for economic benefits, but also for profit. What's more serious is that in the past few years, our government departments have encountered serious problems in the approval of drugs and the approval of drug prices.

There are only seven to eight thousand kinds of medicines in our country, but the number of medicines approved is about 18 or 19. There are dozens of numbers for a variety of medicines, and the prices of the same medicines are different. This has led to multiple names for the same drug and multiple prices for the same drug, and corruption is inevitable.

This problem does not lie in the examination and approval system itself, but in the non-openness and opacity of the examination and approval process. Only a few people approve secretly. This is not a system problem, it is an operational problem.

Regarding excessive medical treatment: The current medical service price system in my country is distorted, and the prices of doctors and nurses are too low to reflect the value of manpower. The problem is that things are more important than people.

Everything related to things is very valuable: high-quality consumables such as catheters and steel plates, and large-scale inspections such as nuclear magnetism and CT.

But the cost related to people is very low: the registration fee has not exceeded 20 yuan for more than 20 years, which is much lower than the parking fee in the hospital; the injection fee is 5 cents, even if other costs are not included, the iodine and cotton swabs are more than 5 cents. ; There are also nursing fees. Under the current price level in Beijing, the price of 24-hour primary care is no more than XNUMX yuan.

This orientation forces public hospitals to compensate by selling medicines and high-quality consumables. Such compensation methods are very inefficient, and the result is excessive medical treatment.

Regarding medical disputes: The implementation of medical dispute resolution mechanisms in hospitals in my country is inefficient.

The ideal situation is that after a medical dispute occurs in a hospital, the hospital or related institutions will intervene in a timely manner, and the doctors involved can work normally.

But unfortunately, in many hospitals, doctors have played a major role in handling medical disputes. This has brought great distress and burden to the doctors involved, and some even committed suicide as a result.

The bloody facts prove that in the face of medical disputes, hospitals, patients, and doctors have no winners.

Regarding medical reform: Since 1985, when “delegating powers and profits and expanding the autonomy of hospitals” was proposed, Pandora’s box was opened. Hospitals and doctors went further and further on the road of profit-seeking, and the public welfare of medical treatment disappeared. Difficult and expensive medical treatment is a prominent problem in China's medical system.

The medical reform goes deeper, lacking basic theory, and health economics has not entered the research field of general university economics for a long time, but is exclusive to medical universities under the Ministry of Health.

Regarding medical insurance reimbursement: the more effective the imported medicine, the less reimbursement.

Our medical insurance institutions have very weak supervision of medical service behaviors, and they also set various restrictions on the health rights of residents. For example, we are all participating in medical insurance. Everyone has a catalog when reimbursing medical expenses for medical treatment. Part of the reimbursement is available for the inside, but there are still quite a lot of drugs and services that are not in the catalog and are not reimbursed at all.

The more expensive drugs, the more imported drugs, and the more effective drugs are not reimbursed.

The problem now is that our medical insurance department only supervises the reimbursement of expenses, and no one manages the expenses paid by the people.

If our public hospitals in order to generate income, guide the people to take more medicines and services at their own expense, how can the burden of the people be reduced?

I do not agree that our expense reimbursement system adopts a dual-track system of partial reimbursement and partial non-reimbursement. All expenses and services related to medical treatment and rescue should be included in the scope of reimbursement.

Regarding government investment: We only found the total national medical and health and family planning expenditure of 2015 billion yuan in 11916 from the Ministry of Finance, an increase of 17.1%.

As a doctor, I just want to ask one sentence about the medical and health expenditures announced by the Ministry of Finance: How much of this money is spent on doctors and nurses, and how much is spent on the people?

Why don’t doctors, nurses and ordinary people feel the money invested by the state? On the contrary, seeing a doctor is more difficult and expensive!

If government funding is only used to improve the infrastructure of hospitals and purchase large-scale equipment, how can this mechanism make medical care dignified, and how can it reduce the burden of medical expenses for the masses?

Regarding hospital income generation: Many of our hospitals adhere to the principle of not supporting people. I can give you money to buy equipment and build a house, but we can’t guarantee your salary. You go to the service to create and receive salary. This mechanism is to treat our medical staff. Pushed to the opposite of the interests of the masses, this is a very important cause of conflict between doctors and patients. It not only hurt the interests of the masses, but also hurt the dignity of our medical staff and the image of soldiers in white clothes.

Regarding disease prevention and control: SARS in 2003 made us realize the importance of public health, so the state invested a huge amount of funds to strengthen the construction of the basic prevention and control system, so now the ability to respond to various infectious diseases and sudden public health emergencies has been significantly enhanced. However, our ability to prevent various common diseases, frequently-occurring diseases, senile diseases, and chronic diseases is still quite weak. Now, serious diseases such as cardiovascular and cerebrovascular diseases, cancer, diabetes, kidney disease, and liver disease are still threatening people's health.

Our current health control system is separate from prevention and control and disease treatment. Most of our disease control personnel deal with the spread of infectious diseases, but there are not many effective means for the spread of chronic diseases and common diseases.

Most of our doctors go to see the doctors, wait for patients to come to their homes, and rarely go to communities and families to investigate and understand the epidemic trend of diseases. We have a lot of work to do in this regard.

Regarding hospital expansion: As long as it talks about hospital expansion, real estate companies are very motivated. Many real estate companies voluntarily promise to build a large hospital free of charge when they build new residential areas.

The guarantee of medical services is quality, and the guarantee of quality is talents. You can invest in building many hospitals and building many wards. The question is where our talents come from.

If we consider from the national perspective as a whole, we can build many large hospitals or medical cities in a short period of time by using social capital, but can not cultivate corresponding qualified and high-quality medical personnel, what should we do?

The fact is true. Nowadays, there are fewer and fewer medical students applying for medical colleges and universities, and the source of students is getting worse and worse. There are very few outstanding medical students left. Who is ultimately hurt?

After so many years, qualified and excellent doctors are still so scarce, and it is still so difficult for ordinary people to see a doctor. Isn't it contemplated?