Notes from a Sydney taxi driver
Due to the killing of doctors at Beihang Hospital, domestic friends asked me to talk about the medical situation in Australia, so I wrote this "propositional composition." Mainly based on my own experience and observations, talking with medical friends, and also consulted some information, it is inevitable that there will be omissions, I hope friends who know how to correct me.
Australia is one of the countries with the best medical insurance and services in the world, and it is at least in the top XNUMX according to the different emphasis of different institutions.
Australia takes universal health insurance, called Medicare, which can be enjoyed by citizens, permanent residents, refugees and resident applicants. A Medicare Card can be issued to obtain various services. Low-income earners also have a health card to receive discounts on self-paid medications, examinations, and specialist outpatient clinics.
One, medical insurance
Medical insurance is roughly divided into three parts: outpatient and examination, medicine and treatment, hospitalization and surgery.
See general medical clinic, blood routine, B-ultrasound, CT examination and general Medicare report. See the specialist outpatient clinics of public hospitals. Basically, all reports are reported, but the appointment waiting period is between one month and three months. Specialist outpatient clinics of private clinics, the appointment period is one to four weeks, the medical insurance card is reported one-third or one-quarter, and the individual needs to pay 50 to XNUMX Australian dollars out of his own pocket. General surgeons' outpatient consultation is cheap, and physicians are more than XNUMX% more expensive. Health card holders or pensioners will get discounts voluntarily given by doctors, saving XNUMX to XNUMX yuan per outpatient visit.
There are two types of drugs that enter the medical insurance system and those that have not. There is no independent pharmaceutical factory in Australia, and all drugs are purchased from major pharmaceutical factories or branch factories in Australia. General drugs are covered by medical insurance, that is, drugs purchased and subsidized by the government. Residents generally need to pay about XNUMX Australian dollars per unit, and low-income/health card holders do not exceed five or six Australian dollars per unit of medicine. But the latest drugs are generally not covered by medical insurance and pay the full price. If you don't have money, you can't afford it. Recently, Australia put a new drug for cancer treatment into medical insurance, saving patients more than XNUMX Australian dollars a year.
No matter if you live in a public hospital, everything is free, including meals. In Australian hospitals, whether public or private, nurses provide 24-hour services, including life care: feeding, bathing, etc. Patients' relatives and friends are not allowed to accompany the night and nursing.
I think the rationality of this system lies in the fact that if you are seriously ill and hospitalized, patients cannot work, and without a normal income, most people will not be able to pay, so it is simply free. There is no limit on the use of the medical insurance card, and you should report as much as you need.
In addition to this, there is a private medical insurance system in various categories. The most basic critical illness insurance is about three thousand five to four thousand a year for a family, including minor children. Insured persons can enjoy two hundred yuan for dental care, two hundred yuan for glasses, two hundred yuan for physical therapy and fitness (doctor's certificate is required). The key is hospitalized surgical treatment. Specialists will issue orders and be admitted to the hospital in different categories. Minor surgery, such as painless gastrointestinal endoscopy, usually pay another five hundred Australian dollars; such as major surgery, the hospitalization fee is free: including food and physical therapy during hospitalization. However, the patient needs to pay about two-fifths of the surgeon’s operation fee, plus an anesthesia fee less than XNUMX yuan. Generally, the cost is between XNUMX and XNUMX, and orthopedics is calculated separately. However, there is no need to pay for drugs and medical materials, which are covered by the National Medical Insurance. The advantage of private medical insurance is not only fast, but also that you can choose a surgeon you know and trust, or recommended by a friend. When you were pushed into the operating room, you met a doctor you knew well, and when he said to you like an old friend: "Mr. Zhang, just take a nap," it is a great comfort to the patient.
Australia is absolutely independent of medicine, medicine and hospitals. That is, doctors only take care of diagnosis and treatment; pharmacies prescribe drugs based on prescriptions, and hospitals provide equipment and care according to the requirements of each doctor.
1. Australia imitates the British system. Doctors are divided into general practitioners and specialists. General practitioners such as the pre-examination department of Chinese hospitals or general internal medicine, we also call them family doctors. Generally, Australians will choose a regular general practitioner as their family doctor. Except for emergencies, if you are generally uncomfortable, you must first see a general practitioner. The general practitioner prescribes medicines, prescribes prescriptions for examinations, and transfers them to relevant specialists based on the situation. Without a letter of recommendation from a general practitioner, individuals are not allowed to see a specialist at will; without a letter of recommendation, the specialist will also refuse to admit patients. This is the law. After the outpatient visit, the specialist will write a letter to the general practitioner explaining the diagnosis and treatment plan. In this way, all your files are in the hands of the general practitioner. If you need to see a specialist again, the letter of recommendation contains all your medical history accumulated to date. The main responsibilities of the general practitioner are the custodian of the medical history and the executor of the instructions of the specialist: such as prescribing medicine. The GP will remind you to have a blood test, B fuck, and other routine checks, if necessary. If you think that specialist doctor is good, you will always see him/her, otherwise you will change. In this way, a long-term friendship of mutual trust is established between the doctor and the patient.
Compared with China, the advantage of this system is that specialists own patients more equally and get practiced more equally, especially surgeons. The surgeons in the top three domestic hospitals are too busy, while the hospitals of other levels are too idle. In addition, the level of doctors is also very different. This creates a vicious circle of busy people getting busy and idlers getting idle, which wastes resources.
2. Medicine and routine inspection
The doctor prescribes a prescription, and you can go to any pharmacy to buy it. Neither the clinic nor the hospital has its own pharmacy. During the patient's hospitalization, the medication is provided by the hospital. This part seems to be tricky, but the medication is based on the doctor's instructions, and the doctor and the hospital do not control each other, so they will never overuse the medication.
The doctor prescribes prescriptions to go to the clinic for blood tests, B exercises, Ct, etc. In principle, the patient can choose the inspection institution by himself, but the doctor generally uses the form of a certain inspection institution as the prescription, and the patient will basically go to the institution for examination. Therefore, it is possible for the doctor to get a kickback from the examination, and overexamination can also occur. But this part generally does not require the patient to pay, so it is related to the fraud of government medical insurance, and the government also closely monitors it. Doctors and inspection agencies will not be too much. My family doctor was investigated by the government and he was very unfair and complained to me, but I believe he is innocent.
3. The hospital.
The hospital is divided into public hospitals and private hospitals.
Public hospitals are fully supported by the state, so there is naturally no problem of paying a deposit before medical treatment. And the law stipulates: it has no right to refuse any delivered patient, no matter who they are? It is Australian and non-Australian; if the latter is the case, it is also a post-doctoral payment. It depends on luck if you can catch it or not.
It may be difficult for domestic friends to understand that apart from the emergency department, public hospitals do not have their own specialist consultation physicians and surgeons. It only resides in junior doctors who are not able to practice independently, such as internship, hospitalization, and registration. Specialists and surgeons generally have their own independent clinics or join other medical centers, but they must go to public hospitals one day a week or other frequency according to regulations. Public hospitals pay a fixed hourly salary, which is lower than their own clinics. Income, the former is roughly only 20%-30% of the latter. That is to say, the relationship between hospitals and doctors is an equal relationship, rather than the relationship between employment and employment. This sets up a structure for the hospital to take doctors and their treatment as the work center. At the same time, if there is a medical accident, the responsibility of the individual doctor is greater than that of the domestic doctor; accordingly, the responsibility of the hospital is less than that of the domestic hospital.
Private hospitals are established and owned by private individuals or organizations, and they have the right to refuse admission to a certain patient. Private hospitals only provide nursing services such as beds, equipment, and nurses. They have almost no full-time doctors, only inpatients and interns, and no complete departments of Chinese hospitals, nor do they accept patients directly. They are usually brought by doctors in private clinics. To enter a private hospital, patients need to pay part of their own expenses, private medical insurance and national medical insurance. The relationship between private hospitals and doctors is similar to the relationship between shopkeepers and customers. It is more obedient to doctors than public hospitals. The doctors have the final say.
4. Lane Act
In 2007, in the Queensland Hospital, a three-year-old boy was deteriorating because he was not properly diagnosed and treated. His parents felt that the situation was not good and the existing treatment was problematic, but their opinions were not taken seriously, and finally Ryan was infected and died. After the incident, the Queensland Health Department established the "Lane Act" to allow patients to consult other doctors in an emergency. As long as the patient or family member has doubts about the existing treatment, they can call the "Lane Act Clinic" to request a follow-up consultation. The "Lane Clinic" will connect you to the top experts in that field. You can first understand the condition and give opinions on the phone. Shi would also rush to the scene to participate in the rescue. This bill has now been extended to various continents to varying degrees, and it is said that it has saved thousands of lives and health. With the development of network telemedicine, "Lane Act Clinic" will play a greater role.
The "Lane Act" is touching and has also added a lot of reputation to the Australian medical community.
Three, the doctor
1. Medical student
Doctors are Australia's most reputable and desirable profession, and the worst-reputed is used car salesman. Half of the middle school graduates with the highest scores each year may go to medicine. Therefore, the threshold of medical school-no matter which university-is very high, the admission criteria is divided into three parts: 1), college entrance examination scores; 2), UMAT/undergraduate medical and health science entrance exam (mainly intelligence and ability test: logic Reasoning, problem solving and comprehension) performance; 3), interview. The first two items are qualified for the interview opportunity. The interview is very mysterious. It is said to examine the students' motivation, attitude, will and kindness in studying medicine. The content of the interview is determined by each interviewer. The interview score is not disclosed or explained, only the results of yes and no will be informed. If you fail the interview, you will come back next year. There are students who specialize in medicine, and it took several years for them to become medical students. The medical school has gathered the best middle school graduates.
2. Become a doctor
Generally, the school system of medical school in Australian universities is six to seven years. After graduation, I will practice in a public hospital for one year, and then become a resident doctor for one to three years. After the examination, he will become a registered doctor of general medicine, specialist, and surgery for at least one year. There are strict annual and local quotas for recruiting specialist doctors, while general practitioners are much more relaxed. This ensures that specialists and surgeons have enough patients to protect their income. It is necessary to pass the examination and registration to become an official general practitioner or assistant specialist. Specialist doctors are not required, but generally a doctorate degree is required here. Generally speaking, it takes four years at the earliest for a general practitioner to graduate, six years for a specialist, and possibly longer for a surgeon, while the heart and brain surgery will be extended by one or two years accordingly. In other words, it is generally XNUMX years old to become an independent official doctor.
In Australia, doctors are more often an independent entity, that is, doctors have full power and responsibility for their medical actions. For example, once the patient signs the form of consent to the operation, the doctor has the right to take any measures he deems necessary for all accidents that occur during the operation, without the need to seek advice.
After becoming independent general practitioners, specialist consulting physicians, and surgeons, most people will eventually seek to open their own personal clinics: rent their own house, purchase corresponding equipment, medical accident insurance, and be responsible for their own profits and losses in one sentence. In this way patients are their customers. In this way, there is no reason for doctors not to be dedicated to their patients, and patients are free to choose their own doctors. If you encounter a major medical problem, in addition to giving your own opinions, the doctor will also actively ask you to listen to the opinions of other doctors and issue a letter of introduction for you.
There are several reasons why Australian doctors can win the reputation of being the best in the industry:
1), take an oath. Medical students must collectively swear an oath before starting to study medicine. The oath is basically based on the oath of the "Father of Medicine" Hippocrates": "The god of medicine Apollo, Asclepius and the gods of heaven and earth are witnesses, my dear Respectfully swear...
I am willing to do my best to abide by the creed of working for the benefit of the sick family, and check all depraved and harmful behaviors. I shall not give harmful drugs to others, and I will not give this guidance, although people request Nor will it. Especially do not perform abortion for women. I am willing to carry out my duties for life with this pure and holy spirit. For those who suffer from calculi, I do not perform surgery, and this requires experts to do it. "
The oath and its oath have a great influence on the morality of Western doctors.
2), stable income. The average annual income of general practitioners is around 20 Australian dollars, and specialists and surgeons are around 20 to 40, depending on the corresponding subjects. Recently, the average annual salary of Australians is around 8. Another advantage is that the doctor profession generally has no difficulty in finding employment, and it is also respected. The doctor has a better daily life and naturally maintains a good mood.
3) The doctor can talk. The medical school pays attention to the expressive ability of examinees when recruiting students for interviews. In the subsequent examinations at each level, on-site performance accounts for more than 70% of the entire examination. According to my experience in visiting the doctor, almost every specialist is like a psychiatrist who can speak well when it comes to your heart.
4) There is a limit on the number of doctors admitted to patients, not too many, so there is more time to explain and communicate with patients. According to my experience of visiting specialist doctors many times, each outpatient visit is at least 10 minutes, and the longest is 45 minutes, usually about 20 minutes. The patient has a full understanding of his symptoms, and the doctor's treatment opinions are also fully understood, and trust arises from this.