Medical reform is related to the health and well-being of more than a billion people, is a long-term and arduous process. Public hospitals are the main body of the medical and health service system, the success or failure of the reform will be directly related to the success or failure of medical reform. However, the current public hospital reform has “two hot, cold in the middle” – the government is very hot, the people are also very hot, but the doctor is very cold situation. The enthusiasm of the medical staff is far from being mobilized, and their insights have not yet been fully expressed. Without the active participation of doctors, it will be difficult to implement measures such as “two-way referral”, “general practitioner”, “reducing medical costs” and “improving the satisfaction of medical services”, which will definitely affect the success or failure of medical reform. It is urgent to solve the problem of how to mobilize doctors’ enthusiasm to participate in health care reform. However, where does the problem of doctors’ “inactivity” lie? Is it the lack of system or the problem of doctors themselves? What should be the health care reform that can fully mobilize doctors’ enthusiasm?
Who should pay for the “inactive” behavior of doctors?
According to Yin Jia, director of the Department of Metabolic Diseases at Peking Union Medical College Hospital, it is not that doctors are indifferent to the medical reform program, but that they have long been unable to express their views and their reasonable demands have not been taken seriously and recognized, so they prefer to remain silent in the medical reform.
The distortion of the benefit distribution mechanism in the field of medicine and health “After reading the new medical reform plan, I think there is a lack of excitement for medical personnel to get excited,” said Chen Hangwei, director of the respiratory department of the General Hospital of Beijing Military Region. The root of the many problems and chaos in the medical field is the distortion of the benefit distribution mechanism in medicine and health. The 2011 China Health Manpower Development Report reveals that the average working hours of medical personnel is 53,4 hours per week, far exceeding the legal working hours of 40 hours per week; on average, they have to work 7 night shifts per month. At the same time, in the process of promoting medical reform, medical institutions have generally carried out activities such as making appointments for medical services, improving the medical environment, optimizing the treatment process, extending clinic hours, and opening double-holiday and holiday clinics. However, the county-level public hospital reform is currently limited to the abolition of drug-plus revenue, to break the “medicine to compensate for medical” mechanism, and almost no progress in service charges, government subsidies are not in place, the doctor’s labor intensity is increasing, and the income is pathetic, imagine the income is so little even to feed the family is not enough to talk about work motivation? In the market economy, doctors also have the need and desire to support their families and improve their lives. In the case of insufficient government investment in medical care, doctors and hospitals have the pressure and motivation to generate income, and it is difficult to effectively link the income of doctors with their medical services, which inhibits the motivation of doctors to improve medical services.
2, the tension between doctors and patients also affects the motivation of the work of doctors.
Today, hospital bloodshed cases spread across the country’s provinces and cities, spanning villages, towns, counties, cities, provinces and Kyoto, with 22 cases occurring in one year in 2012 alone. Hospital bloodshed cases are too numerous to write down, and the injuries vary, from blind people, broken limbs and cripples, to people with their throats slit, and even those with damaged genitals, which can be described as shocking and tragic. Such a tense relationship between doctors and patients makes medical staff tense for their own personal safety every day, and medical staff describe their situation as “eating grass, milking, and being whipped”.
3. Doctors are constrained and have no space or platform for entrepreneurship.
In September 2009, the Ministry of Health issued a notice on issues related to the multi-point practice of physicians. Subsequently, Guangdong, Hainan, Yunnan, Sichuan, Beijing, Jiangsu and other places have started the pilot multi-point practice of doctors. After two years of trial operation, in July 2011, the Ministry of Health decided to expand the pilot areas to all provinces in China, and at the same time lowered the threshold, lowering the qualifications for physicians from associate senior to intermediate level or above. The national policy of multi-point practice was introduced in the hope of directing quality resources from large hospitals to the grassroots and communities, and also received wide public support.
However, three years later, multi-practice is generally cold around the world, many provinces have less than 100 applicants, and in some cities there are even “zero applications”. Why is the multi-practice of doctors “good but not good”?
Doctors to achieve multi-practice, generally through the individual doctor application, the hospital agreed, the Health Bureau registration 3 steps. In public hospitals, the need for the approval of the president of the multi-point practice is almost the same as a virtual nullity. Because medical talent and technology is the hospital’s greatest competitiveness, which president is willing to send quality resources to other hospitals for free? In addition, doctors in research, teaching, academic title evaluation by the hospital; future medical reimbursement, retirement pay, etc. are also counting on the hospital. In a word, public hospital doctors who have the status of state-owned institutions are “unit people” rather than “social people”, and openly demand the right to multi-practice, which is equivalent to using identity protection for freedom of practice, most people do not dare to “risk”.
The implementation of the policy of multi-practice can really be described as “thunder but not rain”, completely failed to achieve its original purpose.
4, some historical problems have not been solved such as our medical law, it is really necessary to see the doctor to the patient, as a potential premeditated crime, from the beginning of the doctor to collect evidence for themselves to avoid liability? Is it necessary to subjective is to save lives of medical errors, as China’s most harsh sky-high sanctions? Is it necessary to put “the patient does not sign, the doctor has no right to save lives” in the code? This is to encourage life first or desecration of life? In short, this is in the deterioration of the doctor-patient relationship, the government did not want to, or the inability to solve the problem when the temporary plugging, copied from the consumer law temporary patchwork of junk laws, there is a need to exist today to limit the treatment of people?
From the above, it is easy to see that the factors that affect the motivation of doctors to participate in health care reform are multifaceted. Medical reform is a complex systemic project, the need to take into account the overall picture, not “headache, foot pain”, otherwise it will lose one thing, “press the gourd to float the ladybug.
How to reverse the situation of doctors are not active?
As the main force in the implementation of health care reform, the enthusiasm and active participation of doctors is crucial to the successful implementation of health care reform. To activate the enthusiasm and energy of doctors, all aspects of society need to give due respect and care to the doctor community. As a doctor expects to get is dignity, and patients expect to get is good medical services, but if the doctor is ashamed and stern, how can the patient’s medical services can be effectively guaranteed? Medical reform involves the interests of all parties involved, but the adjustment of the interests of doctors and patient groups should be the most central, the most should be clear.
1. Establish an incentive mechanism that reflects the value of technical labor. Medical is a high-risk industry, income must be able to reflect the value of the technical labor of health care workers, so that health care work becomes an enviable profession. We should accelerate the reform of performance pay in primary medical and health institutions; give special treatment to famous doctors and other special talents; and implement the treatment of personnel engaged in infectious diseases and other high-risk positions. At the same time, the government should improve the compensation mechanism for primary health care institutions and public hospitals. If medical personnel are allowed to support themselves by generating income, it will only push medical personnel to the opposite side of the people’s interests.
Improve the performance appraisal mechanism by relying on more work and more pay for better work. Develop an evaluation system that can effectively assess the performance of medical and health personnel, and also develop a number of indicators that can be implemented into the daily work of each medical and health personnel, according to his performance to determine his income, break the pot of rice, widen the income gap, so as to encourage the advanced and spur the backward. In addition, gradually shift to “skill-based medical care”, reflecting the value of doctors’ knowledge and skills.
2, reform the personnel management system, allowing doctors to “multi-point practice” to encourage qualified personnel to open clinics or individual practice of medicine. Here we need to emphasize the role of the hospital. As the hospital does not support from the heart of the hospital doctors multi-practice, to the hospital registration will put themselves in the hospital’s opposition. Therefore, multi-practice is in urgent need of policy support, including the resolution of the distribution of benefits and responsibilities between the doctor’s first practice site and the second career site, as well as the risk of medical liability brought about by multi-practice and many other challenges.
3, let doctors participate in management. Encourage doctors to participate in politics, not only can effectively solve the problems of hospital management, but also more conducive to the more rational design and successful implementation of health care reform.
4, to create conditions conducive to the development of practice. To establish a standardized training system for residents, to provide opportunities to improve the business level, to mobilize medical and health workers to study technology, the growth of skills and initiative, to maximize the release of potential for greater career development.
5, to create a “respect for doctors and health” social environment. Whether in the fight against SARS, or in Wenchuan and Yushu earthquake relief, the majority of medical and health workers have shown a strong sense of responsibility regardless of the cost, regardless of pay, this team can be relied on in critical moments, can be trusted. In their daily work, most of them are also dedicated to their jobs. General Secretary Hu Jintao and Premier Wen Jiabao have repeatedly stressed the need to create a social atmosphere in the whole society that respects medical science and medical and health care workers, requiring Party committees and governments at all levels to care for and love the majority of medical and health care workers and enthusiastically help them solve practical difficulties in work, study and life. Vice Premier Li Keqiang pointed out at this year’s national medical and health system commendation conference, mobilize the enthusiasm of medical and health personnel, we must create a “respect for medical and health” social environment, the formation of the whole society care about health work, support for health work, health work, health work, to create a new situation in health work.
6, improve the legal norms, to protect the rights and interests of doctors. Refine and revise the Law on Professional Physicians, especially to strengthen the interpretation of the section on the rights of doctors, including the positioning of personality, social positioning and the nature of the profession throughout life. In addition, the construction of industry associations should be strengthened. The industry association should be legally given specific rights, duties and obligations, and the professional behavior of doctors should be regulated by the information of the industry association. Only when the insiders control the insiders can the management be in place.
A medical reform that cannot gain the cooperation and support of the nation’s 5 million doctors will hardly succeed! In short, the health care reform will ultimately be carried out by doctors, who are the “live” lever to pry the health care reform. Only by allowing Chinese doctors to benefit from the health care reform, instead of sacrificing and giving without compensation, will China’s health care reform be successful.