Shut the means of payment newly and agriculturally in abundant reform of the emolument of Yunnan Keep a grip on the great prescription

Shut the means of payment newly and agriculturally in abundant reform of the emolument of Yunnan Keep a grip on the great prescription
Patient bear is it lighter after seeing the doctor, unless " go over, have pieces of cold that the fevers,doctor except infusion, also prescribe a lot of medicines. But in these two years, there are obviously few medicines that doctors prescribed, and try hard not to allow the infusion, can save half the money while seeing the same disease. " In the intersection of Yunnan and the intersection of emolument and the intersection of Feng County and the intersection of town and the intersection of stockaded village and the intersection of foot and the intersection of village and health station, officer of soil, peasant the intersection of leaf and tree mark, hold, say by a prescription. The same as the leaf tree is marked, the peasants of the emolument Feng County have experienced this kind of change. Since 2006, this county has reformed and shut the way of paying newly and agriculturally, prepay and make the expense total value of the clinic and the expense bed pay the system on day in hospital. Say briefly, but the expense total value of medical organization undertakes to do a job until it is completed. This measure has controlled the hospitalization cost effectively, has promoted and made a diagnosis rationally, has lightened patient's burden, make peasants realize " Spend less money, have an optimistic view of the disease " Hope. For a long time, the medical insurance of our country implements the means of payment paid according to the service item. Its biggest drawback is, the inclination of inducing the demand, excessive service appears easily in the medical organization. In recent years, with shutting the implementation of the system newly and agriculturally, the medical demand of the peasants in Feng County of the emolument is being released constantly, but the unreasonable hospitalization cost thereupon increases. How did ability keep a grip on the doctor " Hands " ,Let the expenditure of the hospitalization cost be more reasonable? The emolument Feng County draws lessons from the internationally advanced medical insurance to pay the mode, combine the China's actual conditions at the same time, have introduced and shut the reform of means of payment newly and agriculturally. The county shuts the management organization to regard population as the base figure newly and agriculturally, calculate through science, implement the hospitalization cost to the medical organization " total value undertakes to do a job until it is completed, overspend and pay for itself, the surplus are reserved for one's own use " . Since this reform is pursued, it is obviously benefited to join and shut to peasants. Investigation reveal 2008, emolument abundant the intersection of clinic and time of health clinics in towns and townships fee 33, village clinic 21 yuan, well below the national rural average level of medical organization. In two grades of health organs in the village, average medicines kind and quantity of each prescription drop year by year, more than 5 kinds of medicines " The great prescription " Basically disappear, antibiotic unites rate of utilization and lower than the average national level with hormone too. 2009, county people's hospital patient in hospital time expense are 1576 yuan, obviously lower than the national average level of hospital at the same level. Fewer and fewer Dong is blue dawn that the clinic doctor writes a prescription, president of commune hospital of officer's town of soil of Feng County of the emolument. During these years, she has felt the pressure is very large. Because the new agricultural joint-venture's money is implemented " The overall rationing system " ,It is fixed that the medical insurance pays total value. So, only calculate carefully and budget strictly and have an optimistic view of the disease with the minimum expenses, otherwise sustain losses in business. "In the past, the more doctors wrote a prescription, took the more bonus, because the income of the commune hospital mainly depended on selling medicines. Just the opposite, the doctor write a prescription more, not only has not rewarded but also been punished now. The hospital requires the doctor, never injection that can take medicine and solve, the ones that can be injected and solved never infuse, try hard to use the basic medicine, stop to write a prescription, hold the expensive medicine behavior more. " Dong XiaoLan says. The intersection of town and the intersection of commune hospital and physician, officer of soil, fine and soft to say from " ask for great treatment only minor illness " while being auspicious king have To construct and cure due to illness, this is a great change. In the past, patient even if only ordinary cold, doctor want, use " the three plain first soup " (antibiotic, hormone, vitamin and brine) . A spore antibiotic of high price has very big consumption, cheap penicillin basically disappears. Different now, in all antibiotic prescriptions, penicillin accounts for more than 60%, become first-selected medicine. And consumption of hormone is less, only special diseases such as irritation, rheumatism,etc. are used. In 2006, the emolument Feng County began to implement the total value of clinic and pay the system. Its main method is: Operate jointly it according to factors such as the visit person of every rural medical organization, service ability,etc. newly and agriculturally, estimate out and pay total value, pay to the medical organization. If the profit, the medical organization arranges oneself; If suffer the loss, medical organization bears. Under this kind of incentive mechanism, the medical organization maximizes in order to reach one's own interests, will try every means to lower costs, reduce the excessively medical behavior, thus reduce the hospitalization cost. Some experts propose, it is fixed because of paying total value, the medical organization, in order to save the cost, may cut down the service, prevarication patient, result in joining and shutting peasant's interests to damage. For this reason, new and agricultural in the emolument Feng County to operate jointly and make the strict system to assess to the medical service quality, each rural medical organization must pay first in advance medical treatment of peasant wipe out fee, operate jointly, examine one per month while being agricultural while being new, appropriate the fund according to the standard after being qualified. If find it is unreasonable to use medicine ng, too little, patient's satisfaction not higher phenomenon of serving persons, reduce its expenses. In hospital the intersection of sick bed and turnover more and more fast not long ago, emolument Feng County put down peasant of wave town Li WenXian because suffered from gynecological cyst, live in the county people's hospital. Several years ago, did such a major operation, it takes one week to check before the mere skill. An unexpected one is, did the operation on the third day if she is in hospital, left hospital in 7 days. She says: "It is not seriously believable, it will be so soon all right and agile! " Jiang YuZhu, director of gynaecology and obstetrics, tells reporters, there were few hospital patients in the past, the sick bed vacancy rate was high, the doctor always wants to let patients live for a few more days. Now, the same class disease, it is the same to pay newly and agriculturally jointly. Moreover, the longer the patient days in hospital are, the less medical insurance is paid, the less worthwhile the hospital is. So, the doctors all use the trick all over, let the patient try hard to recover early, leave hospital early, raise the turnover rate of the sick bed. In 2006, implemented number and paid the system in the emolument Feng County. For example cut open the palace and produce the operation, shut and only pay 2000 yuan newly and agriculturally. However, this kind of way of paying can only cover some common number, there is certain limitation. Since January of 2008, the emolument Feng County is in hospital to pay the system on day according to the bed, covered all number. County operate jointly, divide impatient into worried critical disease, non- worried critical disease, choose date for operation and the intersection of pediatrics and 4 big class while being agricultural while being new. Last standard to be the same disease it is similar,but every day pay according to skill ago, in skill, postoperative and getting more different to some extent. Generally speaking, are in hospital to pay more in one week, fewer and fewer one week later. If the patient goes beyond stipulating in hospital on days, do not pay newly and agriculturally again when shutting. That is to say, short in hospital stays the patient is, treat the the lower expenses, the higher the economic income of the hospital is. So, only let patients enter and nearly go out of quickly, the hospital is profitable. Someone was once anxious: Since the medical insurance is paid it is fixed, the hospital, in order to increase incomes, will let patients leave hospital ahead of time? For prevent the phenomenon, county operate jointly, stipulate if patient the intersection of internal cause and same disease in hospital repeatedly one month while being agricultural while being new, shut the expenses that will deduct and pay the hospital newly and agriculturally. This mean if because patient leave hospital, lead to the fact the condition to be repeated too early, the hospital can not take any compensation. Director of people in Feng County of the emolument Xiong WenYun thinks, the greatest advantage of paying the system on day according to the bed is that do not " restrict the means, only see the result " . After implementing the reform of means of payment, submit an expense account external application of catalogue is examined and approved Having cancelled, the doctor can choose the best healing solution according to patient's reality, do not receive medicines? �� cangue Ke break the beer? 009 year, medical costs of hospital control undertake to do a job until it is completed expenses 95% about, and medicines expenses account for, in hospital all-inclusive cost 35% about only. The patient is in hospital on average day is lower than the average national level as 7.25 days. The county operates jointly staff member Li GuoLin and says newly and agriculturally: "In the past, the medical insurance department spent a large number of energy verifying case history and prescription, but efficiency is very low, the result is very bad. Through reforming the means of payment, the medical organizations at all levels have set up self- tied mechanism, the doctor has got used to checking rationally, treating rationally, thus has reduced the unreasonable medical expenditure greatly, peasants diagnose the illness and seek medical advice the expenses are obviously reduced. "

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