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Reform of public hospitals should be "de-administrative"

Reform of public hospitals should be "de-administrative"

  • Categories:Industry News
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  • Time of issue:2010-11-06
  • Views:170

(Summary description)I mainly want to talk about some major obstacles and difficulties in the advancement of the new medical reform. The main direction or principle of advancing the medical reform can be summarized in four words, called "de-administrative". We often say that the core principle of the medical reform is the separation of management and administration, and the separation of administrative affairs. These eight characters are actually de-administrative.

Reform of public hospitals should be "de-administrative"

(Summary description)I mainly want to talk about some major obstacles and difficulties in the advancement of the new medical reform. The main direction or principle of advancing the medical reform can be summarized in four words, called "de-administrative". We often say that the core principle of the medical reform is the separation of management and administration, and the separation of administrative affairs. These eight characters are actually de-administrative.

  • Categories:Industry News
  • Author:
  • Origin:
  • Time of issue:2010-11-06
  • Views:170
Information

I mainly want to talk about some major obstacles and difficulties in the advancement of the new medical reform. The main direction or principle of advancing the medical reform can be summarized in four words, called "de-administrative". We often say that the core principle of the medical reform is the separation of management and administration, and the separation of administrative affairs. These eight characters are actually de-administrative.
  The current medical system is an administrative system, and this administrative system is reflected in all aspects.
   First of all, the issue of government input. Our original investment system was government finances, which were allocated in the form of business expenses in accordance with the operating principles of the public institution system. At this point, the most critical aspect of the new medical reform is to establish a universal medical insurance system, allowing insurance institutions to pay for them when they see a doctor. In medical expenses, medical insurance institutions have to pay the bulk, that is, "replenishing the demand side."
   But some people say that it is better to directly "replenish the supplier", and the government should establish public medical institutions to provide services to the people. Some people argue that there is no need to provide universal medical insurance at all. Instead, the state pays for medical care at public expense. The state pays for the treatment of patients in public medical institutions. In my opinion, this proposition has certain problems. "Supplementing the demand side" is to change a mechanism, that is, to establish a market mechanism in the medical industry. The medical insurance agency purchases medical services. It is not about the people paying for themselves, seeing doctors all over the world, identifying which doctor is good, and figuring out which medicine is good.
  Many people who advocate universal public medical care actually hope that the government will pay, and the people will not pay much for medical treatment. The administrative department of health distributes the money to public medical institutions and instructs the latter to serve the people well; if they don’t serve well, they will find ways to punish them. This is the idea of ​​administrativeization. In some cases, it also confuses our correct evaluation and correct understanding of the practice of certain places in the new medical reform process.
   Everyone knows that Shenmu County promotes free medical care for all people. There is a voice who thinks that this should be promoted throughout the country. As long as local governments have money, they will provide free medical care for all people, or universal publicly funded medical care. The practice of Shenmu County is indeed that the government pays for the treatment of the people, that is, the government pays the medical insurance institutions, so that the proportion of reimbursement for the treatment of the people has increased, so I think that Shenmu also provides universal medical insurance.
   It is worth mentioning that when the Shenmu County government paid the bills to the people, it paid the bills according to a certain market mechanism. Who is it that provides services to everyone? There are various hospitals, both public and private. The government pays the bill if it does a good job, but does not pay the bill if it does a bad job. To put it bluntly, the role of the government is a group buyer. What Shenmu County does is that the government pays the bill, but uses a purchase mechanism, that is, a market mechanism, when paying the bill. Many of our media articles did not mention this point, or did not mention it enough, and did not attract everyone's attention. Everyone says that the government only needs to take money, but it is not. If the government pays money and follows the administrative system, the consequences may be very serious, and a new system must be established. Shenmu has taken a step ahead at this point, which is very important.
   In short, there are administrative thinking in the process of promoting universal medical insurance, and administrative thinking and specific systems hinder the reform of public hospitals.
   The reform plan of the pilot cities has not been announced. Many people say that the failure to implement government compensation has caused difficulties in the reform of public hospitals. At present, the administrative system of public hospitals is widespread, which hinders the normal operation of public hospitals, let alone development. Whether these systems can be broken has anything to do with whether the government can spend money? Can't the government break these old rules without spending money?
   Gaozhou City in Guangdong Province broke all these systems, or at least broke through. In fact, the local government and higher-level governments did not expressly stipulate what these systems should become, but in reality, the old rules and regulations have completely broken through. The government didn't give any money. Gaozhou People's Hospital made money to build buildings and buy equipment.
   The government also stipulated that you could only perform these operations, and you could not perform those operations. The hospital did not care about it. Many operations were performed without any accident. In the end, the health administration department gave it an award. The health administration department has issued several documents saying that it will promote the experience of Gaozhou, but it has not been promoted. Why?
   Take a closer look, all the documents and experience summaries do not mention the de-administration just mentioned, and always require public hospitals to learn the management of Gaozhou People’s Hospital. In fact, where is learning management impossible? Gaozhou People's Hospital is to study service management of China Southern Airlines and White Swan Hotel. The government should find ways to reform the relationship between the government and public hospitals-the reform of public hospitals is, after all, government reform.
   Therefore, the main obstacle encountered in the reform of public hospitals is not the so-called insufficient government investment, but the de-administration. Our government and all sectors of society pay too little attention.
   (Gu Xin, Professor, School of Government, Peking University)

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