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published in(发表于) 2014/7/9 2:42:52
Medical debt in public hospital is serious， hospital officials are reluctant to refer patients to follow

Yang Guang, July 8, according to voice of the central canton evening news reported, Nanfang daily newspaper reporters learned that every public hospital in Shenzhen has one such bills-arrearages. According to the statistics of the Shenzhen City public hospital management center, the city's 11 municipal public hospitals currently accumulated arrearages have 81.57 million dollars, number of arrears has more than 8,000 people. All tuition is not the patient, including social security and insurance companies.

Shenzhen municipal public hospital in the city's revenue is about more than 8 billion yuan a year. About income 1% in arrears.

Report to raise the issue, "die", "no money died" a clear breach of the doctor's duty and public welfare of public hospitals. However, in hospitals and health care workers on her after attending to a patient, if we do take responsibility for debts, how embarrassing was this, such huge medical debts and who paid for it?

In Chengdu, Sichuan province, shortly before the local huaxi City newspaper has reported 10 level-III hospital in Chengdu in 2013 by arrears totaling more than 20 million Yuan. In May, the WCC had surveyed 10 level-III hospital in Chengdu, survey consisted of West China Hospital of Sichuan University, Chengdu, Sichuan provincial people's Hospital, the sixth people's Hospital, 363, 416 hospitals ten medical institutions such as hospitals. Finally, according to the official statistical data in hospital, provincial hospital in 2013-arrears totalling 5.6 million, highest in West China Hospital of more than $ 6 million, 10 hospitals are owed at least 416 hospitals are owed by a total of more than 800,000, 10 hospitals in 2013 the total owed medical bills exceeded 20 million.

Defaults on hospital costs including low-income patients, three's a crowd no crowd, as well as disputes over the crowd.

Chengdu city third people Hospital Medical Department Minister You Mingyuan: regardless of does didn't determines he is three no personnel, if needs words, are is first treatment first rescue, follow-up of costs is such of, national although has some policy but specific of operation method and funds of disposal has difficult, currently basically are is hospital first itself advance of, General to a years is more than 100,000 to hundreds of thousands of ranging, main is for three no personnel, this on hospital for certainly brings compared big of economic burden

But when a reporter asked about the dispute over the crowd when delinquencies, many hospitals are reluctant to refer to:

Staff: he owes you the cost seems to be common sense, was the country's hospitals.

Staff: hospital on this has always been a chiyabakui, in fact, owe the hospital does have that gap, but it is hard to say, because after that I have fear of more debt.

Hospitals not willing to say much, preferring to chiyabakui. Such a situation not only in Chengdu, in more than one place in an interview with reporters, and have the experience. In Anhui, a reporter in contact several hospitals face in embarrassment of politely declined to be interviewed. In fact, for patients with "escape", is not hesitating to say almost every hospital, such things do not occur sporadically, have encountered almost every big hospital, hospitals are willing to eat "stuffy", fearing that more patients to follow, then the hospital will suffer greater injury.

Second affiliated hospital of Bengbu Medical College medical branch director Wang: debt problems generally are divided into following categories, first class, limited by medical technology, his expectations and the prognosis of his illness, probably isn't his satisfaction, cause he did not want to pay for medical expenses, which is less than the larger category. Another group, due to accidents, traffic accidents, there are fights between all aspects of the dispute, to the hospital after the doctor, because of problems with paying both sides well. There is no master, outburst of the disease on the streets, was 120 or good people were sent to hospital.

Wang said with the improvement of national health insurance system and social security system, currently owe a lot less often.

Director Wang: two years ' experience of our hospital, feeling is winding down, and malicious arrears because of poor economic conditions, were relatively less.

Despite the current debt situation a little, but hundreds of thousands of millions of debt a year, hospitals are so helpless.

Director Wang: Although we are the public nature of the hospital, if the resuscitated patients, took the human, material and financial resources, are not appropriate compensation, this will cause a large burden of hospital operations.

In an interview with this reporter learned that, less time consuming hospital recovering, seems to worry more, means also appeared to be single and limp.

Director Wang: reminders and more difficult because the hospital is a public institution and a public hospital, we have no law enforcement powers, and under normal circumstances we do not want the hospital to court to tell patients, lawsuits have come to these medical expenses, generally speaking we provide contacts, through the Department, repeatedly through friends to work back medical expenses. In terms of recovering, our hospital is absolutely vulnerable, doesn't work too good way.

Also in Anhui, another city of Huainan, also reflecting the debt collector.

Huainan Chaoyang hospital emergency department director Zou Guiquan: fees in arrears, part of the hospital is really poor, and disadvantaged groups. There are traffic accidents, three personnel, drunkenness, fights and trouble-free.

Zou Guiquan said part, can contact their families, costs can be recovered after treatment, while there are quite a few are malicious arrears, have "ride off into the hollow".

Zou Guiquan: frequently drunk in the evening, passers-by alert, the family can't. We want to give him medication, treatment, until he woke up a little bit, he went away, he gives you information that is false, and the cash will be gone.

Also intimidated staff.

Zou Guiquan: fights, even her knives, you have wrapped him, he had no money, and you ask him, he turned to you, how to do it.

There is even no reason to refuse to pay.

Zou Guiquan: late last month, a traffic accident, go to our emergency room, we gave him the stitching, read the Security section, and then family came, say no money, real money he'd cut.

According to reports, malicious arrears accounted for less percentage of patients in emergency department patients about 70%.

Zou Guiquan: "run book" should be around 70% and malicious arrears are the hospital most headache thing.

Reporter finds almost Huainan hospitals owe patients admitted each year, resulting in medical debts are also very impressive, some tens of thousands of dollars, as many as hundreds of thousands of.

Chief of the finance section of Chaoyang Hospital of Huainan Hu Fang: our hospital patients escape charges tens of thousands of dollars a year, and almost every year there are so many losses, loss of the tens of thousands of dollars for no reason, we would not like to see.

This arrearage beg for it is very difficult, and civil litigation practice will face great difficulties, the Government does not have a corresponding compensation mechanism, hospitals can only own fallback, and digestion.

Zou Guiquan: he is dynamic, it is unable to find a clue. In such a case, only our hospital nuclear fall out this account as a loss.

For nearly two years, the hospital also has a new charging mode, in some places, the pilot, called "heal postpaid." Starting from May this year in Anqing city, Yixiu district started in the whole township hospitals and primary care centres in the region, for patients requiring hospitalization "doctor first and then pay" service mode. This is the first County in Anhui province for the integrated set of pilot.

The implementation of "doctor first and then pay" service mode is good, but the biggest concern is unable to bear the related costs after the patient is discharged, or malicious arrears. Yixiu district Zhang Xian XI, the Secretary of health has for many years been committed to the "new rural cooperative", he felt, at the grass-roots open implementation of "doctor first and then pay" medical service model, in fact, there are great possibilities, which is also derived from characteristic of grass-roots, which is to see lower overall costs, fewer 90% for reimbursement.

Zhang Xian XI: a total of six hospitals, average cost of us $ 1380 per person, 90%, 10%, 138 dollars. A year is approximately 2000 inpatient. If 10% who fare is 200 men escaped charges, 138 x 200, is more than 20,000 dollars, we expect the worst plan, the money is within our control.

And township grass-root units to enjoy "the doctor first and then pay" service model, and only local residents, there is no trouble remote settlement, village folks's acquaintance added a mechanism to drive each.

From the pilot, occurred more than a month has not occurred in patients with outstanding medical bills. Zhang Xian XI delighted about this, and also felt the weight of responsibility. In his view, the biggest challenge has come from the grass-roots medical institutions in themselves, what better cure for the patient, and provide better service to patients.

65 year old Li Qingxiang is Xin ' an Nan Li Wei Zhuang village, village in Henan province, a few days ago due to diseases of the old attack, were people of Xin ' an family members rushed her to a hospital, when the old man still worry about a deposit for thousands of dollars in hospital at the time, hospital staff told them that now hospital "to see a doctor first, then settle" policy, see a doctor don't have to pay money, costs and then clearing.

It is understood that Xin ' an people's Hospital, "doctor, postpaid" service model is based on health care and rely on ncms, provide patients with medical green channel, and ensure effective treatment of patients in the first time the new service mode of clinic. According to provides: all participate in town workers basic medical insurance who, and town residents basic medical insurance who, and new rural cooperation medical of farmers, and no name, and no address, and no accompanying family of "three no" patients, also has and labor units has signed cooperation agreement of injury patients, five class patients, in handle hospital procedures and hospital treatment during without again pay hospital deposit, just to in admitted Hou and hospital signed hospital treatment costs settlement agreement, And patients ' medical assurance or the new rural cooperative medical certificate and the original identity card of himself and his immediate family to hospitals to keep for the time being, discharge settlement, will Medicare or the new rural CMS reimbursement of costs incurred by an individual after a one-time settlement.

In order to best serve patients, Xin ' an people's Hospital, also set up a very liberal repayment policy, if the patient is financially secure, cost to settle at discharge if pinched, can sign the agreement, choose "pay". Xin ' an people's Hospital, Chen Muqing, told reporters: the first half of the year, first doctor of the hospital patients contracted rate paid mode after 88%.

Chen Muqing: runs through this really does improve the doctor-patient relationship, alleviated the conflicts between doctors and patients, and increased patient satisfaction, hospital business income growth.

Implemented in public medical institutions in Luoyang, Henan province is also one of the first doctor before they are paid one of the pilot cities, the work first started in March 2012, the Luoyang City Government also issued a related document, accelerating the city's medical authorities to carry out "a doctor first, then pay" service mode, after two years of operation, hospitals take root in Luoyang, this policy for the benefit of people.

Health Bureau of Luoyang City Health Bureau of Medical Affairs and Chief of the science and education section CAI fragment: as of now, the city's total of 218 medical institutions to implement this model, in line with the handle the idea of 1.201 million patients, according to the principle of voluntary, 731800 patients choose this mode, contracted rate of 60.23%. From the perspective of city, city signed up at 51.3%, high proportion of counties, reaching 73.16%, this mode is convenient in the patient as a whole, by the crowd home.

Last March, in Quanzhou, Fujian quangang district went against all odds, the first to introduce "a doctor first, then pay" service mode, 9 public hospitals starting from the pilot realized the whole area up to now 14 hospitals in the region, including private hospital coverage. "Look before you pay" model of diagnosis and treatment have been welcomed by crowds and hospitals.

On the big screen in the Spring Harbor hospital halls, always rolling, "a doctor first, then pay" model of diagnosis and treatment advocacy subtitles. Inhabitants of quangang Zheng Yaying suddenly of acute suppurative appendicitis was taken to Spring Harbor hospital, where she did not have to pay the deposit to preoperative check is also having to queue to pay, as long as the family and the hospital signed an agreement, was able to prepare for surgery, all expenses after discharge settled again. Zheng Yaying weighed again and again.

Last March, quangang district took the lead in basic-level synchronization implemented in public hospitals in the region "to see a doctor first, then pay" policy. Eligible patients without advance deposits, just signed a relevant agreement, you can directly apply for admission, discharge and payment of medical expenses again.

The start of the reform, many hospitals feared that the new model will result in medical expenses not to be brought back, dianzi overload, and so on, in order to eliminate the hospital's concerns, quangang district financial support of hospital funding policy for all hospitals had a "psychological boost".

Chen Zongzhong told reporters that as of the end of June this year, Spring Harbor more than a total of more than 26,000 patients enjoy the "doctor first, then pay" service, only 3 patients the outstanding fees owed rates did not differ significantly compared with before the reform, risk in hospitals within the controllable range, reform is going well. This thanks to a new policy to provide patients with a more liberal and diverse ways of paying for it, and more user-friendly payment mechanism.

This reform bring convenience to patients, but also forcing medical personnel to change the concept of service, improve service levels. Service has been the target of criticism in public hospitals in the past, service first, after charges, patients can evaluate the level of hospital services and reminders and nurses are responsible for all the charges, medical staff did not dare to have ignored, disputes between doctors and patients is greatly reduced.

It is understood that the implementation of "the doctor first, then pay" mode, quangang district hospital in a "double l" business volume rose 8%, patient satisfaction rating increased by 8%. Quangang district early this year of 4 private hospitals have volunteered to join the clinic model, quangang district has achieved 14 hospitals in the region, "look before you pay the" clinic mode of full coverage.

Also of situation, Qingdao June 1, 2012 began in district city II level and the following medical institutions full implementation "first hospital Hou paid" clinic policy, participate in town workers Medicare, and town residents Medicare and new agricultural collection of rural residents sick Hospital in these medical institutions Hospital of, are without AC deposit on can first hospital treatment, discharged Shi settled personal bear of medical on can, two years to, city has has 470 million people benefit, hospital first behavior patients advance medical up 1.52 billion yuan, no appeared malicious escape fee phenomenon.

Only exception is in Guangfu hospital, Jinhua, director Tang Shiwei told reporters over the past two years, hospital arrearages have shown a rising trend, in particular by applying "the first clinic, postpaid" later, owed a fee of patients is increasing.

Ningxia yinchuan, "first hospitalized, after paying" applies to participate in urban workers ' basic medical insurance for urban and rural residents and patients, as well as by the local departments of Civil Affairs and administration departments confirmation of begging the patient audit. Pioneering has benefited more than more than 20,000 patients in yinchuan city, not a case of "escape", and patient satisfaction.

View fully staffed the pilot results in yinchuan city, Ningxia since April 22 counties in the whole area hospitals, maternal and child health care in the public County Hospital, township hospitals, community health centers and full implementation of the "hospital before they are paid" conditions are ripe in the region's medical institutions at all levels to fully implement. In Ningxia Hui autonomous region occurred in acute, severe injuries and emergency care patients but the status is not clear or they cannot afford to pay, medical and health care institutions on the cure's arrears, in accordance with the relevant provisions after review by the relevant departments, subsidized by disease emergency relief fund.

　　Zhuang Yiqiang, Deputy Secretary-General of the Chinese Hospital Association: some regions have taken first-pay-later also have the option of, for example, must choose a Medicare patient, you must be a local resident, for three personnel don't look before you pay.

Doctor first and then pay for ease of implementation of his situation at the grass-roots, high degree of acceptance, for grass-roots hospitals in a closed environment, liquidity is not too large, community hospitals, we are neighbors, and easy to find.

So, practice of treatment before they are paid varying levels of hospitals in the country as a whole to promote the trend is still small, debt escape, there are two, one is really no money, and the second is to be malicious escape. Does not escape this part of the patient, the Government should set up some medical treatment, such as charitable fund from the Ministry of Civil Affairs allocated some money should pay for the poor from the Government's perspective of responsible Government. There is the establishment of a social charitable foundation.

(Original title: public hospital arrearages serious grass-roots "doctor first and then pay" good results)

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