Media: patients owe money should allow doctors to back pan | | patient owes money to medical disputes _ news
Today, Knight Island wanted to talk about a social issue.
March 30 is international day of doctors. The qianjiang evening news pulls out a "microblogging": new year's day, a Ningbo hospital more than 10 obstetric doctor overnight for treatment of a high-risk pregnancies, sat down for more than four hours surgery managed to keep adults and children; the results after 5 days the patient runs, owes more than more than 20,000 medical bills. Under the hospital provision, 20% due to the costs to be borne by departments, so doctors can only spread over more than 4,000 dollars in medical bills.
Sounds really not a story with a positive energy.
Scale
Turned turned know between, above medical workers told has many similar of even than of story: treatment of emergency patients owes fee has, home people anyway contact not Shang, results died zhihou children is run to hospital to falsely money; some doctor see patients difficult do has surgery, results owes Xia of costs to full Department bear; some patients owes has is money run off has, results because credit records poor was stopped off has Medicare, outweigh the......
Island, a friend of Uncle in grass-roots hospital administrators also often encountered such a thing. She told the island uncle, some years ago when Medicare, CMS did not scale as they are now, the hospital set up "debt collection group" ran yaozhang is often the thing. If the patient is not running, Department doctors and nurses in the bonus suspension was also helpless but have to practice.
The qianjiang evening news reports illustrate the universality of this phenomenon to some extent: two well-known hospitals in Zhejiang Province, more than tens of millions of Yuan have escaped charges, and according to media statistics, national hospital for one year "three without" patients (no family, no identity, no money) arrears of 3 billion or 4 billion yuan.
Mechanism
Treatment of patients, health care workers themselves also lose money, looks not too unreasonable things.
Who is probably due to the fee?
Health care workers, health care, agriculture, commercial risk insurance of patients arrearage is relatively small, because the high rate of reimbursement, relatively limited amount themselves; but if you are experiencing financial difficulties, multi-party disputes, or malicious defaulters, the hospital's limited means.
Like I said hospitals "debt collection Department", if the patient's address and telephone number clearly is still relatively easy to find, if fuzzy, first not found found after very limited means, after all, and there is no coercion. Uncle's friend said the island, even if due to family difficulties owed to medical, civil affairs, public security and judicial departments rarely intervene in such events.
So to lose is only the hospital: if Medicare patients, once the arrears, there is no way to go through the discharge formalities, the hospital is unable to reconcile claims the health care sector, patients are only 100 dollars, but thousands of pieces of the cost of treatment can only be themselves; if at their own expense, it is even more chiyabakui only.
This mostly happens in public hospitals. It is said that public hospitals should not State financial support for the development of it?
The fact is that many public hospitals are almost self-financing status, financial limited, probably less than 10%. Despite medical equipment purchase these necessary expenditures, hospital construction, staff salaries, and all hospitals at their own expense. Because, although they are prepared, but this part of the expenditure and it is to return after the financial return.
Hold the bag
"On the operating table, no one more than your doctor want you to live. ”
Saving lives is, of course, the doctor's duty, consisting of money I'm afraid not. Doctors also need to feed their families, and health care has always been a social topic. So, the State will provide medicine for public hospitals to implement "zero profit" while raising the costs of diagnosis and treatment, and for dangerous patients with distress, hospitals also need to be admitted unconditionally.
So, the pot should be who is going to back it?
According to the lawyer explained, hospital doctors referred patients there is anything illegal about cases in which the provision. Which, according to the State Council on the establishment of emergency rescue system of disease guidance requirements, critical injuries requiring first aid but identity is not clear, or unable to pay the medical expenses of patients after receiving emergency treatment in medical institutions in emergency medical expenses incurred, "diseases established by the special emergency assistance fund to benefit". The bailout's original intention, of course, very good. But in practice, the application of more stringent conditions on the one hand, on the other hand if the local financial difficulty, it is more difficult to implement.
Then again came back, economic difficulties could not afford, and multi-party disputes owe, how many extenuating circumstances; but for malicious default, or even have some consequences and make noise in the hospital, it's hard to generate sympathy and even disgust.
System vulnerabilities? Of course. Input to the public hospitals lack health care system with imperfect coverage is large enough to improve the problem and while, for lack of malicious debt constraints, vulnerability is enough to reflect the credit system is not perfect. Media cited Canada's example: in improving the public health insurance system, if escape charges, will be included in the personal credit records, affecting all aspects of life.
As a health care worker, know friends Mr Hu's words more food for thought:
"Doctor can do of just is flesh Shang healing, for incomplete of soul and fall of moral, we also powerless, for whole social has pay has too high of cost mutual between of not trust, we also hard opened prescription, this also not just a doctor groups can change of, need all tireless of efforts, doctor maximum of wishes is just treatment patients, and not by any other things of effect. To form a more perfect system, we desire more than anyone, I want all patients to age, rather than malicious escape in this way, I hope that future income is to provide professional and technical rewards, rather than being labeled drug rebate vampire label. ”
Text/Ming Riling
Source: Knight island
Responsible editor: Liu Debin SN222
Article keywords:Medical dispute in patients with less money
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媒体：患者欠钱跑了 应该让医生背锅么|医患纠纷|患者欠钱_新闻资讯
今天侠客岛想聊一个社会话题。
3月30号是国际医生日。《钱江晚报》则翻出了一则“旧闻”：大年初一，宁波一家三甲医院的十几位产科医生连夜救治一名高危产妇，四个多小时手术坐下来成功保住了大人和孩子；结果5天之后病人跑了，欠下了2万多的医药费。根据医院规定，欠费的20％要由科室承担，所以几位医生就只能平摊了4000多块钱的医药费。
听起来真不是一个具备多少正能量的故事。
规模
翻翻知乎，上面医务工作者讲了很多类似的甚至有过之而无不及的故事：救治的急救病人欠费了，家里人死活联系不上，结果去世之后子女却跑到医院来讹钱；有的医生看病人困难做了手术，结果欠下的费用要全科室承担；有的病人欠了一点钱跑掉了，结果因为信用记录差被停掉了医保，得不偿失……
岛叔的一个朋友在基层医院做管理者，也经常遇到这样的事。她告诉岛叔，前些年医保、农合没有现在这样规模的时候，医院成立“追债组”跑去要账也是常有的事儿。如果病人欠费跑路了，科室里的医生护士奖金停发也是虽然无奈但不得不为之的惯例。
《钱江晚报》的报道则说明了这种现象一定程度上的普遍性：浙江的两家知名三甲医院，已经有超过千万元的逃费；而据媒体不完全统计，全国医院一年“三无”病人（无家属、无身份、无钱）的欠费则有三四十亿元。
机制
救治了病人，医护人员自己还要赔上金钱，看上去不是太合理的事情。
欠费的大概都是什么人？
在医护人员看来，有医保、农合、商业保险的患者欠费的几率比较小，因为报销的比例较高，自己承担的金额相对有限；但如果遇到经济困难、多方纠纷、或者是恶意拖欠者，医院的手段也很有限。
比如前面说到的医院“追债部门”，如果患者留下的地址电话之类比较明确还比较容易找，如果模糊，首先是找不到；找到了之后手段也极其有限，毕竟也没有什么强制手段。岛叔的朋友则表示，即使是因为家庭困难拖欠医药费，民政、公安、司法部门也很少干预此类事件。
所以吃亏的只能是医院：如果是医保病人，一旦欠费，就没办法办理出院手续，医院就没法跟医保部门对账报销，可能病人只欠了100块钱，但产生的几千块治疗费用只能自己承担；如果是自费，就更加只能吃哑巴亏了。
而这种情况大部分还发生在公立医院。有人说，公益性的公立医院不是应该国家财政支持发展的吗？
事实是，许多公立医院几乎都是自负盈亏的状态，财政给予的相当有限，大概10%都不到。除去医疗设备购置这些必要的开支，医院的建设、人员的工资，也全都是医院自行负担。因为，虽然他们是事业编制，但是这部分开支也是医院交给财政之后再返还回来。
背锅
“在手术台上，没有任何人比你的主刀医生更希望你活下去。”
治病救人当然是医生的天职，治病贴钱恐怕就不是。医生也需要养家糊口，而医疗从来就是一个社会话题。所以，国家才会规定公立医院的药费要实行“零利润”而提高诊疗的费用，而对于急难危症的病人，医院也都需要无条件收治。
所以，这个锅应该谁来背呢？
按照律师的解释，医院对于医生垫付病人欠款的规定没有什么违法之处。而根据国务院《关于建立疾病应急救助制度的指导意见》的要求，急危重伤病、需要急救但身份不明确或无力支付医疗费用的患者，其在医疗机构接受紧急救治后发生的急救医疗费用，“将由专门设立的疾病应急救助基金予以补助”。这个救助办法的初衷当然很好。但在实际操作中，一方面这种申请的条件比较严格，另一方面如果地方财政困难，就比较难落实了。
话又说回来，经济困难负担不起的、或者是涉及多方纠纷产生欠费的，多少还情有可原；但对于恶意拖欠的、甚至在产生一定后果之后大闹医院的，就很难让人产生同情甚至是生出厌恶了。
制度有漏洞吗？当然有。对公立医院的投入不足、医疗保障体系的不完全覆盖就是足够大的可以完善的问题与；而同样，对于恶意欠费者的约束不足，就足以折射出信用体系不健全的漏洞。媒体举出了加拿大的例子：在完善的公众医疗保险体系下，如果逃费，就会列入个人信用记录，影响生活的方方面面。
作为一名医疗工作者，知乎网友Mr Hu的一番话更让人深思：
“医生能做的只不过是肉体上医治，对于残缺的灵魂和堕落的道德，我们也无能为力，对于整个社会已经付出了太高的代价相互间的不信任感，我们也很难开出处方，这也不是仅仅一个医生群体能够改变的，需要所有人不懈的努力，医生最大的愿望就是只管救治病人，而不受任何其他东西的影响。对于建立更加完善的医疗体制，我们比谁都更渴望，我希望所有病者能有所依，而不是靠恶意逃单这种方式，我希望以后的收入都是我提供专业技术的回报，而不是被贴上拿药品回扣吸血鬼的标签。”
文／明日绫波
来源：侠客岛
责任编辑：刘德宾 SN222
文章关键词： 医患纠纷 患者欠钱
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