Health Planning Commission: improving paediatric health care pay solutions pediatric medical doctor shortage | children _ news
Children's health resource shortage is one of the challenges of health reform in China. On May 9, 2014, capital Institute of Pediatrics, a parent holding a child queue registered. File photo/the Beijing News reporter Xue 珺 photography

The Beijing News recently, State Health Planning Commission, the State development and Reform Commission and other six departments jointly issued the Declaration on strengthening child health service reform and development (hereinafter referred to as the views). The views put forward, by 2020, the number of beds increased to 2.2 per thousand children per thousand children in pediatric practice (Assistant) number of physicians to 0.69. Adjust the pediatric medical services price for children in clinical diagnosis of invasive biopsy and detection, surgical treatment and other projects, charging higher fees for medical services for adults, and according to the provisions included in the scope of Medicare payment.

　　Chinese paediatrician per capita, below the world level

National Health Planning Commission had revealed, every thousand children aged 0-14 in pediatric practice (Assistant) doctors at 0.53, down from major developed countries of the world, in pediatric practice (Assistant) physicians there is a big gap.

The views put forward, the "Thirteen-Five" period through "training, transfer, promotion", increasing the number of pediatric medical staff, improve the overall quality. Promoting pediatric medical personnel training in colleges and universities. Reform of Pediatrics professional education, development of common pediatric specialty training program in colleges and universities.

Furthermore, the expansion of specialty residency training in Pediatrics. Based on the number of graduates of clinical medicine, paediatrics and position requirements, admissions to pediatric resident standardization training tilt today by 2020 to recruit more than 30,000 residents in training Pediatric professional. Increase strength pediatrician transfer training. Qualified medical professional trained, qualified on the basis of the original scope of specialty practice of increase in pediatric practice.

　　Expert pediatrician directed assistance proposal

At present, the national health family planning Commission and the Ministry of education supports the China Medical University, Chongqing Medical University 8 universities organized Pediatrics undergraduates, and will start in July this year to recruit Pediatrics undergraduates.

Ding Jie, Deputy Director of Peking University first hospital, Beijing news reporters, solve the problem of shortage of pediatricians, one is to encourage the development of talent, second is to keep the pediatrician.

She said that currently has returned to the Pediatric Department in some colleges, but that's only one of the means to solve the problem. If the excessive expansion of students in the Department of Pediatrics, will cause some students to find work experience and internship opportunities in the future, thus leading to clinical training capacity is not enough. Expanded Department of Pediatrics caution.

Ding Jie said that training a doctor takes 8 years, thus the problem of shortage of pediatricians, is very important to keep existing pediatrician. At present, the pediatrician job transfer and loss are more common. Recommends that the countries according to the number of beds or the number of Pediatricians give targeted subsidies, to stabilize the existing doctors.

　　Focus 1

　　Child surgery price reimbursement rate will be adjusted

The views put forward, adjust the pediatric medical service prices. Children invasive biopsy in diagnosis and detection, surgical treatment of embodied technology paediatric medical service features and value of health care services, charging higher fees for medical services for adults, and according to the provisions included in the scope of Medicare payment.

During the two sessions this year, the CPPCC, Peking University first hospital Vice President Ding Jie had suggested raising children clinic fees, in part by expanding children's health care coverage, increase the proportion of claims and other measures to compensate for and developed specifically for children's Hospital, has a paediatric General Hospital compensation mechanism, alleviating the current Pediatric "loss leader" dilemma.

Ding Jie of Beijing news reporters to improve pediatric medical service price is because children's clinical treatment more difficult, such as children to cope with the situation occurs. A case study of venous puncture, son of fine blood vessels than adults, and sometimes hard to find. If a child crying is the case, take a few nurses work together, then it would raise labor costs.

Ding Jie said, are most concerned about the opinions and how to implement, how long it will take to implement. Hoping to identify the item price can increase the reimbursement rate increase are problems.

Peking Union Medical College Hospital public Yuanli Liu, Dean told reporters, in a market economy, pricing of medical services need to consider two factors, first cost, then the scarcity in the market. Our pediatric development talent shortages, lack of professionalism, lack of beds. Adjusting the pediatric medical service price no doubt release signal, would like to encourage the development of more Pediatric professionals.

He said, to see price adjustment is only one aspect of the reform of medical and health services for children. China's health care reform is "three-linkage", so after medical service price adjustment, be sure to follow up on the health care. "Pediatric medical service price, the Government will not let the people take, appropriate reimbursement and directories you want to adjust in the future.

　　Focus 2

　　Child medicine prices policy support

"Dose by guessing, medicine by snapping" called the situation of children in China by outsiders. During the two sessions this year, the national health Director of the family planning Commission Li bin said, children are not adults versions, fixed-point production children also revealed that this year China will bid to protect pediatric medication.

The views put forward, do the children's medicine supply. Establishing Pediatric drug review and approval of specialized channels, give policy support to children's medicine prices, giving priority to support the production of children's medicine product upgrade, technological transformation of enterprises. Establish and improve the shortage of drugs supply warning mechanism, grasp the shortage of children's medicine production, and actively coordinate and solve production problems and difficulties.

Ding Jie said, about children, the biggest problem is that good policy lever how to use, from the supply source to solve the problem. How to guarantee children's medication supply? Some good cheap children's medicine is gone, because these drugs lower profits, drug companies had stopped production. Some drug supply policy, allowing manufacturers to enjoy the incentive policies produced small dose for children and special forms.

　　Focus 3

　　Peak period for children patients should plan

The views put forward, provincial health and family planning sectors (including Chinese medicine departments) and the peak of the medical institutions at all levels to develop a treatment plan.

Experts said, has seasonal characteristics of childhood diseases, respiratory diseases in winter and spring, summer and autumn flu and digestive system diseases with a high incidence, and during winter and summer seasons overlapping, pediatric medical services to patients at their peaks in demand, inadequate paediatric medical problems are more severe.

The opinions and requirements, during student holidays and seasonal peak period, according to the medical needs of the child, should allocate power paediatric medical, outpatient and emergency effectively connect, meet peak in children with medical needs.

Beijing News reporter learned that, in 2010, the Beijing children's Hospital has started the rush out plans, increase doctors '.

Since then, the contents of the emergency plan has been expanded. In 2011, the Beijing children's Hospital during the summer to start emergency plans, extended clinic opened at the same time, according to the characteristics of eye treatment in children with increased, emergency repatriation out of doctor, nurse. In addition, the management unit's doctor after the round is over, also to work in the clinic.

Emergency response plan for 2013 is based on the original, further increase nighttime special outpatient clinic type and increasing skin branches, dentistry and other professional 24-hour emergency department.

This version of interview/Beijing News reporter lidandanxinna

Responsible editor: Liu Debin SN222

Article keywords:
Children's health

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卫计委：提高儿科医护薪酬 解决儿科医生短缺|儿童医疗_新闻资讯
　　儿童医疗资源短缺是我国医改面临的难题之一。图为2014年5月9日，首都儿科研究所，一位家长抱着孩子排队挂号。资料图片/新京报记者 薛珺 摄

　　新京报讯 近日，国家卫计委、国家发改委等六部门联合印发《关于加强儿童医疗卫生服务改革与发展的意见》（下称《意见》）。《意见》提出，到2020年，每千名儿童床位数增加到2.2张，每千名儿童儿科执业（助理）医师数达到 0.69名。合理调整儿科医疗服务价格：对于儿童临床诊断中有创活检和探查、临床手术治疗等项目，收费标准要高于成人医疗服务收费标准，并按规定纳入医保 支付范围。

　　中国儿科医生人均数低于世界水平

　　国家卫计委此前透露，我国每千名0-14岁儿童儿科执业(助理)医师数为0.53人，低于世界主要发达国家，儿科执业(助理)医师存在较大缺口。

　　《意见》提出，“十三五”期间要通过“培养一批、转岗一批、提升一批”，增加儿科医务人员数量，提高队伍整体素质。一是推进高等院校儿科医学人才培养。改革儿科学专业化教育，制定普通高校开展儿科学专业人才培训规划。

　　此外，扩大儿科专业住院医师规范化培训规模。根据临床医学、儿科学毕业生数量和岗位需求，住院医师规范化培训招生向儿科倾斜，到2020年累计招收培训 儿科专业住院医师3万名以上。加大儿科医师转岗培训力度。符合条件的相关专业医师经过培训，考核合格的在原专科执业范围的基础上增加儿科执业范围。

　　专家建议国家给儿科医生定向补助

　　目前，国家卫生计生委和教育部支持中国医科大学、重庆医科大学等8所高校举办儿科学本科专业，并将于今年7月起开始招收儿科学专业本科人才。

　　北大第一医院副院长丁洁对新京报记者表示，解决儿科医生短缺问题，一是要鼓励培养人才，其次是保住现有儿科医生。

　　她表示，目前一些院校已恢复儿科系，但是这只是解决问题的手段之一。如果过快扩大儿科系的生源，会造成今后一些学生难以找到见习和实习的机会，因而导致临床培养能力不够。因而扩大儿科系要慎重。

　　丁洁说，培养一个医生需要8年，因而针对儿科医生短缺问题，非常重要的是要保住现有的儿科医生。目前，儿科医生转岗和流失现象较普遍。建议国家根据床位数或儿科医生数给予定向补助，来稳住现有医生。

　　焦点1

　　儿童手术涨价 报销比例也将调整

　　《意见》提出，合理调整儿科医疗服务价格。对于儿童临床诊断中有创活检和探查、临床手术治疗等体现儿科医务人员技术劳务特点和价值的医疗服务项目，收费标准要高于成人医疗服务收费标准，并按规定纳入医保支付范围。

　　在今年全国两会期间，全国政协委员、北大第一医院副院长丁洁曾建议适当上调儿童诊疗费，增加的部分通过扩大儿童医保报销范围、提高报销比例等措施来弥补，同时制订针对儿童医院、设有儿科的综合性医院的专门补偿机制，缓解当前儿科“亏本经营”的窘境。

　　丁洁对新京报记者表示，提高儿科医疗服务价格是因为儿童临床治疗比较难，比如会出现儿童不配合的情况。以静脉穿刺为例，孩子的血管比成人的细，有时很难找到。如果孩子出现哭闹情况，需要几个护士一起合作，那么就会提高人力成本。

　　丁洁表示，最关心的是《意见》如何落实，需要多久落实。希望能明确哪些项目的价格可以提高以及报销比例能提高多少等问题。

　　北京协和医院公共学院院长刘远立对记者表示，在市场经济下，医疗服务定价要考虑两个因素，首先是成本，再就是市场的稀缺程度。目前我国儿科的发展缺人才、缺专业、缺床位。因此调整儿科医疗服务价格无疑释放了信号，希望鼓励发展更多的儿科人才。

　　他说，要看到价格调整只是儿童医疗卫生服务改革的一个方面。中国医改是“三医联动”的，因此在医疗服务价格调整后，医保上是肯定跟进。“儿科医疗服务提高的价格，政府不会完全让百姓承担，今后相应的报销比例和目录也要调整。

　　焦点2

　　保障儿童药供应 价格给予政策扶持

　　“剂量靠猜、吃药靠掰”被外界称为是我国儿童用药的现状。今年全国两会期间，国家卫生计生委主任李斌表示，儿童不是成年的缩小版，同时透露今年我国将招标定点生产儿童用药，以保障儿科用药。

　　《意见》提出，做好儿童用药供应保障。建立儿童用药审评审批专门通道，对儿童用药价格给予政策扶持，优先支持儿童用药生产企业产品升级、技术改造。建立健全短缺药品供应保障预警机制，及时掌握短缺儿童用药生产动态，积极协调解决生产企业突出问题和困难。

　　丁洁表示，关于儿童用药，最大的问题是政策杠杆怎么用好，要从供应源头来解决问题。怎么保障儿童用药供应？目前一些好用的便宜的儿童药消失了，因为这些 药的利润比较低，药企就停止生产了。因此一些药品的供应需要政策倾斜，让厂家享受到激励的政策生产适合儿童的小剂量的和特殊剂型。

　　焦点3

　　高峰期制定儿童就诊应对预案

　　《意见》提出，各省级卫生计生部门(含中医药管理部门)和各级医疗机构要制定儿童就诊高峰期应对预案。

　　相关专家表示，儿童疾病具有季节性特点，冬春季呼吸系统疾病、流感和夏秋季消化系统疾病高发，季节交替及寒、暑假叠加，儿科患者医疗服务需求处于高峰期，使儿科医务人员不足问题更为突出。

　　《意见》要求，在学生假期和季节性疾病高发期，根据儿童医疗服务需求，应合理调配儿科医务人员力量，做好门诊和急诊的有效衔接，满足高峰期儿童患者医疗需求。

　　新京报记者了解到，2010年，北京儿童医院已启动高峰时段门诊预案，增加出诊医生。

　　此后，应急预案的内容也在不断扩充。2011年，北京儿童医院在暑期启动应急预案，门诊延长开诊时间的同时，根据眼科就诊患儿增加的特点，紧急调回在外学习的医生、护士。此外，管理病房的医生在查房结束后，也要到门诊工作。

　　2013年应急预案更是在原有基础上，进一步增加夜间特需门诊科室种类，并增加皮科、口腔科等专业的24小时急诊等。

　　本版采写/新京报记者 李丹丹 信娜

责任编辑：刘德宾 SN222

文章关键词：
儿童医疗

新京报