Wake up（223）

 

223

 

As the dinner welcoming veteran Chinese medicine Chai Jianhua arrived in Hong Kong continued, the chief doctor of the clinic, Dr. Bai Bingqing, chatted with Chai Jianhua. He criticized Mao Zedong's medical education reform and the barefoot doctor system that sent doctors to the countryside.

At this time, the old Chinese doctor Chai Jianhua seemed uneasy and confused. Because of his experience as a barefoot doctor, he has long believed that rural doctors like barefoot doctors have a very long history in China.

Before Huangdi Neijing, before Bian Que, there were country doctors in China. At that time, the village doctor was Doctor Ling. Ling doctors carry medicine boxes on their shoulders, ring bells in their hands, and some even carry tiger braces; they walk around the streets and alleys, visit villages and households, and do not escape the cold and heat. He has personally experienced the greatness of Ling doctors.

Whether in China or in the West, the so-called orthodox medicine is a sitting doctor. Hospitals were established in modern times in the West. Before the establishment of the hospital system, just like China, all kinds of small clinics were orthodoxy. Small clinics are already the highest form of medicine. In comparison, Lingyi is only a little lower than the small clinic.

Difficulty in seeing a doctor has been a big problem since ancient times. Most of the serious doctors are concentrated in the cities, and the villages mainly rely on local bell doctors and even religions to treat diseases. This was the case until the Republic of China. It can be seen that this form of medical treatment by barefoot doctors has been popular for a long time.

In Chai Jianhua's cognition, barefoot doctors are things that appeared with cooperative medical care after the founding of the People's Republic of China. Many people still miss Barefoot Doctor as much as myself. This is because the barefoot doctor has mainly accomplished two major achievements: greatly reducing the infection of infectious diseases, especially schistosomiasis; greatly reducing infant and maternal mortality.

Chai Jianhua still insists on his opinion: these two achievements alone are enough to make the title of barefoot doctor go down in history. The World Bank and the United Nations have also recognized barefoot doctors, calling them China's first health revolution.

At this time, Qu Ting, a female nurse at the clinic, intervened. She was trying to smooth things over for Chai Jianhua.

Qu Ting said: Barefoot doctors do not have a fixed salary, which is a special product in the history of health care in China, that is, unofficial doctors in rural areas who are not included in the national establishment. They have some health knowledge, can treat common diseases, and can deliver babies for mothers. The main task is to reduce infant mortality and eradicate infectious diseases.

By the end of 1977, 85% of the country's production brigades had implemented cooperative medical care, and the number of barefoot doctors once reached more than 1.5 million. On January 25, 1985, the "People's Daily" published the article "No longer use the name "Barefoot Doctor" and consolidate and develop the team of rural doctors", and "Barefoot Doctor" gradually disappeared. According to the "Regulations on the Administration of Rural Doctor Practice" that came into effect on January 1, 2004, rural doctors can practice with a formal license after passing the corresponding registration and training examinations. The history of the barefoot doctor has since come to an end.

Qu Ting also said: The barefoot doctor is an angel who truly serves the poor. Although the barefoot doctor does not have white work clothes, his feet are often muddy and he is dressed in coarse clothes, he has the most genuine, purest and warmest heart to serve the people. The simple and practical treatment model met the primary medical needs of most people in rural areas at that time. Looking back at today's medical institutions, it is this kind of civilian awareness that is missing. The wards are becoming more and more luxurious, the fees are becoming more and more astronomical, and the large and improper medical system makes the contradiction between doctors and patients more and more prominent. It is not surprising that the "barefoot doctor" who has long faded out of history has returned to people's memory.

Liu Hanyu, deputy director of the clinic, interjected: "Barefoot doctors" can be understood as foreign health care physicians in the 21st century. He provides the public with 24-hour, immediate personal medical services without queuing. For common colds, coughs, and common injuries, "Barefoot Doctor" can provide you with medical services within minutes. Compared with urban medical services, such as waiting for a bus, queuing, paying fees, and seeing a doctor within 3 minutes, the "barefoot doctor" system has something worthy of serious consideration by today's medical reform department.

According to reports at the time, there were 1.02 million rural doctors in China, of which nearly 70% had graduated from junior and senior high schools, and nearly 10% had graduated from primary school. At that time, it happened to be accompanied by educated young people who went to the mountains and went to the countryside. This group of young people had a high level of education, and it was these people who eventually became the main body of barefoot doctors. When I went to the countryside, I became a barefoot doctor there.

Liu Hanyu recalled: The treatment methods adopted by the barefoot doctors are mainly traditional Chinese medicine. Because Western medicine requires a large number of examination equipment and complicated treatment methods, Chinese medicine has become the mainstream of barefoot doctors because of its simplicity and efficiency. Barefoot doctors grow their own herbs to treat farmers. The main treatment methods are acupuncture and herbal medicine. Injections are largely discarded because aseptic conditions are not possible. The main methods of Western medicine they can use are painkillers, anti-inflammatory injections, red mercury, iodine, and aspirin.

Farmers only need to hand in one yuan a year, registration costs only five cents, and the rest is paid from the public funds of the brigade. This made the farmers very happy. So cheap and convenient, why not do it? However, this low cost has also resulted in insufficient successors to the barefoot doctor model, often hit by underfunding.

However, with the reform and opening up, due to the insufficient level of barefoot doctors, the state abolished this system and replaced it with rural doctors. However, due to the professionalization of rural doctors, the number of doctors is scarce, and the problem that it is difficult for farmers to see a doctor has reappeared. In this case, it is actually beneficial to implement the system of semi-professional barefoot doctors. But it depends on what the country does.

Liu Hanyu said to Chai Jianhua: Barefoot doctors are not professional doctors, but half farmers and half doctors. They have the status of farmers and are engaged in medical activities at the same time. Now most of the mainland rural areas do not feel scarred by the Cultural Revolution, but instead feel nostalgic. Most of them are because of the barefoot doctor system that was widely promoted during the Cultural Revolution. Although barefoot doctors are generally not skilled, they can treat common minor diseases. But if no one treats these minor illnesses, minor illnesses will drag into serious illnesses. Most of the farmers now are stubbornly resisting, leading to serious illnesses and having to go to the hospital.

Bai Bingqing said to Chai Jianhua: The barefoot doctor system is not a good medical reform, but the current medical education and medical reform have become market-oriented. As a result, it is difficult to see a doctor and there are constant medical troubles. China's medical system is full of corruption.

Bai Bingqing said to Chai Jianhua: Supporting doctors with medicine is the root of corruption.

The income of public hospitals in China mainly comes from: financial appropriation, medical service charges and drug mark-up income. Due to limited government subsidies and low prices for medical services, doctors and hospitals can only rely on products to make profits.

Supporting doctors with medicines - the implicit benefit transmission relationship between pharmaceutical companies, hospitals and doctors is the norm in China's medical industry. For a long time, hospitals have used the high profits of drugs to drive economic benefits and maintain the normal operation of hospitals.

Before 2015, the drugs used in public hospitals were purchased by the provincial centralized drug procurement management department through unified bidding to form a drug catalog and bidding price. Hospitals choose from the drug catalog approved by the provincial government, and can sell them to patients at a price increase on the basis of drug bidding prices, but the price increase rate is guided by the National Development and Reform Commission, generally not exceeding 15%, and the price increase rate of traditional Chinese medicine decoction pieces can be appropriately relaxed.

Drugs need to go through several procedures such as pharmaceutical companies, medical representatives, hospitals, doctors, etc., and go through drug bidding before reaching the hands of patients. The power rent-seeking and the resulting public relations costs will eventually enter the drug price and be paid by patients . "Inflated drug prices" are naturally inevitable. Drug kickbacks are one of the unusual sources of income for physicians. Since 2015, the National Development and Reform Commission, the price management department, has canceled the government pricing of most medicines in China, but the status quo of hospitals relying on "selling medicines to make money" has not changed. In addition to medicines, doctors may also receive kickbacks for the use of medical equipment, instruments and consumables. For more than ten years, although the government has been monitoring drug prices, drug expenditures have been rising year by year, and over-medication is very common in China. This is the "difficult to see a doctor, expensive to see a doctor" in the eyes of ordinary patients.

Qu Ting interjected, "Getting the number to see a doctor in order - commonly known as "registration", was originally one of the most common procedures in the hospital. However, due to the permanent shortage of number sources in many large hospitals, some people have started the business of reselling "numbers", and these people are "number dealers". Some number traffickers will queue up outside the hospital all night to register, some will seize the source of numbers through online channels, and some even collude with hospital staff to resell the "numbers" obtained through internal channels to patients at high prices , earn the difference from it.

Registration fees in public hospitals in China have always been relatively low, and prices are regulated by the government. Based on the price regulations of different provinces and cities, the registration fee for general outpatient clinics ranges from 0.5 yuan to 15 yuan (RMB), the registration fee for expert outpatient clinics ranges from 10 yuan to 20 yuan, and the registration fee for a very small number of well-known experts can reach 50 yuan. . Therefore, some economists pointed out that the price of "number" is far lower than the actual value of medical services, and the supply is far from meeting the actual demand, which provides a huge profit possibility for number traffickers. The price gap of medical services is passed on to patients and patients through the transactions of traffickers. At the same time, the labor of doctors has not been motivated by reasonable prices.

Liu Hanyu said angrily to Chai Jianhua: China's medical care corruption and the quality of patients have seriously affected the medical construction. Some patients' "minor ailments are too serious," has become a cancer in the medical field. For common illnesses such as colds and coughs, patients must seek medical treatment in tertiary hospitals, rather than in community hospitals. There is a very strange landscape in China: large hospitals are crowded with people, but grassroots hospitals are empty. In particular, large hospitals in big cities have to receive patients and their families from all over the country, and they are always in a "war state" and are overloaded for a long time. Take Peking Union Medical College Hospital as an example. According to media reports, its "ace department" allergy department has 10 doctors and receives about 60,000 patients from all over the country a year. Doctors in Shanghai are under the most pressure, with an average of 15.2 patients per day, followed by Tianjin, Beijing and other places. These figures are only average values, and according to the field investigation of media reporters, in large hospitals in first-tier cities, it is the real workload of doctors to diagnose and treat hundreds of patients every day.

The distribution of medical resources is severely uneven, and high-quality medical resources are mostly concentrated in big cities. However, there is no price difference between tertiary hospitals and grassroots hospitals. For patients, regardless of the size of the hospital, they all spend the same money. Ordinary patients lack medical knowledge and lack of trust. They often do not trust the medical resources of primary hospitals. Even for common diseases, they have to go to big cities and big hospitals to see the highest-ranking doctors. As a result, some truly difficult and severe patients cannot receive timely and effective treatment. Medical problems are both professional and social.

Chai Jianhua agrees with his friends. He understands that the management and operation of the medical system is complicated and involves various fields of profession and society. But there was nothing he could do about it, nothing to say. Government investment in the health system, doctors' salaries and professional training costs, media reports on doctors, public understanding of medical knowledge, patients' expectations of curative effects, and whether poor families can afford medical expenses...