Wake up（227）

 

227

 

The reform of China's medical system is an endless topic. The old Chinese doctor Chai Jianhua talked about these things with Bai Bingqing and Liu Hanyu, and they talked endlessly.

At this time, Qu Ting, a female nurse, interjected. Her mother had worked as a barefoot doctor in the inland area, so she paid close attention to medical hygiene since she was a child. She said: When Premier Wen Jiabao took office, he pointed out that medical care must adhere to the direction of public welfare. Perhaps more mainlanders believe that the correct health care reform plan that the society is looking forward to will surely pave the way for a virtuous circle in the future. However, the health care reform plan that has been long-awaited by all parties in the society for many years has been delayed due to various reasons, and widespread public grievances have accumulated. Although there are various small-scale or local "improvements", they are all scratching the surface, unable to match the national tide and being washed away without a trace.

Since the outbreak of the financial crisis in the United States, some impatient Chinese people thought that the era of China was just around the corner, and they linked it with the medical reform problems accumulated in the United States over the years, creating a sense of superiority from looking at the fire from across the ocean. Once American politics collapses and international interference ceases, many of China's difficult problems will be solved, including the issue of health care reform. This is an unrealistic misjudgment. Indeed, the financial turmoil sweeping across the powerful countries in the United States and Europe started suddenly and violently, and fully exposed the greedy essence of capitalism. In a sense, it does give China, which is trying to rise peacefully, a once-in-a-century opportunity. However, a body that has been ill for a long time cannot go into battle lightly, let alone bear the burden of history. But how many Chinese people are seriously reflecting on their own problems? In fact, medical care is not the only social problem that has been unresolved in China for a long time. As far as the US health care reform is concerned, it is true that the US system has many problems. But reading history must be understood. The perfect public welfare system in the United States after the war began in the 1960s, and it was healthy and effective in both public and private aspects. At that time, the American economy was growing rapidly, and the proportion of public investment was also the highest. caused by forced atrophy. Although it is still growing, it lags behind the medical expenditure of the whole society. It can be said that without the government's forced increase in investment, the medical system of the public welfare sector will be more difficult, and it is likely to have already been ruined.

Qu Ting said, I once studied medicine in the United States. What I just said actually looks like an interesting paradox. The capitalist United States seems to be repeating the mistakes of the extreme public welfare system in the past three decades, while socialist China is tasting the "market economy" of medical care. consequences. Another paradox of medical reform is that what he wants to change, that is, privatization and marketization, are the mainstream and core of the reform tide. And the elements he wants are precisely the one big and two public, eating a big pot of rice, extreme public welfare, etc. that are denied by the tide of reform. No one has the intention to turn a blind eye to the ills that were revealed at the beginning of the reform, but in the era of emancipating the mind, people are willing to believe that this is a by-product of the reform, which can be absorbed through deepening reform and social assimilation. Therefore, in fact, public welfare undertakings, which should be done with caution and acted after thinking twice, are just at the forefront of reform.

Bai Bingqing said: Qu Ting is right. Taking the epoch-making 1979 as a watershed, the extreme medical public welfare system in the first three decades made the medical industry represent a typical example of "big pot rice syndrome". The medical system is inefficient, wasteful, overstaffed, and the distribution of health resources is seriously unfair, which has become a heavy burden on the social economy. Because of this, with the tide of the reform era, the medical industry, as a serious loss-making institution, also bears the brunt of "household production contract". On the one hand, the abolition of universal medical care at public expense and the responsibility of various enterprises and institutions overnight excludes most urban and rural residents from medical insurance and other social security systems such as pensions, or the level of social security is very low. It was not until recent years that the social medical insurance system had a difficult start. Due to the lack of support, the service effect is not good, and the coverage ratio is very low, it is difficult to win the favor of policyholders, which in turn limits its development. The new rural cooperative medical system "New Rural Medical Care", which is newly born to serve farmers, is jointly funded and established by the state and farmers. Due to the small scale, it can only cover a small proportion of the cost of serious illnesses, and it does not guarantee the outpatient services that farmers use the most. As a result, it is difficult for urban and rural residents to have a sense of security in terms of health and financial resources. The concept of small farmers such as "saving for retirement" and "saving for disease prevention" has regained a strong vitality in our ancient nation, which has made the current economic crisis worse because of the lack of exports and the urgent need for domestic demand.

On the other hand, the government has stopped subsidizing hospitals. In recent years, the government’s public financial investment in medical care is less than 17% of the total medical consumption, which is less than one-third of that in the United States. Most of them are concentrated in big cities and large hospitals, and there is a shortage of medical care in small towns and rural areas. less medicine. In this way, the latter is forced to be responsible for its own profits and losses, actively charge fees, seek a way out of the market, and seek to make a fortune. So the doctor changed from an angel in white to a "white-eyed wolf", asking for red envelopes, prescribing expensive medicines, and conducting expensive examinations. Medical expenses are rising year by year and fall directly on patients. Due to the blockage of medical expenses, many people do not go to the hospital until they are "critically ill", thus missing the best time for treatment. the

Bai Bingqing said angrily: "What's more extreme is that if you ask for a huge sum of money before being hospitalized, otherwise you will refuse treatment, which will cause delays and even death for many patients due to economic reasons. When these gradually become the social norm and "common sense", it becomes difficult and expensive to see a doctor, and poverty due to illness has become a difficult pain for the Chinese people.

Liu Hanyu interface said:

The above-mentioned phenomenon mentioned by director Bingqing is not surprising at all. Since market means are used, don't be surprised that market rules mean that bad money chases good. Hospitals and doctors have become stores and salespersons. Of course, they must use value to judge what products to give to customers. Their lives and development depend on it. However, medical services are neither ordinary commodities nor luxury goods. The sentient beings who are struggling and crowded in the hospital do not have the leisurely mind to shop in the store. They are buying necessities that are often expensive. What they care about is the health and life of themselves and their families, rather than the income of the service providers. They often do not have social security, or even have financial problems, and need and count on hospital support. In their eyes, the hospital should represent the government more than the store. The huge gap between the two concepts has resulted in a great reduction in the services required by patients, and medical personnel and institutions have also borne the brunt of unprecedented pressure and accusations. It is common for doctors to be beaten and accused, and hospitals are also struggling to cope with lawsuits. What makes such a noble and respected profession a much-reviled one? Why are medical personnel and institutions also bearing the brunt of unprecedented pressure and accusations? The fundamental reason is not that people are not old-fashioned and morality is low. It is that the government has got rid of the burden of duty, but the burden has not disappeared, but falls on those who should not bear it, causing both doctors and patients to compete and confront each other under the environment of limited medical resources, and both sides suffer. Make social harmony far away.

Bai Bingqing said angrily:

If the success or failure of the first three decades is a manifestation of the extreme public welfare system. The success or failure of the next three decades is the lack of a universal medical security system and extreme marketization under government investment.

A higher standard of living can reduce the government's investment burden, but even at the level of developed countries in Europe and the United States, the government still has to continue to invest a large proportion of investment to maintain the level. For example, the United States invests more than 40%-50% of the total medical expenses every year. In China, where the per capita income level is relatively low, without large-scale government investment and support, it is impossible to maintain normal and adequate medical services. The patient would immediately be in trouble, and society would pay a heavy price for it, in the absence of lasting and stable social harmony. Therefore, the center of the reform must be to recover the lost government investment and to operate in a public welfare mode. Establish a universal health insurance system.

Liu Hanyu said to Chai Jianhua:

In short, the current medical reform in China should be different from usual. The government should have a clear understanding of the pros and cons of the medical reform practice and the future direction. It is not a return to the public medical system with one major and two formulas, but a health security system that involves the participation of all people and is enjoyed by all. In the form of a “government-led” social welfare system that covers all the people, the government should not only bear most of the start-up funds for the establishment of insurance systems at all levels, especially rural cooperative medical care, but also continue to make substantive investments. Only in this way can we ensure the healthy and sound operation of this system and ensure the health and stable life of the whole people.

Liu Hanyu sighed to Chai Jianhua: It's a pity that the Chinese government can't do this. Now that you move to Hong Kong, you don't have to worry about your medical insurance. In the 1970s, Hong Kong’s economy was still relatively backward. In addition, the British colonialists of that era were all ruled by "powerful power" and "scraping money for the ancestral home (Britain)", so they paid little attention to the livelihood of the Hong Kong Chinese. There were also "public hospitals" at that time, but there were too many monks and too little food. Poor people had to spend half a day in the scorching sun or cold wind to get a "chip (number)", and waited for hours to see a doctor for a few minutes. The cost is quite cheap, a few cents. Those with better financial conditions will find "private doctors". Public hospitals also allocate part of their resources for richer patients, called "private rooms". These charges are on par with private hospitals, plus they are government-funded, so there are also some world-class famous doctors. But the charges can only be afforded by at least the upper-middle-class people in the society. Even if you enter a public hospital, you have to spend more "red envelopes" to the general staff, otherwise even if you live in a "private room", you have to go to fetch water yourself. And almost all private hospitals also have to accept emergency patients such as car accidents. Many private doctors with good medical ethics will set up outpatient clinics in the streets, and treat neighbors with relatively low fees, which can be accepted by working people with stable incomes. Generally speaking, the medical care in Hong Kong at that time was insufficient and not affordable for the working people, which also made domestically produced Chinese patent medicines very popular among the working people in Hong Kong. For example, "Yinqiao Jiedu Tablets", "Bao Chai Pills" (later changed to Kangning Pills due to registration issues), "Liushen Pills", etc., the proprietary medicine department of the domestic product company occupies a considerable place. By the way, during the Vietnam War, many U.S. troops who invaded Vietnam through Hong Kong went to domestic companies to snap up "Yunnan Baiyao" (it is said that it can pull shrapnel out of the muscles, but the effect of the drug on blood disinfection and blood accumulation is my own experience. So far it is still my family’s regular guardian medicine), and "Pian Tze Huang", which is a liver-protecting and liver-curing medicine, is now sold for more than 100 yuan a pill. The U.S. military is afraid that the miasma in the tropical forest will be unhygienic. Take it to strengthen the liver and strengthen immunity , This time of pneumonia, doctors also use it to cooperate with other treatments. There is also an orthopedic medicine "Bone-setting Water" divided into "Yunxiangjing" and so on.

Medical care in Hong Kong began to change in the 1980s. In fact, it is inseparable from the struggle of the Chinese descendants against the colonialists, which forced the British to change the deprivation and oppression of the Chinese residents in Hong Kong. This was the "Anti-British Rebellion" in 1967. It was precisely because of this vigorous patriotic mass movement that the British colonialists were forced to adopt a softer policy towards Hong Kong, and they no longer dared to steal the fruits of Hong Kong people's hard work back to the UK, but returned Hong Kong people's hard work to Hong Kong. Back then, the domestic situation provided Hong Kong with a large amount of cheap labor, making Hong Kong one of the four Asian tigers and laying the economic foundation for Hong Kong's medical care. Since the 1980s, Hong Kong has basically achieved free or low-cost medical care for all.

Liu Hanyu told Chai Jianhua that at that time, I left the mainland and returned to work and live in Hong Kong. Hong Kong basically has a relatively complete medical system with Western medicine as the main body. There is no "street wheel syndrome" for minor illness registration, that is, queuing on the street. Usually you can see a doctor within three days. Because during this period of time, the young and strong (28-45 years old) seldom see a doctor, and they are also busy with work, and they care less about the society. I can only use a few examples to talk about it. I have a friend who immigrated to Canada. He was diagnosed with cancer at an early stage in Canada, and waited half a year in Canada for surgery. He immediately flew back to Hong Kong and had surgery in the public medical system that month. The cost was similar to that in Canada. Canada was free of charge. Hong Kong only paid a few dozen yuan for registration and a daily hospitalization fee. Canada allows dual citizenship, and Hong Kong also allows Hong Kong permanent resident status, so Hong Kong people immigrating to Canada can use Hong Kong's public medical system. Although Canadian critical care public medical care is good, the queues are long and the cost is high.