Hangzhou Yuhang buy-back commune hospital of high price is prominent to raise and cure the predicament with medicine

Hangzhou Yuhang buy-back commune hospital of high price is prominent to raise and cure the predicament with medicine
Hangzhou Yuhang buy-back commune hospital of high price is prominent to raise and cure the predicament with medicine
In the last ten days of October, the medical reform of the well-known writer in Yuhang of Hangzhou initiates and pays close attention to. Have media it describes their medical reform route to be " Have drawn a circle " . 7 years ago, all subordinate health clinics in towns and townships of district government of Yuhang, fixed a price for 75,840,000 yuan to sell off to folk capital management; 7 years later, the government retracts in full at nearly 3 hundred million. Sold off originally, because the health clinics in towns and townships generally suffered the loss, the staff everybody eats from the same big pot, overstaffing, and the local government with more than 50 billion of value of industrial output puts him into insufficiently; Retract nowadays, it is after privatization because of the commune hospital, raise medicine and overflow with medicine, the people are boiling with resentment, and the medical reform of Ministry of Public Health is required: Each county must have publicly-owned commune hospitals. While interviewing, Professor Guo Qing says, hopes the medical reform of Yuhang is after this circle finished leaving, the local government can understand that there is its public attribute, especially the prevention and health care to the citizen in health care, the government must spend money, must bear this responsibility. Like this, this circle does not draw in vain. Taking action in buy-back of the health clinics in towns and townships of Yuhang begins since December of 2008, lasts 21 months. By September 30 this year, two commune hospitals and town governments liking to rejoin the unit sign the conterpurchase agreement finally, so far put and belong to 28 private health clinics in towns and townships for a time, is all retracted. About two weeks later, Xinhua News Agency releases news, thinks the way is worth reviewing in the 7 of medical reform of Yuhang, and draw common concern. October 28, Yuhang district " citizens' home " The 5th floor of the mansion, the office of chief of health bureau, the forest of chief's the Huang 's covers and calls, refuse to interview, say " I that should speak have said, it is nothing OK " ,Leave away on one side hurriedly. The department of public health of Zhejiang Province is good at understanding the mood in forest of the Huang 's defending a vice section chief in the place agriculturally. He says, reports the medical reform of Yuhang means that is revealing others' sore spot. The county with developed economy, it is lost that the commune hospital is general The fiscal revenues of Yuhang are more than 1,200 million yuan in 2001, put into commune hospital 900,000, more than half commune hospital suffered the loss, it is a yellow lake town community health Center director to hold Jean as bright red of reason of selling off it now. According to her introduction, sold off that reform of the commune hospital seven years ago, the risk factor was the large area loss of the health clinics in towns and townships that year. In 2002, Yuhang more than half districts belonged to the commune hospital in losing state. Zhu ShengZhen 1998 came to the health clinics in towns and townships of garrison post of yellow lake after graduation from special secondary school. At that time, there were 19 medical workers in the courtyard, the highest education were special secondary schools, but most staff transferred to from the barefoot doctor. In the bright red holds precious memory, the commune hospital basically had no medical apparatuses at that time, there is only a microscope, a most ordinary X-ray machine, one leads and unites the electrocardiograph nine times, "these apparatuses were still all given after upgrading by large hospitals of the coordinated cooperation. " Suffer the loss commune hospital year after year,until everybody eats from the same big pot,whose name is ordinary medical worker each is about 900 yuans on the month, even this money will be delayed, " the salary of this month frequently, if having for two or three months, will send. " This is not the problem that the yellow lake town one commune hospital meets. Stroll cloud, the intersection of health bureau and chief, district of Yuhang, he " whether commune hospital reform system performance appraisal " in one China counts, there are 29 health clinics in towns and townships in all in Yuhang district. In 2000, there were 11 families that loss appeared, 15 suffered the loss by 2002. Obvious in the western and eastern of the difference of Yuhang region, it is the most serious that the western health clinics in towns and townships of mountain area suffer the loss. Reveal finance, district of Yuhang, used in the intersection of commune hospital and the intersection of house and transformation, the intersection of apparatus and the intersection of person who purchase and collective, subsidize funds at that time still in the article, 900,000 yuan every year. "The shareholding system is before the reform, the health clinics in towns and townships assume sole responsibility for its profits or losses, on the subsidy of several ten thousand yuan every year, the fee of number of people used for worker, live reluctantly. " Original yellow the intersection of lake and the intersection of town and Shen, president of commune hospital, increase good fortune to recall. Yuhang does not have no money to put into the commune hospital, it is the office of the famous land of plenty, silk, after reform and opening-up, rank among the national one hundred prosperous counties many times. In 2001, the fiscal revenues of Yuhang were 1,281 million yuan. In 2003, the value of industrial output of Yuhang district is 57,700 million yuan, it is (municipal or district) to list the national comprehensive strength one hundred prosperous counties 20th. "The government is rich not to mean being sure to put into the public health. " Vice President of Hangzhou normal university Guo Qing says. Guo Qing is a new expert of rural cooperative medical service expert's technological guidance group, since 1986, engaged in studying in rural elementary health care. He thinks, the government put the public health into insufficiently, because did not really regard the hygiene at the basic level as a people's livelihood project at that time. " against the wind " Selling off commune hospital Hangzhou Municipal Health Bureau objects to the privatization of commune hospital, it is unable to bear the public health function after worrying reforming system; Yuhang remain unchanged their " Sell off " Incumbent the intersection of health bureau and chief, district of Yuhang, stroll cloud remember commune hospital shareholding system reform in 2001. Before reforming system, Yuhang sent officers and studied to investigate to Suqian and Wenzhou, Xiao Shan inside the province outside the province and other places. Suqian had already introduced all the health clinics in towns and townships to the market in 2000, and took value orientation as the core, " someone high has someone's bid " . The medical reform of Wenzhou is pursued and held share inside the health bureau. The medical reform of Xiaoshan, only a pair of some privatization of health clinics in towns and townships. For the one that avoid in the medical reform of Suqian " The butcher runs the hospital " The phenomenon, the medical reform of Yuhang stipulates, the commune hospital only sells to the professional personage in the hygiene system. "Want to lighten the burden on one hand, on the other hand even want to vitalize resources. " Have explained the original reform motive like this when being interviewed before this in the forest of the Huang 's of Yuhang director of health bureau. Objected to sounds too at that time. The original yellow lake town president of commune hospital Shen ZengFu is one of the few open opposition persons originally. "The health bureau has a meeting, I have queried publicly several times, the shareholding system of commune hospital must get it wrong. " 29 commune hospitals at that time, only 2 to object to shareholding system reform, Shen ZengFu had also written to the department of public health of Zhejiang Province, express different opinions. Shen ZengFu says, objected to it at that time, mainly two points were considered, " the commune hospital practised the shareholding system and increased the financial burden that ordinary people saw the doctor " ; " the shareholding system reforms a few people and makes money, most people lower the salary " . The person in charge of Hangzhou Municipal Health Bureau office tells reporters, cured at that time and changed in Yuhang, Municipal Health Bureau is opposing too, because had already considered whether the private commune hospital after reforming system still can bear public functions such as prevention and health care, chronic disease management, sanitary control,etc. at that time. This person in charge says, but because the hygiene system is too executive to manage vertically, have only professional guidance to the intersection of district and health bureau, and people of district health bureau property solve by the district government, unable to prevent Yuhang district finally " Sell off " Commune hospital. In 2001, the curtain of medical reform of Yuhang was opened. Calculate revealing, total assets are 84 million yuan that 29 health clinics in towns and townships of the whole district authorize according to the assessment of the health bureau of the district, debt is 33,550,000 yuan. Finally, commune hospital these, until 75,840,000 yuan is fixed a price for altogether, given to the system the personage managesed. The premium is sold, make assets of the health clinics in towns and townships appreciate by 50% actually this time. Remove the expenses subsidized in worker's identity replacing, retired personnel's stripping and house, the remaining sum is held 50% respectively by the districts, towns, and so as to set up the development fund of rural hygiene. Why want in rich Yuhang " Sell off " The commune hospital? Guo Qing said, because the macroeconomic background at that time was that market economy went, and think market economy goes in the medical health organ. Take place [2002 ] for the 13th in the State Council " on further strengthening the work of rural hygiene a decision " ') Propose, should advance the reform of health clinics in towns and townships, recombinate and reform system of resources to the health clinics in towns and townships, explore that invigorates many kinds of operation forms of the commune hospital, set up the rural hygiene service network developing together in the form of taking of public ownership as the leading factor, many kinds of ownership. Guo Qing says, the government did not realize at that time what questions are brought on earth after complete marketization of medical treatment at the basic level. It is more expensive by nearly 20 yuan than the district belongs to the hospital than a box of stomach medicines commune hospitals after reforming system expensively in the large hospital that the commune hospital sees the doctor, raise medicine and overflow with medicine, and little someone carries out the prevention and health care After the privatization of commune hospital, had not exposed and gone wrong at once. On the contrary, medicine of Yuhang changed to the economic aspect to also make the prominent effect. In 2004, in only one year after reforming system, only there are two the health clinics in towns and townships lost. The statistical report form reveals, the business gross income of 29 commune hospitals reaches 101,026,000 yuan, increase by 54.5% compared with 2000. Zhu ShengZhen recalls, the yellow lake town commune hospital finished reforming system in November of 2003, the total assets assessment price was more than 2,600,000 yuan, all staff held share at that time, undertook the risk together, business is more of backbones, there are a bit fewer ordinary workers. She holds 4 whifves, every strand is 26,500 yuan. After reforming system, the hardware of the yellow lake town commune hospital is put into beginning to increase, the shareholders gather 180,000 of money, acquire semi-automatic biochemical appearance, semi-automatic blood count analysis instrument, regular monitoring devices such as the blood glucose appearance,etc.. Enthusiasm and medical portfolio of the staff of commune hospital obviously rise. After making a profit instead of suffering a loss in some commune hospitals, the question comes one after another too. Though Yuhang issues the file, after stipulating the commune hospital reforms system, still belong to the non-profit-making medical organization, but the shareholder maximizes for the interests, " raise medicine with medicine " Overflow very much, and more serious than the district belongs to the hospital. Secretary of Yuhang district health bureau Wang WeiMing introduces, the district belongs to the hospital though raises medicine with medicine, but the district belongs to 15% that the medicine price of the hospital can't exceed the bid by the regulation. And what the medicine price of health clinics in towns and townships is carried out is the ceiling price. For example, Aomei draws thiazole (a stomach medicine) ,The commune hospital sold according to the ceiling price of Price Bureau at that time, 40 yuan / box, the pharmacy price needed only more than 20 yuan. Wang WeiMing says, such a phenomenon appeared later, went to the large hospital to have an optimistic view of a doctor, the medicine price is low instead, the expenses are cheap instead; Go to the health clinics in towns and townships, the small hospital sees the doctor, the expenses are more expensive instead. The health clinics in towns and townships after reforming system, the proportion that the medicines income takes the gross income is higher and higher. In 2004, the proportion that the medicines income of commune hospital of the whole district of Yuhang accounted for the business income was up to 78.21%. Reveal, this courtyard of total business incomes of June of this year are 1,315,900 yuan on the announcement board of the rich land town commune hospital, medicines income 990,800 among them, medicine account for than 75.3%. And, before reforming system, the issue that Hangzhou Municipal Health Bureau is afraid has appeared too, such public health functions as the health care epidemic prevention, birth control of the health clinics in towns and townships is propagated have been weakened seriously. Shen ZengFu says, public health projects such as the management of rural chronic disease, peasant's health file,etc., dealing with it in the courtyard each time, several rural doctors go to the countryside and do, the medical worker of the commune hospital will not go to the countryside. Shen ZengFu says, the reason is very simple, does not make money in public health project, there are no profits, the medical worker has gone to the countryside, there is no people to see the doctor in the commune hospital, did not include, influence benefit. Guo Qing thinks, public function and its market-based attribute of the commune hospital, the two run counter to. Citizen's prevention and health care work has been done well, patients have few. And market-based commune hospital hope patient to be many and kind certainly. Spend nearly 300 million retracting in full Zhejiang Government requires: One villages and towns must have one government-owned commune hospital, Yuhang take this opportunity all repurchase of commune hospital After the privatization of health clinics in towns and townships, though rely on and " raise medicine with medicine " ,Management takes a favorable turn for a time, but a good time never lasts long. Reform system at the beginning, there are 2 to lose commune hospitals, it is close to 10 progressively to lose the commune hospital subsequently. According to the introduction of secretary of Yuhang district health bureau Wang WeiMing, Yuhang about 1/3 of commune hospitals has realized surpluses, 1/3 fair, another 1/3 suffer the loss. Lose the commune hospital and mostly lie in the area with lower relatively remote, economic development level. The yellow lake town commune hospital is located in the mountain area of the northwest of Hangzhou. The original yellow lake town president of commune hospital Shen ZengFu remembers, later on the patient does not make up a prescription in the hospital, they come to the commune hospital to see after being ill, hold the prescription to the pharmacy to make up a prescription. By 2007, the macroscopical policy environment changes too. Zhejiang Government issues " Size 69 " Gentle, require to establishing the strong county of hygiene: There must be a community health Center which governments holds in a township of organic town. "There are requirements in the province, in addition, these questions exposed, the district government determines to buy back the commune hospital sold out. " A person in charge of health bureau of Yuhang district says, but it is likewise difficult to buy back and sell out. Curing to change it since 2008 again of Yuhang. In September of 2008, Yuhang district will confirm the scheme of reforming system, the government is wholly-owned to repurchase the stock right of commune hospital, and compensate compensating with 15% of the investment for certain interest according to investment amount. On September 30 this year, 28 health clinics in towns and townships and Yuhang government in all signed the agreement, the corporate rate costs 278 million yuan altogether, besides the original cost, also include the input of 119 million yuan. Buy enormous fund shortfall sold as to this, public opinion queries, it is run off whether state-run assets exist. Wang Wei will explain tomorrow, and 15% of the compensation that this comes from repaying capital with interest. The investors of the health clinics in towns and townships do not think prices too high. The mountain town president of commune hospital Chu Hong says in succession, in 2003, he and 7 shareholders invested 3 million yuan altogether in foot-path, later on Add extra and invest more than 2 million yuan in a few years. The government is wholly-owned to repurchase their stock right this time, and add 15% of the appreciation and at one time give more than 6 million yuan altogether. The president of town commune hospital Lu Hong products and original high virtuous president of town commune hospital Li JianRong all express in front of the original storehouse, "2003, if we shoot the intersection of house market and 75 million, don't say more than 3 pieces, more than 7 pieces have now. " Wang WeiMing tells reporters, this former government still considers introducing third party's appraisal agency, evaluate assets of commune hospital, purchase according to assessing prices, but not selected this set of sides for use finally? Float? He explains, if so complexity is very great, operation is very difficult. After 7 years of development, the assets of commune hospital of 29 of reform appreciate, but the western and eastern, region in urban and rural areas are widely different, appreciate scale to be too different, if government make third party assess, very much realistic. "Certainly, it is for saving money too that the government does in this way. " A person in charge of health bureau of Yuhang district says. Is it equal to public service to buy back? Has bought back the last some drawback and already appeared, the expert thinks, it can also be chosen other means that the government should fulfil the public health function The yellow lake town commune hospital is the first " Rejoin the unit " Commune hospital. It signs the conterpurchase agreement with yellow lake town on December 31, 2008. The first thing that the yellow lake town commune hospital is done after buy-back is to lower the medicine price. For example, see cold, at the time of the shareholding system, a prescription wants between 120 yuan and 130 yuan, after buy-back, a prescription drops to between 70 yuan and 80 yuan. Zhu ShengZhen recalls, at the beginning of 2009, the peripheral health clinics in towns and townships are still implementing the shareholding system, because yellow lake medicine price drops, has presented villagers to " see the doctor across the town " Phenomenon. President of town commune hospital Lu HongPin says in front of the original storehouse, this is that most commune hospitals would like the reason of buy-back too. "If the car not putting up this reform, does not go back, compete with public commune hospital later, they do the basic medicine system, implement a price differential of medicines, how to survive our private commune hospital return? " Lu HongPin says. " the commune hospital is back buy-back, the role is changing too, " ShengZhen Zhu say, sit in patients such as the office,etc. in the past, see the doctor in the morning now, go to the countryside in the afternoon. The government stipulates now: Prevent, medical treatment, keeps healthy, recovers, health education, birth control technological guidance, six blocks should be all finished in the commune hospital. After buying back, the district government of Yuhang renames the commune hospital as the community health Center, and increased input. According to schedule, after the buy-back of these commune hospitals, will become finance allocating funds fully, " two lines of revenue and expenditure " The community health Center of management, and confirm administration and supervision authorities again through competing for. Yuhang district will press " Every ten thousand service population allocate 13-15 people, every berth and increase 0.7 establishment " Standards provincial be authorized to work out, and invest by about 400 million yuan hardware constructions used for community health Center, allocate the health physical examination of superior grade of colored B high-standardly " Six major possessions " . In software, the government promises to increase the funds of personnel of 6000 yuan of per person every year, and subsidize the specialized personnel of undergraduate course and the above education. After buying back, the drawback of administrative management appears to some extent too: Electric rate for some the previous year such as commune hospital just 10,000 more than, one want 12,000 yuan month only now. In the view of professor of government of Peking University management college Gu Xin, the government should fulfil the function in public health and basic medical treatment, not taking over the medical organization only in an all-round way, this selects. "For example can reform the means of payment, allow the rural patient's free choice commune hospital, truss up jointly while being agricultural while being new, impel the benign competition between the health clinics in towns and townships the intersection of public health and funds, raise the service efficiency of the fund of medical insurance. " Guo Qing thinks, in any case, buys the commune hospital back today. Because the government has seen what should be done, what should be born, the managerial detail can be adjusted. Wang WeiMing says, Yuhang is exploring that makes the system to assess of the performance, in order to evade the worry that commune hospital raises sleepers, not does things after buy-back. Staff reporter Liu Gang Zhejiang Hangzhou's report


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