After the rise of mobile medicine , large-scale entrepreneurs and capital influx, from registration, light consultation to medical big data , all kinds of concepts are flying, dreaming of playing a new world in the medical field that everyone is not satisfied. And the hospitals look on the sidelines: or look down, "Isn't it a mobile app?" Or don't understand, "people are stupid enough to speed up", don't understand what so many people and money are investing in this field; Deans and medical informatization vendors are thinking about how mobile healthcare is used by hospitals and extending in-hospital services to the Internet.
Most of the dean and medical informatization experts believe that mobile Internet is only an information tool, and it has not changed the true nature of medicine. Mobile medicine has limited value for hospitals, so it is frosty; and mobile medical entrepreneurs, perhaps most enterprises will become "Cannon fodder", but they are taking out the spirit of "the bare feet are not afraid to wear shoes" to attack the medical system that has fallen into the quagmire, so the enthusiasm is like fire. The top-down medical reforms of the past decade have been proven to have limited results. Why not let this bottom-up mobile medical tide try?
I. 窘 – Medical reform is stagnant
The medical reform has been changed for more than ten years. During the period, the two extremes of public welfare and marketization have repeatedly swayed, resulting in the status quo of today's nondescript. "Seeing a doctor is expensive" and "difficult to see a doctor" is a false proposition. The real problem is:
Lack of graded diagnosis and treatment: patients are over-concentrated in large hospitals, large hospitals are in the market, small hospitals can be ridiculous; public monopoly: public hospitals monopolize most medical resources, medical resources are not flexible enough and enthusiasm; medical care: medical service prices since 1999 The year has not been changed, and the price of medical services is subsidized by medicine. The consequences of this approach are extremely bad. First of all, the cost is high (the price difference between the ex-factory price and the terminal sales price is at least five times, about 30% of the medical income is spent in the middleman), and secondly, the interests of the hospital doctors and patients are inconsistent. As a result, the trust of doctors and patients collapsed, and finally led to high-risk and high-pressure workers in the entire industry; medical insurance pressure: in 2014, the balance of medical insurance exceeded more than one trillion, medical insurance control fees caused the hospital and doctors to deform in clinical operation, bringing a lot of inconvenience to patients Waste of resources. In addition, in the long run, the aging society will increase the pressure on medical insurance to pay more and more. In the future, the state may increase financial input or focus on developing commercial health insurance, but no matter which solution is facing great challenges; medical education is not balanced. Among the more than 2 million practicing doctors, only 54.5% of them have bachelor degree or above, and nearly half of them are college graduates or below. The medical education method is also relatively backward. Compared with the highly standardized and practical training system of foreign medicine, China is still basically in the hands-on training of the masters and apprentices. This is one of the fundamental reasons for the large differences in the level of Chinese doctors.
The biggest credit of the new medical reform in 2009 was that the coverage of medical insurance was greatly improved, but the result was that medical treatment that was originally suppressed was further erupted, and the reform of medical supply was very limited, resulting in further imbalance between demand and supply. If you follow the current path, the above major problems will become more serious.
The following is the growth of hospitals in different levels of hospitals in 2013 and 2014. It can be seen that the growth rate of tertiary hospitals is two to three times that of small hospitals, which means that we are making great strides toward the opposite direction of graded diagnosis and treatment.
Figure 1 Growth of medical treatments in China from January to November 2014
Figure 2 Growth of national medical treatment in 2013
The country’s nominal determination to break the medical treatment of medicines is very big, lowering the price of medicines and raising the price of medical services. Unfortunately, this year's Chongqing 325 medical reform incident let us see that adjusting medical prices is much more difficult than imagined. What is the determination of the government that will maintain stability as its top priority and challenge medical prices? In addition, the long-term development of patients' payment habits is not a change can be changed. Compared with drugs and inspections, the people's recognition of the value of “doctor services†is limited. If you spend 5 yuan to register, spend 200 yuan to buy medicine; with the flower 200 yuan registration, spend 5 yuan to buy medicine, the common people are more likely to accept which choice? In fact, the real expectation of the people is to spend 5 yuan registration, spend 5 yuan to buy medicine. The expectation of free medical care left over from the planned economy era is so deeply rooted that the government hopes to satisfy this illusory dream by continually squeezing the potential of hospitals and doctors.
The violent medical injury incidents that have intensified in recent years are superficial symptoms that the original medical model is unsustainable. According to government statistics, the number of doctor-patient conflicts has declined last year. However, since June, there have been many cases of medical injuries in the country. It is hard to believe that the contradiction between doctors and patients is improving. We can legislate to allow the injured doctor to be sentenced, or to force the purchase of medical insurance, or even increase the number of hospital security to the doctor with a shield, but these are only antipyretics, if the cause is not resolved, the symptoms will continue to erupt.
Medical care is changing year after year, but it has already fallen into a quagmire and stagnated. We are in the "warm boiled frog", and the bad consequences of many problems may not gradually appear after five years and ten years.
Second, ice – public hospitals are struggling
After so many years of medical reform, public hospitals have been numb in addition to occasionally shouting slogans to cater to the will of the peak. The medical system is a "multinational killing", and all parties have their own vested interests, which are mutually constrained and difficult to move (see Figure 3). The Health Planning Commission will control the hospital's rating and doctor's title, the party committee organization department is responsible for the hospital's high-level personnel appointment, the Ministry of Finance is in charge of the hospital's financial subsidies, the Ministry of Human Resources and Social Security is in charge of medical insurance, the Food and Drug Administration is in charge of drug and equipment access, and the National Development and Reform Commission manages medical care. Pricing, the Ministry of Education is in charge of medical education. In addition, the introduction of large-scale medical equipment requires an environmental assessment, and the opening of a clinic requires firefighting acceptance... There are more than a dozen medical-related ministries.
Figure 3 Duolongzhi underwater medical system
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