公立医院资源浪费及解决方法

公立医院的资源浪费及解决方法

Waste of medical resources in public hospitals

causes and solutions

1. Background

Hospital and department overview: Yunnan Provincial Tumor Hospital, Yunnan Province set of medical, research, teaching, and prevention in one of the Provincial Tumor Hospital, Yunnan Province Cancer Prevention Research, personnel training and the center of the tumor academic exchanges. Hospital in 1992 officially clinic existing medical space of approximately 100,000 square meters, 1,500 sheets open beds, has 23 clinical departments, 11 medical technology departments. Founded in June 1994, the Department of Medical Oncology Yunnan cancer chemotherapy clinical research center affiliated cancer chemotherapy specialist. Sections of the existing medical staff of 25 people, including physicians 9 (Branch Officer 1, 8 all physicians), nurse 16, 46 open beds. Only 10% of the hospital's financial portion of the payment of wages and salaries and social insurance by government funds, and the remaining 90% of income generation by all staff.

2. A hospital economic performance appraisal Profile

Hospitals to implement hospital, department two management systems, scientific director responsibility system, so the management of human resources department, finance department director rights are vested in the hands of one person, only the department director has the authority to decide whether to appoint new staff and additional equipment. Departments to implement full cost-accounting, performance pay for all employees’commission in accordance with the types of income, such as: treatment costs (physician checkups, care, physiotherapy fees) commission of 32%, inspection fees (laboratory tests, ultrasound, CT and other equipment checks charges) commission of 10% and so on. And every penny of expenditure should be deducted from revenue department, and even brought

a clothes from the hospital should be deducted from the pay for performance (but more expensive than buying from the market expensive); sections introduce personnel, equipment costs have to be deducted from income, the cost allocated to each employee, but both at state-owned asset management. This led to strict cost control, director, trying to reduce spending in order to avoid reducing the income of existing staff. Despite nearly five years since my department where the number of patients admitted and key performance indicators (efficiency wages) than before, more than doubled, but the department did not introduce new physicians, all clinicians often overload, overtime work. Hospital encourages employees to generate income, the monthly economic performance appraisal, according to balance of payments surplus allocation of performance pay.

Department for the distribution of pay for performance indicators as the department is mainly based on whether management positions, seniority (in the hospital and department of years of service), job level, the performance and time to score, based on numerical scores assigned performance. This resulted in leadership and high qualification and high titles, the more income pay for performance, but also the level of managers and administrators differential is large, income polarization, take a lot of front-line clinical staff working the lowest income.

3. Waste of medical resources is widespread

February 2013 "Guangming Daily" published "shocking waste of medical resources," the article caused widespread hot. The article pointed out that according to an estimate, China waste of medical resources accounted for 30% of total health care costs over affected areas up to 40% -50%. More experts pointed out that the waste of medical resources has become detrimental to the national health care industry, "cancer." While public hospitals complain lack of government investment, while they are wasting. In order to curb the behavior of various waste of medical resources, although the relevant health authorities such as the restrictions formulated drugs accounted for, according to DRGs; provides for Medicare patients with an average length of stay and average cost savings of medical resources such as hard and fast rules, but the effect of controlling medical costs poor, health care costs continue to grow rapidly. Waste of medical resources manifested in some doctors indiscriminate opening checklist prescription, excessive use of unnecessary surgery, the

abuse of some of the expensive new drugs and new technologies, the abuse of certain disposable medical supplies auxiliary, etc., are in the medical side non-medical purposes, driven by an increase of only medical treatment resource consumption unreasonable behavior1.

Now, cancer patients into the hospital, they have to carry out tests and checks, ranging from a dozen to as many as dozens of items. Where, CT, MRI or PET-CT and other high-tech equipment inspection, some physicians have become a routine examination.

1.Wang Xudong, “Eliminate the waste of medical resources, reduce the burden on patients”, Chinese Medicine News, vol.2, 2006, p.2485

But in fact, a considerable part of the examination and the disease is not directly related, belonging to the scope of the investigation may be investigated; such as CT, MRI, etc. have radiation, the more expensive the inspection, unless the condition changes, short-term repeated examination unreasonable. There are still some people with better economic conditions, blind superstition tech inspection equipment, volunteered to do a variety of expensive tests, thinking that it would be early detection and early treatment. As everyone knows, the money did not spend less, the effect is not necessarily ideal, but also may become victims. I recently encountered a patient admission that bothering: Mr. Xiang due to back pain treatment, because of the trouble, listening to experts PET-CT is currently the most advanced diagnostic equipment; it only had the inspection, only to find destruction of bone lesions. To many hospitals orthopedic hospital, made a film X-ray radiation, and many other vertebral MRI examination, consider the "cancer bone metastasis may be." Ultrasound examination revealed "liver lesions, inguinal lymph nodes, consider the shift", biopsy prompt "metastatic cancer, it is recommended to trace the digestive tract tumors," do colonoscopy found that "anal cancer", after pathological examination finally diagnosed: anal duct carcinoma and liver, bone metastases. The entire examination, diagnostic procedures consuming more than two months, is now proposed to oncology chemotherapy. Mr. Xiang was wondering, Why did so expensive advanced PET-CT examination (cost

I explained to him that even the most advanced imaging will have to check out of the lesions, only the rational application of various inspection methods to confirm the diagnosis as soon as possible.

Corey has experts on the diagnosis and treatment of patients both sloppy and careless, casual arrangement unnecessary expense checks and the use of expensive drugs, often improper application of chemotherapy, his patients suffered adverse reactions so tortured and forced to assume a high the amount of medical expenses. But he treats patients with very warm, with a title called relatives of patients treated for his impeccable attitude of patients and their families (in fact, until today I have been learning his way of communicating with the patient). He was good with the leadership, peer relationships, a lot of people introduced to his patients in the hospital by the blitz, his students adored him, even in patients treated group he belongs mostly confined to thank him personally. Face the extra cost of treatment and prolonged hospital stay, and even some patients hasten death due to improper treatment, patients and their families can only blame their misfortune fate. Director of an error on the expert blind to think as long as departments earn more money, the patient no opinion and disputes like, we all have to do advocacy, "the most important, good service attitude, professional and technical capacity followed." Of this undesirable phenomenon, some employees objected, that should be the patient's interests, but rather expose fellow physicians being marginalized and maligned, everyone preferred to remain silent.

Division Director to implement the excessive control costs reduces expenditures necessary management directly lead to inefficiency, employee dissatisfaction gradually increased2. Division Director habitual disregard the views of subordinates, using simple and crude, blindly repressive treatment of subordinates, motionless on the threat: "Who smashed sections of their jobs, departments smashed whose jobs!" Affect staff motivation. Departments do not have a democratic ethos, to the contrary, by advocating the wrong style, long-term effect the majority of staff also met with inertia do not blame the suit, only the pursuit of economic efficiency, waste of medical resources, simply disregard the interests of the patient, ultimately hurt patients. Mere formality performance appraisal methods, unreasonable, unscientific assessment system enables human resources management, lack of effectiveness, deeply affected the enthusiasm of the employees work.

4. Hospital Economic Performance appraisal is the root cause waste of medical resources

Many people take the waste of medical resources directed at the doctor, and the face

of public criticism, the doctors unable to defend him. In online forums question was raised: "price expensive, how you not curse construction worker. Prices expensive, how do you not curse stations. Expensive, they scold the doctor, what is the logic?" Is what causes the Chinese public hospitals it's such a waste of medical resources? I think there is a waste of resources caused by medical reasons for patients, doctors and hospitals are also reasons, but one rooted in the hospital due to the imposition of economic performance appraisal should not all the blame on doctors, but another deep-seated reasons.

2. Tao Dailan, “Current Situation and Countermeasures of Human Resource Management in public hospitals”, Chinese Medicine, vol.23, no.4, 2007, p.118

In the Chinese market economy environment, between hospitals compete in the medical market is inevitable, medical insurance fund in order to eat this "big cake", almost all of the large public hospitals to bank loans, engage in new building expansion, buy device. Hospital, continuous expansion, buying high-tech instrument high investment, high profits necessarily expect a return. Hospital administrators sided pursuit of economic growth in the unit, down to every level of economic indicators, a variety of "management by objective assessment approach" virtually encourage the doctor of medical resources atmosphere, prompting the department to carry out a variety of excessive medical services . Some hospitals in order to improve the utilization of certain types of equipment, the doctor actually give out high commission incentives. Hospital in order to recover as soon as possible the various inputs, motivate doctors, nurses, hospital, "money" can tricks one hundred, one of the most common tricks is the "economic performance appraisal", almost every hospital doctors will put into the so-called performance appraisal on the cusp . In this way, the public will know the truth waste of medical resources directed at the victims of the doctor. Now many public hospitals can afford to cover high-rise buildings, to afford expensive equipment, but do not want to recruit physicians, nurses can not afford to allow existing staff overload overtime work, which is very normal. Therefore, the hospital's medical quality and lack of security, the patient irresponsible not timely handling medical disputes arise, extremely bad social impact, resulting in doctor-patient relationship has become strained.

Sort of a variety of waste, but also to some extent, devouring the outcome of China's new medical reform, international experts also directed at China's new medical resources

are wasted. Professor, Department of Public Health, University of Oxford, Harvard University School of Public Health professor, professor of Feudal University School of Public Health, the joint at the internationally renowned journal "Lancet" published an article pointed out that China in such a short period of time close to full health insurance coverage commendable success, However, the current medical services still subject to waste, inefficiency, poor quality of service, as well as the scarcity of qualified medical staff and the allocation disorders and other problems, making health reform funding and health insurance coverage effective medical services steering difficult. They believe that the Chinese government should increase investment, but investment growth should slow down in order to ensure the funds and resources into effective medical services.

5. Measures to reduce the waste of medical resources

5.1 Reform of the state system of public hospitals to cancel economic performance appraisal.

"Spend less, can see more patients, to cure disease," the doctors of course, is most people welcome the doctor, but that doctors command a living space, because "can not make money," the doctors in hospitals and departments are unwelcome. Some experts have pointed out: "If a hospital survives, doctors rely on revenue from the most vulnerable groups to make money; the doctor-patient relationship can be okay?" This is obviously that the State can not rely on Doctors earn money to feed themselves and the patient's hospital and doctors have been looking forward to have enough sunlight income, so that their professional dignity and honor back to square one, from the fundamental solution to the doctor in a market economy under the conditions of severely twisted psychological contrasts, such as stress, depression, anxiety, irritability, career burnout and so on. From the national system, no longer allow doctors to generate income, so that public hospitals return to public welfare, the abolition of public hospitals economic performance appraisal and " Doctors rely on patients survival " policy, formulate a reasonable price of medical services, this is a waste of medical resources radical the fundamental strategy.

5.2 Hospital administrators use network statistics; cost control, rational allocation of medical resources.

Facing the public demand for medical services infinite growth and rapidly rising expectations, very limited medical resources can not meet all the needs of the public. In

order to provide medical services to more patients, hospital administrators need to use network statistics information, combined with the actual completion of the department and hospital management by objectives, as requested various sections of the annual management objectives, cost control, rational allocation of health care resources. Medical Services established by the hand, inspection and supervision of physicians' medical practices are compliant, establish the appropriate reward system, and promote the rational allocation, use of medical resources.

5.3 Hospital comprehensive budget management, strengthen internal controls to minimize waste of medical resources.

Comprehensive budget management as a modern management tool to clear the entire hospital, functional management departments, clinical medical departments, logistics as well as grass-roots workers budgetary targets, the promotion of hospital development, mobilize the enthusiasm of all employees work to improve management efficiency, strengthen internal control has a significant role. Implementation of a comprehensive budget management is to achieve the financial management of scientific, standardized an important way, the overall budget management to strengthen internal management control as the scientific method in the implementation and development of the hospital, the hospital will help to achieve strategic objectives, financial management and market competitiveness further improve hospital efficiency, minimizing waste of medical resources3.

5.4 Implement the National Health Service project cost control, the hospital's medical service efficiency assessment.

By the health administration department heads, through the project, social tendering organizations to share information platform development and construction, as soon as possible with the various regulatory authorities of financial information between medical institutions docking system, developing effective, shared medical cost accounting platform, the establishment convenient, efficient cost information channels. Implement the National Health Service project cost control, the hospital's medical service efficiency assessment. Balanced Scorecard to strengthen the public hospital medical services cost control, one can ensure that evidence-based hospital care costing, on the other hand can be balanced scorecard theory, from a financial, patients, internal processes, and learning and growth of four dimensions of the cost of hospital care for effective control, patient satisfaction and

acceptance fees and other aspects of assessment. Guiding public hospitals cost control, the protection of health care quality and safety of the premise, and continuously improve the efficiency of medical services in public hospitals.

Hospital financial system, 1998 (11)

References:

1.Wang Xudong, “Eliminate the waste of medical resources, reduce the burden on patients”, Chinese Medicine News, vol.2, 2006, p.2485

2. Tao Dailan, “Current Situation and Countermeasures of Human Resource Management in public hospitals”, Chinese Medicine, vol.23, no.4, 2007, p.118

Hospital financial system, 1998 (11)