As well as the announcement of the “2021 Statistical Bulletin on the Development of my country’s Health and Wellness”, a bloody storm broke out in the medical community immediately. The incident was caused by the debt problem of the public hospital in Huludao City, Liaoning Province. According to the local health and health committee in response to the proposal of the CPPCC members recently, the city’s fiscal revenue has been greatly impacted, and the situation is tense. It is very difficult to ensure the timely repayment of debts and the payment of wages for employees of government agencies and institutions. It is very difficult to maintain normal operation. The hospital compensation mechanism is difficult to implement. The reply also revealed that due to the impact of the epidemic, the cost of protective materials has increased significantly, medical income has decreased, and the debt level of public hospitals has risen sharply. As soon as this remark came out, it immediately aroused many discussions among doctors and patients. Not only in Huludao City, according to the results of the “National Examination”, among all public secondary and tertiary hospitals, hospitals in 20 provinces across the countryThe medical surplus is 20%. Negative, accounting for 62.5%, an increase of 56.25 percentage points from 2019 . That is to say, 56.25% of hospitals across the country will turn from a profitable state to a loss in 2020. Affected by this, doctors left messages and complained, complained that their wages were too low and their performance was too low. There are too few, and patients say that medical treatment is too expensive, which makes people think, what is going on? What about money? Where did the money go? Many people have moved out of the average income of doctors in tertiary hospitals in recent years, and boldly said: You see, the income of doctors is almost 1.5 times that of urban workers, which is still low ? How do you make us live? 
In response to such remarks, many doctors can only feel bitter smiles. Not worth the salary? Compared with the Internet and the financial industry, the income of doctors is indeed too bleak! However, we need to understand a question, why there are different viewpoints from the perspectives of doctors and patients. For medical care, they compare their own income with their own efforts: What the doctor pays>The doctor’s income will naturally feel that the salary is too low. For patients, they compare their own income with the cost of seeing a doctor: Patient’s income < cost of the patient, naturally they feel that seeing a doctor is too expensive. Looking at China’s national conditions, they are all right! Nothing is wrong! But what causes this? Here, Mays Medicine would like to discuss with you.
A cheap doctor, whose sorrow?
And who took money from doctors and patients?
A study published in the “Chinese Journal of Hospital Management” showed that in 31 provinces (autonomous regions, autonomous regions, In 136 tertiary public hospitals in municipalities) and Xinjiang Production and Construction Corps, front-line clinicians were selected as the survey objects, and a stratified sampling method was used to conduct a questionnaire survey on doctors’ salary level and satisfaction, and the χ2 test was used to compare between groups. The sample sizes of doctors in the three surveys were 20 786, 23 289 and 22 836people. The median after-tax annual income reported by doctors for 2017, 2018 and 2020 was 100,800, 120,000, and 150,000, respectively, the median expected after-tax annual income of doctors is 196,000 yuan, 250,000 yuan and 250,000 yuan respectively, the proportion of doctors who are satisfied with their current income Only 16.5%, 17.8% and 26.9%, respectively. 
It is clear that most doctors are not satisfied with their current salary. To explore the reasons carefully, we feel sad. In the current situation of rising prices, the price of medical services in my country has always been at the lowest level, which makes the value of doctors very cheap. 
Let’s take a look at the three periods of our country’s medical service price policy:The first stage (before 1957)< /span>: The medical service price is lower than the cost but the national financial capacity is subsidized. The second stage (1958-1980): The stage of greatly reducing medical prices but insufficient government subsidies. There were three major price reductions for medical services during this phase. The policy of “full management, itemized subsidy, and balance handover” is implemented. But the increase in government subsidies did not go hand in hand with the price adjustment for medical services. During this period, the price of medicines is allowed to increase by 15%, forming a system of “supporting medicines with medicines”. The third stage (1980-2000): The stage of transition to a market economy. The government is still responsible for the capital construction and purchase of equipment and equipment. The financial management principles of hospitals above the county level follow the principles of “full management, special subsidy, remaining balance, and no supplement for overpayment“. In 1992, the charging standard was merged, and self-paid patients and public-funded labor insurance medical patients were charged the same price. Although the price of medical services has been adjusted several times since then, the hospital has always been unable to make ends meet, which neither reflects the value of medical personnel nor the relationship between supply and demand in the medical market. A national survey in 2009 showed that the cost recovery rate of medical services in general public hospitals was only 28.47%~37.86%, and most of the losses were the most. Basic medical service items, in other words, are used the most frequently, and the more diligent the doctor, the more the hospital loses. With the in-depth period of medical improvement, DRG and DIP will be piloted in 2019-2020, and the three-year action plan of DRG/DIP will be launched in 2022, and the income of hospital medical insurance will increase. Steps are tight, and it is not feasible to open prescriptions and inspections to generate income. At the same time, high-value consumables are purchased in bulk, and the hospital once again loses its pricing power for high-value consumables. So far, medicines, consumables, and inspections are the three hospitals The failure of the traditional compensation mechanism, coupled with the impact of the new crown epidemic, hospitals will only get poorer! When various financial compensation mechanisms are deprived, it is particularly important to increase the price of medical services. By increasing the proportion of the price of medical services in the overall cost, the value of the work of medical staff will be reduced. As for being cheaply processed. But based on my country’s national conditions, it is a difficult thing to increase the price of medical services, so we have to suffer again for our vast number of medical workers! A department director once complained to Mays Medical that performing a tumor resection operation would take several hours and require four to five doctors and two nurses , Two anesthesiologists, the operation is about eight people. The operation cost is more than 3,000 yuan, and all medical staff can get 7% of the performance. Among them, the chief surgeon gets half of it, and the assistant doctors and nurses finally get a pitiful amount of money. The average hourly salary is tens of yuan, you say Even students who haven’t graduated can earn more than this amount of money by going to summer jobs, right? 
In addition, from an international point of view, the proportion of labor and technical expenses that reflect the value of medical personnel in my country is also far below the international level. Taking heart surgery as an example, for a heart surgery in the United States, the costs of doctors, sommeliers, and perfusionists account for 1/3 of the total medical expenses. In my country, the patient needs to pay 40,000 to 50,000 yuan to perform an operation on the complex congenital heart disease Tetralogy of Fallot, but the actual operation fee received by the hospital is only 2,000 yuan, which is only equivalent to the total cost. 1/20 of the patient’s use is not even up to this ratio, so there is a question, where did the patient spend so much money? Some people say that the most profitable in the entire medical service chain is not the pharmaceutical factory, nor the hospital, nor the medical staff, nor even the president or director of the hospital, but those pharmaceutical companies or medical equipment. The company, the money was taken away by them. Perhaps, this could be true, who knows? However, this is the current salary status of medical staff, who do overloaded work but can’t get a matching salary. Which doctor can balance in his heart? 
Of course, we can also understand why medical care wages are so compressed from the formula of hospital income. Patient expenses + medical insurance + financial subsidies = hospital income = housing infrastructure + medical equipment + medicine equipment + medical salary. Medical insurance comes from taxation and cannot be increased on demand; under the market-oriented operation of medical care, financial subsidies will only be less or less; housing infrastructure + medical equipment + pharmaceutical equipment cannot be compressed, alas! Then I’ll have to work harder for the medical staff!
Cumbersome back-office administrative staff
whose pie?
The hospital has revenue, which needs to be distributed to the medical staff. They generate revenue and they deserve it. But ah, I am already pitiful, but I have to support more administrative staff than doctors, it is really tiring! This is probably a reflection of the hearts of countless doctors. Some doctors once complained like this. There are more than 100 medical staff in their hospital, but there are more than 200 administrative + logistics staff. This is a shocking big tooth. Every doctor has to support himself, including himself. Of the three, who do you think will be balanced? What surprised the reporter even more was that there were dozens of itemsItems can deduct the doctor’s salary, but the administrative logistics department allocates salaries on an annual salary system, which means that the hospital’s efficiency has nothing to do with administrative logistics, which is a veritable drought and flood. In the current situation that the cake is getting smaller and smaller, the cake allocated to the administrative and logistics staff remains unchanged, can the cake allocated to the medical staff be bigger? Good guy! Abe Shinzo, who met Marx, also called this wave of operations too expert after hearing about it! This is an extremely harsh reality that has to be faced! No one is allowed to dodge:In order to increase the salary satisfaction of medical staff, part of the redundant and idle hospital administrative logistics personnel must be cut out! Perhaps, we should have this courage!
Patients are not satisfied either!
It’s hard to have both h2>Doctors’ wages are low, they are not satisfied, are the patients satisfied? nor. At the moment, what is every migrant worker most afraid of? Not unemployed, but sick. On the one hand, the busier the doctor and the busier the hospital, the more indebtedness (except for private doctors and private clinics). On the other hand, people often spend a lot of money to see a doctor. It is not uncommon for people to go bankrupt in order to see a doctor in their daily life. Many people have accumulated a lifetime of savings, but spend 80% in the last month of their lives. This is because patients feel that seeing a doctor expensive reason. Accurately speaking, it is not expensive to see minor illnesses, but expensive to see serious illnesses. This is the case in any country in the world. Is there a way to solve the problem of patients seeing a serious illness? It is difficult or even incomprehensible.High-end medical care itself is very expensive, and it is difficult to have both. However, the country is always working hard to solve the dilemma of high-end medical care. The hope that everyone expects is always there, isn’t it?
References:
[ 1]“Chinese Journal of Hospital Management”. Status and trend analysis of doctor’s salary and satisfaction rate in tertiary public hospitals in China[2]https://mp.weixin.qq.com/s/Sdj2cSgY4TXKIFaDPbpNig[ 3] https://www.zhihu.com/question/460926214/answer/1917309490utm_source=wechat_session&utm_medium=social&utm_oi=1303453751785639936&utm_content=group3_Answer&u tm_campaign=shareopnWriting | Alaska TreasureEditing | Alaska Treasure
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