Go, go, go! ! ! ! When did the country put forward the policy of paying after seeing a doctor first? What is the specific content?

Since June, county hospitals in Shandong Province have implemented the policy of paying after seeing a doctor.

More than 10 provinces and 200 medical institutions visited the country.

You don't have to pay a deposit when you enter the hospital, just leave the medical insurance or the new rural cooperative medical system certificate, sign an agreement with the hospital, and settle the self-funded part when you leave the hospital. If it weren't for a dilemma two years ago, Shandong Yanzhou Traditional Chinese Medicine Hospital was just an ordinary county-level hospital, and Kong Qingmin's name would not be widely known in the field of medical reform. Nowadays, Yanzhou Traditional Chinese Medicine Hospital is regarded as a successful forerunner of the service mode of "seeing a doctor first, then paying money", and receiving study delegations from all over the country has become a part of Kong Qingmin's daily work.

At present, this model has been implemented in some hospitals in more than 0 provinces in China. In June this year, Shandong began to implement it in hospitals at and below the county level. By the end of July, only 120 patients in Shandong evaded fees, accounting for 0.0 13% of all "prepaid" patients, which is not high in the view of Shandong Provincial Health Department.

See a doctor first and pay later.

Go to the door (emergency) to determine whether to be hospitalized. Register at the admission office with the Admission Notice and go through the hospitalization procedures. Provide medical insurance or new rural cooperative medical certificate to the medical insurance office, and check whether the identity is within the scope of medical insurance and new rural cooperative medical system. Provide medical insurance, new rural cooperative medical certificate, ID card or copy of household registration book to the inpatient department, and sign the "Discharge Settlement Agreement for Inpatients" with the inpatient department. Go to the ward for hospitalization with the notice of hospitalization and the settlement agreement for discharged inpatients. At the end of hospitalization, the medical staff told the general expenses spent during hospitalization and the general expenses that need to be borne by individuals to prepare for fund-raising and discharge settlement. After receiving the discharge notice, with the help of medical staff, go to the medical insurance office for discharge settlement and reimbursement procedures. Go to the inpatient department to settle the money and go through the discharge formalities. Discharge. Sign an installment (deferred) repayment agreement with the hospital for installment repayment.

A

Dean broke through

The meeting in Chengdu attracted him and seduced him by paying the doctor first.

Time goes back to two years ago. In August of 20 10, Kong Qingmin was then the president of the Second Hospital of Yanzhou City, Jining. At that time, the hospital was in debt of nearly 60 million yuan, and the newly-built 13-story building had no money to decorate the fifth floor. At this time, Kong Qingmin received a notice of the merger of Yanzhou Second Hospital and Yanzhou Chinese Medicine Hospital.

In June 5438+in the same year 10, the two houses merged. There are not only 149 employees from the former Chinese medicine hospital, but also debts of100000 yuan. The new Yanzhou Chinese medicine hospital also has debts of 70 million yuan. In 2009, the annual business income of the former Yanzhou Second Hospital was only 29 million.

Recalling the beginning, Kong Qingmin bluntly felt very depressed: "So many medical staff always have to eat, right? The pressure is great, and I am at a loss. " In the same year, at the end of 1 1, the fourth annual meeting of China Hospital Dean was held in Chengdu, attended by Kong Qingmin. At the meeting, he specially listened to the symposium on how primary hospitals adapt to medical reform. Jinshui District Hospital of Zhengzhou City implemented the installment payment method of "seeing the doctor first and paying the money later" for poor patients of the new rural cooperative medical system, which attracted him.

"See a doctor first, and then pay the money. These six words are so tempting! " Still at the venue, Kong Qingmin intends to implement it in hospitals and expand its implementation. Kong Qingmin said that the situation of the hospital at that time was: the number of employees was large, close to 500; There are more than 400 beds, but there are only 200 inpatients, and a large number of beds are vacant. "Anyway, it is such a situation. If you burn your bridges, you must change it. "

B

Reform implementation

Patients who can't afford to see a doctor can pay in installments for two years.

201early February 10, Kong Qingmin made an implementation plan after his inspection in Zhengzhou. On February 27th, 65438, the whole hospital held a mobilization meeting, and officially began to implement "see the doctor first, then pay the money".

Before the implementation, Kong Qingmin calculated an account. In principle, the hospital will not lose money, and it will be busy for nothing at most. "But if patients all evade fees, this society will be terrible."

The implementation scope of "treat the disease first, then pay the money" covers the residents who participate in the basic medical insurance for urban workers, the basic medical insurance for urban residents and the new rural cooperative medical system, the "three noes" patients (no name, no address, no accompanying staff) and the patients who are seriously ill and need emergency treatment. Injuries caused by traffic accidents, fights and other liability accidents, as well as patients who did not participate in medical insurance or the new rural cooperative medical system, are not within the scope of implementation.

When the patient leaves the hospital, only the self-funded part will be paid after reimbursement. If you really can't afford it, you can sign an agreement with the hospital to pay the medical expenses in installments or at one time within two years.

Three months later, the sweetness of the "see the doctor first, then pay the money" model began to appear. The number of inpatients in Yanzhou Traditional Chinese Medicine Hospital has reached more than 300, and the number of inpatients remained at around 400 in May. Until now, Kong Qingmin still does not deny that the original intention of the reform is to "attract more patients to see a doctor".

In 20 10 year, the annual business income of Yanzhou Traditional Chinese Medicine Hospital was 46 million, which was 9 10 year, almost doubling. "This is an incredible development." Kong Qingmin said that he thought there would be changes, but he didn't expect the changes to be so obvious. This service model has achieved a win-win situation for hospitals and patients: it not only attracts patients, but also reflects the public welfare of hospitals.

Up to now, there are more than 24,000 patients in the hospital who "see the doctor first, then pay the money", accounting for more than 92% of the inpatients in the hospital. There is no malicious default, and no one pays in installments.

According to Kong Qingmin's analysis, the average cost of hospitalization in this hospital is about 3600 yuan, and the self-funded part is only 1000 yuan or 2000 yuan. Patients have the ability to bear and avoid risks. In addition, social integrity has improved. "/kloc-more than 0/000 yuan is not worth blacklisting."

C

Reform feedback

Jining model welcomes ten provinces for reference.

On July 24th, Yanzhou Hospital of Traditional Chinese Medicine welcomed a delegation from Juye County, Heze City, Shandong Province. Since 20 1 1, more than 200 medical institutions from 10 provinces have visited, and this effect is not unrelated to the promotion of local government departments and media reports.

In Kong Qingmin's view, the government's enthusiasm for promotion is beyond imagination. 20 1 1 March, Jining has been visited by relevant leaders. On May 18, Jining Municipal Health Bureau held an on-the-spot meeting in Yanzhou Hospital of Traditional Chinese Medicine, and issued the Guiding Opinions on Promoting the Mode of Paying after Seeing a Doctor in Medical Institutions in the City, requiring all counties and cities to choose a hospital of traditional Chinese medicine and a township hospital as a pilot before the end of June, and general hospitals above the second level and hospitals of traditional Chinese medicine at the third level to start the pilot of clinical departments.

In February this year, Jining Municipal Health Bureau issued a document to fully implement this model in all kinds of medical institutions at all levels in the city. Zhong Shuguang, chief of medical administration department of Jining Health Bureau, said in an interview with Huaxi Daily that no matter what the original intention of the reform of Yanzhou Hospital of Traditional Chinese Medicine is, this model is really effective and worth popularizing.

According to the incomplete statistics of Huaxi Daily, from 20 1 1 to April this year, relevant departments of Jining City have issued 12 documents, covering a number of supporting policies to promote the implementation of this model.

Among them, the most popular is to adjust and improve the new rural cooperative medical insurance policy. Last year 1 1, Jining Municipal Health Bureau, Human Resources and Social Security Bureau and Finance Bureau jointly issued a document requesting that, starting from this year 1, the new rural cooperative medical system should allocate working capital in advance to hospitals that implement "pay after seeing a doctor" according to the proportion of hospital settlement funds last year1,and the pre-allocated funds for medical insurance will be changed from the original1. In April this year, Jining City set up a special fund of "seeing a doctor first and then paying" to deal with business risks and add double insurance to hospitals.

D

Pattern generalization

All 1256 grass-roots hospitals in Shandong province pay after seeing a doctor.

After the implementation of 1 month, only 120 patients maliciously evaded fees, accounting for only 0.0 13% of patients.

According to the statistics of Shandong Provincial Health Department, from June/KLOC-0 to the end of July, 256 primary hospitals in Shandong Province/KLOC-0 carried out "treatment first, then payment", benefiting nearly one million people. At present, some hospitals in more than 10 provinces across the country have implemented the mode of "seeing a doctor first, then paying".

On July 26th, a deputy director of the Medical Administration Department of Shandong Provincial Health Department said in an exclusive interview with Huaxi Daily that the implementation of this model has enhanced the public welfare of hospitals, diverted patients with common diseases and frequently-occurring diseases to choose primary hospitals, and reduced the pressure on hospitals above the county level. For patients, lowering the threshold for medical treatment, allowing patients to get timely treatment, and achieving a win-win situation for doctors and patients.

On June 5438+ 10 this year, the Health Bureau of Jining City mentioned the mode of "seeing a doctor first and then paying", and directly showed the residents the reform achievements in medical security, primary medical services and zero-difference rate of essential drugs in the past three years.

Zang Shujiao is the head nurse of the Department of Cardiology, Yanzhou Hospital of Traditional Chinese Medicine. She started nursing on 1999. These two years are the purest years for her. "I used to be in charge of dunning, and I have to urge any patient who owes money." Zang Shujiao said that she used to serve with a smile, but reminding patients would make them feel that the meaning of a smile was complicated. Now she just needs to concentrate on nursing and spend more time communicating with patients.

Qiu Fei and Zang Shujiao, head nurses of breast and thyroid surgery in a hospital in Jining, had similar experiences. In addition, she believes that "seeing a doctor before paying" also puts forward higher requirements for service quality. "Postpaid patients may ask for more. If the quality of service during hospitalization is not good, it will increase the risk of evasion. "

According to the statistics of Shandong Provincial Health Department, from the implementation of 1 in June to the end of July, only 1256 households in Shandong Province had 120 patients maliciously evaded fees, amounting to 447,000 yuan. Patients who evade fees account for 0.0 13% of the total number of "prepaid" patients, which is relatively low in the view of Shandong Provincial Health Department.

The patient said that the hospital is more humanized.

In the patient's view, "seeing a doctor first, then paying" is not only more convenient in the form of seeing a doctor, but also more humanized in the emotional experience.

Zhang Jimei, 78, lives in Yanzhou. Because of diabetes and coronary heart disease, she will come to Yanzhou Traditional Chinese Medicine Hospital every one or two months. It turned out that the deposit was paid before entering school, and now it is "carrying a bag." This time I was hospitalized on July 2 1, and I spent more than 2 100 on July 24, not counting medical insurance reimbursement, and I paid about 300 to 400 out of my own pocket.

Every day, the medical staff will type out the list of the expenses of the previous day, and she will be informed of the paid part one or two days before leaving the hospital. Ren, the son of Zhang Jimei, said that it was very troublesome to pay the deposit in advance, and only the self-paid part was paid at the final settlement.

On July 23rd, Li Xiuzhen, 63, from Lige Town, Yutai County, Jining City, came to a hospital in Jining City for goiter. She participated in the new rural cooperative medical system. Before she came, she prepared the expenses for examination and operation, and after she was hospitalized, she didn't pay a penny. "In the future, you don't have to prepare money first, and then see a doctor. This is the people's hospital. "

Chen Jing, 55, has spent 1 10,000 yuan on breast cancer surgery. According to the implementation plan of "seeing a doctor first, then paying" in a hospital in Jining, some expenses exceeding 5,000 yuan must be paid in advance. However, because Chen Jing's children couldn't catch up for the time being, the hospital never urged him. Chen Jing said that in this way, doctors and patients trust each other and feel that hospitals are more humane. "This is really a place to save lives." .

The industry said that "look first and then pay" is more suitable for primary hospitals.

Although all hospitals in Jining have implemented "look first and pay later", in the view of hospitals and administrative departments, this model is more suitable for grass-roots hospitals at or below the county level.

Jining No.1 Hospital is one of the two top three hospitals in the city. Wei Zhen, director of the inpatient department of the hospital, said frankly that the pressure and risk of implementing "look first and then pay" in top-three hospitals are greater than those in primary hospitals, but the driving force and benefits are not as direct as those in primary hospitals.

First of all, the patients who come to the top three hospitals have complicated conditions and high expenses, and the actual reimbursement ratio of medical insurance and new rural cooperative medical system is lower than that of primary hospitals. The patient pays a high part and avoids risks. Wei Zhen said that the average hospitalization fee in this hospital is around 8,000 yuan. Before the implementation of "look first and pay later", patients evaded fees every year.

Third-class hospitals are more prone to disputes between doctors and patients because of their complicated conditions. The implementation of "look first and pay later" puts forward higher requirements for service quality and doctor-patient relationship. "Some patients may think that they didn't pay anyway. If the treatment effect is not satisfactory, can they pay less or not?

From the implementation motivation, the top three hospitals don't have empty beds like primary hospitals. Grassroots hospitals use this model to increase the number of inpatients, and tertiary hospitals can ensure the source of patients without implementation. Wei Zhen said that the hospital's 2,200 beds have basically reached saturation.

Wei Zhen said that despite many doubts, the hospital began to implement "look first and pay later" in February this year. Last week, in an emergency operation, a patient of the new rural cooperative medical system spent 890,000 yuan in the hospital. When he was discharged from hospital due to financial difficulties, he signed an installment agreement and promised to pay it off in one year. By the end of July, about 50% of patients in this hospital have enjoyed this model. Some patients can't enjoy it because they forgot to bring medical insurance or new rural cooperative medical certificate. Others have taken money to see a doctor and offered to pay a deposit. The hospital also respects their opinions.

The relevant person in charge of the Medical Administration Department of Shandong Provincial Health Department said that considering the actual situation of tertiary hospitals, there is no mandatory requirement for tertiary hospitals at present.