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美国公共政策作业:A study of the reason behind the ‘Patient Village’

时间:2019-05-09 14:08来源:未知 作者:anne 点击:
SUBJECT:A study of the reason behind the ‘Patient Village’ in Beijing and possible solutions
DATE:xx / xx / xxxx
主题:北京“病人村”背后的原因及可能的解决方案研究
日期:XX/XX/XXXX
 
在过去的十年里,北京每一家知名医院都观察到来自全国各地的病人及其家属聚集在医院附近的跳蚤袋中(吴、张等)。2004)。因此,与预期值相比,北京医院接收的患者总数至少翻了一番。这是一个严重的问题,因为它使这些医院超载,而使其他地区的市政医院闲置。另一方面,拥挤的“病人村”被认为是当地社区安全和卫生的主要风险之一。在本备忘录中,讨论了“病患村”背后的原因,并对该问题提出了建议,包括适当的政策。
Over the past decade, gatherings of patients and their dependents from every other area in this country and typically staying in fleatbags in the vicinityof the hospital have been observed for every renowned hospital in Beijing(Wu, Zhang et al. 2004). As a result, the overall quantity of patients received by hospitals in Beijing is at least doubled as compared to the expected value. This has been a severe issue as it overloads these hospitals, while leaves the municipal hospitals in other areas unused. On the other hand, the crowded ‘patient village’ is considered one of the main risks of security and hygiene forthe localcommunities. In this memo, the reason behind the ‘patient village’ is discussed, followed by suggestions on this issue, including appropriate policies.
The reason for the formation of ‘patient village’“病人村”形成的原因
这一现象的第一个可能的根本原因是整体医疗资源有限,更重要的是其分布不均匀。目前,大部分医疗资源,包括预算、高素质的医疗专业人员和声誉,都集中在城市地区,尤其是北京、上海等大都市。因此,全国各地的患者都倾向于挤压Intosek以获得更好的医疗服务,导致每年需要1.2亿患者,而所有医院的空缺不超过200万。这种短缺导致病人在北京不必要的长时间逗留。
The first and perhaps the fundamental reason of this phenomenon is the limited overall medical resourcesand more importantly its non-uniform distribution. Nowadays, most of the medical resources, including budget, high-quality medical professionals and reputation, are concentrated in urban areas, especially metropolises like Beijing and Shanghai. As a result, patients all over the country tend to squeeze intoseek for better medical treatment, leading to a demand of 120 million patients annually, while the vacancies provided by all the hospitals are no more than 2 million. This shortage leads to unnecessary long stay of patients in Beijing.
第二个原因是这些医院管理不力。在北京的大多数医院都没有使用像在线注册和远程诊断这样的现代系统,这种系统可以让患者从千里之外的地方去医院,并被其他国家的医院广泛使用。更重要的是,由于管理层的纵容,插队绝非罕见。更糟糕的是,由于他们无与伦比的财富和社会地位,政府官员和成功的商人等贵宾患者可以在不遵守排队规则的情况下立即获得医疗服务(赵和李,2011年)。
The second reason is the ineffective managementof these hospitals. Modern systems like online registration and remote diagnosis, which may save patients a trip to the hospital from thousand miles away and has been widely employed by hospitals in other countries, is not used in most of the hospitals in Beijing. More importantly, queue jumping is by no means rare due to the connivance from the management. To make it worse, due to their incomparable wealth and social standing,VIP patients such as government officers and successful businessmen can get medical services at once without following the queueing rules(ZHAO and LI 2011).
另一个原因是患者和/或其家属的过时概念(Yip,Wang等人1998)。来北京的病人可以分为两组:第一组是病人,只有顶尖的医生才能使用先进的设备治疗,这两组都集中在北京;第二组是病人,由于不信任当地医院或估计过高而选择来北京。埃尔病。不幸的是,在北京,超过一半的非本地患者属于后者,后者应该被最小化(Liang,Lan等人2011)。Another reason is the obsolete conception of the patients and/or their dependents(Yip, Wang et al. 1998). The patients coming to Beijing can be categorized into two different groups: the first group includespatientswho can only be treated by top doctors using advanced equipment, both of which are concentrated in Beijing; the second group consists ofpatients who choose to come to Beijing due to their mistrust of local hospitals or over-estimation of their illness. Unfortunately, over half of the non-local patients in Beijing belong to the latter group, whichis supposed to be minimized(Liang, Lan et al. 2011).
Suggested policies as solutions to the ‘Patient Village’
Generally, it is impossible to completely eradicate the ‘patient village’ at this stage. Instead,policies should focus on reducing the staying durations of these patients by enhancing the management effectivenessand dissemination of medicalconceptions of the patients and their dependents(Hsiao 1995).
First of all, an effective registration system must be established and strictlyexecuted. The VIP patients should be minimized, if not completely eliminated, so that ordinary patients are treated equally.Also, scalpers who hog the vacancies for commercial use should be punished and prevented. More importantly, online registration and remote diagnosis should be promoted and used whenever possible.This system has been used for a long time in countries like U.S. and Japan. In China, it was not widely employed as Internet access is not available for the majority. Fortunately, this system is suitable for Chinese hospitals asthe majority of urban residents and approximately half of the rural residents have Internet access nowadays(XU, TAO et al. 2011; ZHANG 2012).
Secondly, as the existence ofthe ‘patient villages’ will still be observed for a considerable duration in the future, the basic hygiene and security of the ‘patient village’ should be improved.Due to the extremely large population in these areas, public hygiene andsecurity have been a long-standing problem naturally. To make it worse, some patients are virus/disease carriers and therefore source of infection. As a result, the public hygiene in these areas was poor, despite the efforts by local community and government. To improve that, policies aiming at eradication of unauthorized hostels and restaurants should be released as they are under no supervision at all.
In the long term, however, patients should be diverted from hospitals in Beijing to local hospitals. To achieve that, significant upgrading of medical resources in other areas, especially the rural areas, is required(ZHENG and LIU 2010). Firstly, medical professionalsare the key factor in the medical system. Therefore,well-trained personnelshould be allocated to municipal hospitals with reasonable compensations.Alternatively, rotation of renowned doctors in different hospitals is also a good choice. Last but not least, a hierarchy consists of local clinics, municipal hospitals and specialized hospitals should be established. In this system, most of the patients are to be digested by the local clinicsand municipal hospitals should be generally occupied. Only patients with rare diseases that need specialist and most advanced equipment are to be sent to specialized hospitals located in Beijing. In this way, the amount of patients coming to Beijing can be drastically reduced(ZHAO, TAO et al. 2010).
In conclusion, gatherings of patients and their dependentsin the vicinityof hospitals have been a severe issue in Beijing. This can be attributed to the concentration of medical resources in Beijing, ineffective management in these hospitals andobsolete conception of the patients. To solve this problem, both short-term and long-term measures shall be taken. The short-term measures include improvement of the management effectiveness and promotion of online registration system, while diversion of patients to local clinics and municipal hospitals should be achieved in the long-term.
References
Hsiao, W. C. (1995). "The Chinese health care system: lessons for other nations." Social science & medicine41(8): 1047-1055.
Liang, X.-y., L. Lan, et al. (2011). "Disease distribution and medical resources during the Beijing 2008 Olympic and Paralympic Games." Chinese Medical Journal-Beijing124(7): 1031.
Wu, Y., Y. Zhang, et al. (2004). "Factors associated with the extent of care-seeking delay for patients with acute myocardial infarction in Beijing." Chinese medical journal117(12): 1772-1777.
XU, J., J. TAO, et al. (2011). "Out-patient Service Utilization of Rural Residents." Chinese Health Quality Management2: 045.
Yip, W. C., H. Wang, et al. (1998). "Determinants of patient choice of medical provider: a case study in rural China." Health policy and planning13(3): 311-322.
ZHANG, J.-y. (2012). "The Opportunities and Challenges in the New Health Care Reform for the Medical Students at Basic Level." Chinese Medical Ethics5: 056.
ZHAO, M., J. TAO, et al. (2010). "Analysis of the Fees of the Out-patient Prescriptions of the Rural Medical Institutions under the New Cooperative Medical Scheme." Chinese Health Economics6: 017.
ZHAO, S.-z. and Z.-j. LI (2011). "Hold the People-oriented Concept, Enhance the Quality of Medical Service, and Construct a Harmonious Doctor-Patient Relationship." Chinese Medical Ethics4: 038.


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