The "red envelope ban" that was over-expected

In Nantong Third People’s Hospital, some patients and their families stated that, in addition to quality medical resources, the hospital’s rejection of the red envelope atmosphere over the years had made patients feel “saving and worrying” without having to send in a red envelope. During the interview, the reporter found that the Nantong Third Hospital had implemented the “Medical and Patient Ethics Contract” for many years and was considered as the “formula” of the rejected red envelope agreement requested by the Health and Planning Commission. However, in addition to the contract, the former has another set of strict rewards and penalties. As the earliest hospital without a red envelope named by the government, relevant persons in the Nantong Third Hospital felt that simple administrative requirements could not really put an end to the phenomenon of red envelopes, and they must have a supporting system; otherwise, they could only become a piece of paper.

> Policy refinement

When the National Health and Family Planning Commission issued the "red envelope ban" notice on January 19 this year, I am afraid that it would not have led to such a large controversy.

According to the notice from the Health and Planning Commission, the medical institution shall provide the “patient and patient non-acceptance and non-delivery red envelope” agreement to the patient or the patient's representative within 24 hours after the patient is admitted to the hospital. Maternal and child health hospitals, specialized disease prevention and treatment hospitals, etc. that open hospital beds must be established, and other medical institutions can refer to them for implementation.

In fact, this is not the first time that the Health and Planning Commission has said no to red envelopes.

All along, the health authorities have expressly provided regulations. For example, the "Law of the People's Republic of China on the Practice of Doctors" clearly stipulates that the use of positions to obtain or illegally receive the property of patients or obtain other improper interests shall be given by the health administrative department at or above the county level. Warn or order a suspension of practice activities of more than six months and less than one year.

The National Health and Family Planning Commission has continuously strengthened supervision over the phenomenon of red envelopes and doctors collecting red packets for patients. On August 1, 2012, the then Ministry of Public Health publicly solicited opinions on the “Guidance Opinion on Strengthening the Prevention and Control of the Risk of Integrity in Public Hospitals”. It is proposed that the patients should not receive “red envelopes” and the patients should not send “red packets” to the two-way signature when they are admitted to the hospital. The agreement was incorporated into the management of medical records.

At the end of 2013, in order to further strengthen the construction of medical hygiene, severely discipline the industry, promote the practice of law, practice medicine honestly, and respond to the outstanding problems that the masses in the medical and health sectors have responded to, the National Health and Family Planning Commission and the State Administration of Traditional Chinese Medicine have formulated “Strengthening medical care. The "Nine-times-not-accepted" health-building campaign includes the refusal to accept "red envelopes" from patients.

Before the introduction of national regulations by the Health and Welfare Commission, local policies have been gradually introduced in many places across the country. In Jiangsu Province, except for the 223 medical institutions led by Nantong Third People's Hospital, which promised no red envelopes, Taizhou City has also started the work of creating “non-red envelope hospitals” since 2007. The total “red envelopes” rejected and handed over by doctors in the past seven years More than 7.7 million yuan. However, there are not only “bans” in local policies, but also related rewards and penalties. Nantong No. 3 Hospital Association told reporters that it is of course a good thing to be able to implement the policy of hospitals without red envelopes throughout the country. However, it is difficult to achieve the level of acceptance of red envelopes in this hospital by relying solely on a paper agreement.

> "Insulting and dignity"

A paper notice from the Health and Planning Commission did not receive an imaginary response. In a rather spectacular wave of opposition, the voice also included Huang Jiefu, the deputy minister who stepped down from the Ministry of Health. "It's ridiculous. Doctors sworn on the first day of their careers (no red envelopes.) In addition, don't you really sign up for the agreement and you really don't receive red envelopes? Is this a scientific and reasonable rule?" Huang Jiefu asked. He believes that people who formulate policies must be well-intentioned and hope that these phenomena can be eliminated through signing contracts. However, those who have formulated this policy do not necessarily understand the doctor's feelings.

Compared with Huang Jiefu's "courage," members of the National Committee of the Chinese People's Political Consultative Conference and professor Ge Junbo of the Zhongshan Hospital of Fudan University are frankly insulted. He believes that the mandatory signing of the agreement means that there is a premise that all doctors at or above Class 2 hospitals are likely to receive red envelopes. This is unfair to doctors who do not receive red envelopes, and it is an insult to personality. “I refused to accept the red packet slogan for 20 years. Can a paper agreement be managed well?” said National Committee of the Chinese People's Political Consultative Conference member Ge Junbo. Doctors must sign an agreement every day. “Hands and hearts are numb.”

Ling Feng, vice president of the Chinese Medical Doctor Association, also believes that the signing of the refusal to accept the red envelope agreement has magnified everything and it has become possible for every doctor to receive red envelopes. This is a guilty assumption and an insult to the doctor's personality.

Ge Junbo is not optimistic about the implementation prospects of the notice: "It's a bit like 'children's house' and it's over. It's hard to implement this time."

The facts also confirmed Ge Junbo's judgment.

In March of this year, the Beijing Coal General Hospital tried both the doctor and the patient to sign the "red envelope" agreement. After nearly two months of trials, the hospital conducted an anonymous questionnaire survey of 122 patients and their family members and 55 resident doctors who signed the agreement. It showed that nearly 60% of the respondents believed that the signing of the agreement was necessary; In 50%, about 20% of doctors choose "not to say."

On April 30th, in the Nantong Third People's Hospital, which pioneered the concept of “no red envelopes”, relevant stakeholders in the hospital were also not optimistic about the “red envelope ban” of the Health and Development Commission. "Notice, many hospitals will respond and implement, but the effect is hard to guarantee."

> Collection and delivery

When does the red envelope phenomenon arise? It is difficult to have time nodes. However, taking the Nantong Third Academy as an example, when the slogan “No Red Packet” was proposed in the mid-1990s, the hospital has already felt the crisis of confidence that has become increasingly fierce.

Doctors who have been employed for many years in the industry have once received income red envelopes and how much red envelopes they can receive. They have become a measure of doctors' reputation and medical skill.

Under such a background, Zhong Nanshan, an academician of the Chinese Academy of Sciences and the president of the Chinese Medical Association, once said during the interview that he had consulted him or sent a red envelope to his doctor.

As a well-known surgeon who has been a doctor for 45 years, Huang Jiefu talked about this year at the two sessions of the national interview. Finally he smiled and told CCTV host Dong Qian an industry secret: “The overwhelming majority of doctors will not receive red envelopes. He It is better for you to serve. On the contrary, he will not dare to take risks because he has received your red envelope."

He further explained that besides refusing to accept red envelopes in violation of relevant regulations, during the operation, many doctors felt that “patients' family members were more difficult to engage in because of the red envelopes” and chose to be conservative because of fears of surgical risks. “The vast majority of doctors hope that the operation will go smoothly and do not want to have problems with their own patient treatment. There is nothing to do with giving the red envelope.”

Zhu Yonggen, director of the Department of Infectious Diseases at the Third People’s Hospital of Nantong City, once said that he took the patients’ red envelopes and was always restless after the surgery. In the event of a medical dispute, it would be very passive. Doctors who do not take red envelopes are very straight, and even with medical disputes, they can be limited to the scope of technology or accidents.

The patients attending the clinic, whether they are willing or unwilling to do so, will follow the unspoken rules of sending red envelopes when the situation comes. Health portal 39 Health Network once conducted a red envelope survey on more than 20,000 netizens. The results showed that 60% of netizens personally sent red envelopes to doctors, and the mentality of seeking peace of mind became the main cause.

As the dean of the No. 1 Hospital of Peking University, Liu Yucun frankly admitted that he had been stuffed with a red envelope. Although it is considered that "red packets" is a good word in China, Liu Yucun said that it needs to be treated differently. “The poor get their hard earned money, sell their houses, and even borrow money to see a doctor. If doctors receive their gifts and money, they are indecent. Someone gave doctors money before the operation, saying that for 'buying peace', if you received it, the doctor would Insult to his own personality."

Liu Yucun had rejected the red envelope given by a patient. Later, the patient’s family members insisted on expressing their gratitude. He accepted the vermicelli made by his family sweet potato as a gift. "If I take these things, I can say from my conscience that there is no problem with moral standards."

> Difficult to cure

One side is a heavy ban, while the other is a bullish red envelope market. Some doctors disclosed that red envelopes were comprehensively determined according to the hospital's grade, the size of the operation, and the economic condition of the patient. The reporter found in the register of the tenth ward of the Third People's Hospital of Nantong City that the amount of red packets returned by doctors ranged from 300 yuan to 15,000 yuan, but it was generally around 2,000 yuan.

In addition to these obvious red envelopes, there is also a "dark" red envelope that is hardly noticeable. According to reports, due to the lack of high-quality medical resources, it is basically acquaintance to be able to plug and request additional medical treatment. In many cases, the “red envelopes” do not take the form of physical cash, but take the form of “human debt”.

According to industry insiders, almost all patients are seeking good hospitals and good doctors. Therefore, red envelopes have become a means to snatch medical resources. "The scarcity of quality medical resources makes it difficult to truly equal the doctor-patient relationship. It can be said that patients send red packets. Behind repeated prohibitions is the problem of the allocation of medical resources."

Zhong Nanshan's investigation of the top three doctoral hospitals in Guangzhou in 2013 with “more than 40,000 books and more than 190,000 actual” findings also confirmed the widespread phenomenon of doctors receiving red envelopes.

He clearly stated that the registration fee of around ten yuan for a general outpatient clinic does not reflect the real value of the doctor's diagnosis at all, and it is bound to cause problems such as over-examination, high drug prices, high food rebate, and red envelopes.

Liu Yucun revealed that the surgeon did not perform as much as a tailor or a carpenter. "A gastric cancer surgery requires three doctors, two nurses, and two anaesthetists, but the surgery costs a total of only a few hundred dollars." Liu Yucun reveals secrets, "How to make up for lack of income? Use some consumables to add the price code. If I With conscience, 'adding code' will have a degree; if I am not well-educated, I will add a lot to it."

During the two sessions this year, some deputies said that doctors' acceptance of red envelopes is a moral issue. The underlying cause is still the system. If the primary medical care fails, large hospitals are still "difficult to see a doctor," and the labor value of medical workers has still not been properly reflected. It may be difficult for doctors to accept red packets.

Regarding the “red envelope ban” of the Health and Family Planning Commission, it was commented that although the original intention was for the sake of the patient, it was rather funny. The rejection of red envelopes was the basic conduct of doctors, and the failure to send red envelopes was also a basic moral and rights of patients. To deepen medical reform and resolve the contradiction between supply and demand of resources is the fundamental means. Who can manage a piece of paper?