Attend to the service price and deviate from value seriously

Attend to the service price and deviate from value seriously
Attend to the service price and deviate from value seriously
Staff reporter Sun Meng When 5 12 International Nurses' Days come, when the reporter goes to some hospitals to interview, hear most, topic how to charge that it is the care. What merits special attention is, after every large hospital launches the demonstration project of the high-quality care this year, partial to workers and accompanied and attended to the quantity of relatives to reduce, the nurse's working pressure, labour intensity are further strengthened, but the present nursing service charge has been continuing to use the pricing standard more than 10 years ago all the time - -" was municipal Price Bureau in 1999 that the current grade in Beijing attended to the expenses standard and continued to use to attend to and charge and only account for about ten percent of cost, " Beijing unifies the medical expenses standard of services " which the health bureau issued, tertiary the intersection of hospital and first grade leave every day such as bed on fee 9, second leave every the intersection of bed and day 7, tertiary to attend to fee as every the intersection of bed and day 5 on fee among them. But learn to the medical project cost accounting of 8 city owned hospitals through last year, the average unit cost that the grade attends to should be 90 yuan every bed day, that is to say, basically attending to the price project and charging about 10 timesly in hospital of the hospital. " Beijing Municipal Health Bureau cures the policy Chen Jing, vice section chief of office to say, attends to and charges too low, this is the fact that everybody admits. An operation patient of intestines and stomach surgery of the People's Hospital of Peking University is in hospital for 15 days, costs 46860.96 yuan altogether. Among them, the fee of Western medicine is 20731.44 yuan, accounts for 44% of the all-inclusive cost; The fee of material is 14578.13 yuan, accounts for 31%; The fee of operation is 4603.20 yuan, accounts for 10%; Test the fee of 2902.50 yuan, accounts for 6%; Treat the fee ' Such as preparing against cover, catheterization,etc.) 446.70 yuan, accounts for 1%; Attend to the intersection of fee and 120 only, account for 0.3% only. Last year, Beijing Municipal Health Bureau, Bureau of Finance showed to 8 medical project cost accounting results which hospitals carried on such as Beijing Chaoyang hospital, the nursing projects of these hospitals charge and can only remedy 17.34% of the cost. "The cost input on attending to of the hospital includes the worker, material, 3 parts of fee. The worker referred to the cost of manpower, nursing manpower cost in one year was about 100 million yuans last year; The material refers to attending to consumption and expenditure of basic raw materials in the course, probably there is 1 million yuan in one year; The part of the fee includes the assessment of comprehensive management cost of hospital such as water, electricity, coal, depreciation of fixed assets, probably there is 24 million yuan in one year. It can be regarded as that thick, the nursing in one year of the hospital is invested and close to 130 million yuan. " Sail Liu, assistant of director, people of Peking University, tell reporter, such one the intersection of cost and input, can't be mended back by attending to and charging. It is reported, attending to the price project of charging mainly includes two parts. A part is a basic nursing price project in hospital, for example attend to the fee, special sickness nursing fee, neonate and attend to fee, psychosis and attend to the fee etc. according to the grade in need of setting up of the condition; Another part is a daily general treatment price project implemented by the medical personnel, for example injection, oxygen intake, atomization suck, change dressings, physics temperature-dropping, catheterization,etc. treat and other projects attend to the fee. In the regulation of the price department of Beijing at present, it has 60 items altogether that open subject of the hospital attends to the charging item, among them, the highest one is the deep vein of artery put and managed, charges 75 yuan to charge; The lowest one is the hypodermic injection, only charges 0.5 yuan. In 78 trainings attend to the charging item, the project of charging the highest one is the clear sore skill (cover subject) of blister ,Charges 120 yuan; The lowest one is the phototherapy of neonatal jaundice, only charges 0.5 yuan. One knows very well and attends to the expert who manages and runs to tell reporters, our country is current the nursing paying price is far lower than the actual cost in hospital. Take intravenous infusion as examples, charge for 2 yuan each time while being current, and according to calculating, its cost is about 18.93 yuan, among them the labor cost is about 12.74 yuan, cost of consumables is about 6.19 yuan. Charge low to make it run off " invest and produce relation, smooth out, obey, one's own development of hospital circulate naturally smooth not to attend to talent. Attend to and charge and attend to the distortion of the cost proportion, must cause behavior and nurse's behavioral distortion of the hospital, medical resource distribution and distortion that the medical care offers that thus lead to the fact. " Chen Jing says. Head of the nursing department of the People's Hospital of Peking University Xu GuoYing says, it influences nurse's income directly to attend to and charge low, bring the loss of attending to talents. The nurse has insufficient manpower, in addition, to the constant improvement attending to the job requirements at present, having caused nurse's work load to strengthen directly, their service quality and attitude will unavoidably drop, " seven fen is protected " Can't guarantee both quality and quantity to finish. Look from the view of nurse, because the work is not paid attention to, the treatment is low, some nursing staff drop to the curiosity of new knowledge, attend to the enthusiasm of the engineering level to drop in improving, the improvement of personnel's quality is influenced. "Some hospital administrators think that make money, in order to lower costs, control the nurse to work out strictly. The clinical nurse's quantity is insufficient, patients have to be engaged and partial to workers to remedy and lack. " Ministry of Public Health cure the intersection of policy and department attend to the intersection of management office and person in charge say the distortion of nursery work expedite the emergence of a middle industry chain at the same time - -Accompanying and attending to the company, the patient engages one and is partial to workers to need sixty or seventy yuan each day, this money is drawn by patient, the financial burden which has increased them does not say, influence the normal medical order of the hospital too. Moreover, are partial to workers being provided service by patient's bed directly by the formal training of the nursing speciality, it is unable to guarantee to attend to security and quality. Planned price, PK of market price, in fact, the intersection of hospital and administrator and attend to circle, work, rise in price, raise a cry of warning a lot of years for attend to already. Chen Jing says, takes Beijing as examples, since making the public medical expenses standard of services of medical organization in 1999, this price has not already changed enough for 10 the coming years. "But should solve this problem, a department says and does not include, it is very difficult. " Is it so difficult why to want to rise to attend to the service price? Relevant person in charge of wealth department analyzes the rule of Ministry of Public Health to point out, in the course of pricing, the related departments think prices should be mainly compensated tangibly and consumed, invisible and difficult to measure to consume. The direct consequence of this kind of understanding is, in the formulation of the expenses standard, it is difficult for the technological labor service value of medical care to be reflected, force hospital to be more through offer tangible to consume ' If medicines and apparatus are checked) The harvest one back and forth. It is one of the forming factors of the bottleneck too that the price adjustment mechanism is rigid. The person in charge say medical service price will certainly for many years often, though personnel expense,etc. nearly all prices of the input key element change during that time, but the service price is not thereupon change. This kind of mechanism is actually to let the hospital face two kinds of pricing system: For market price, for planned price that change for many years service it offer factor of production it need. This person in charge says, the price Adjusting must pass coordination and price hearing of several departments, and the society is very sensitive in rise of the price at present, the price is very difficult to raise to pass. "Raise and attend to the service price, need to consider ordinary people's ability to accept. Moreover, if improve? �� of �� dizzy gangue the intersection of quality and the intersection of Li and the intersection of duck and eight Qu of Lu �� loyal the intersection of sedan-chair and Pan cough, go straight the intersection of border and the intersection of Bao and the intersection of buttocks and the intersection of sinus and the intersection of gully and the intersection of shelf and bag stir product �� Dou ZouChu �� gray �� curtain beautiful? Improving should take three steps to charge to attend to the demonstration project of the high-quality care to start from this year, attending to the service charge low becomes the main bottleneck which promotes this job. The problem is how should price adjustment be done? The person in charge seems at the place where it is managed that it is attended to that Ministry of Public Health cures the policy department, the concrete step can be divided into three steps: Promote the hospital and attend to the service level - -Try to improve and charge - -Include the expenses in the medical insurance. Among them, need regional Ministry of Health more also and price and work the intersection of person who ensure and a lot of communication and linkage. Look from the whole country at present, Jiangsu Province has already taken the lead in taking one step in raising and attending to the service charge. 2008,it is if you can't accompany and attend to by grades of ward pilot, attend to to charge since bed 10 yuans, bed 6 yuans, bed 3 yuans days every days every days every before this not to should save by 3, improve, get first grade attend to every the intersection of bed and day 90, second attend to every the intersection of bed and day 60, tertiary to attend to every the intersection of bed and day 30. After this standard is implemented, the hospital can basically be equilibrated on the business accounting of these wards. According to should save department of public health, cure the intersection of policy and the intersection of and relevant introductions of person, as far back as 2001, department of public health of Jiangsu Province, Price Bureau were through attending to and charging to the hospitals at all levels and attending to the research of the cost and calculating actually, have obtained the grade and attended to the day cost per bed: First grade attend to every the intersection of bed and day 51.48, second attend to every the intersection of bed and day 38.14, tertiary to attend to every the intersection of bed and day 20.49. In more than 7 years, the medical organization does enormous efforts for improving and attending to quality, the Ministry of Health coordinates, communicates with other departments actively, just charges the care grade to bring up to the current standard. At present, the problem that Jiangsu Province faces is, the grade attended to the fee though mentions, but this charge has not been approved by medical insurance department, the nursing fee risen is that the patient pays the bill by oneself, sustainability causes anxiety. And expenses standard this implement in pilot inpatient area only, launch a pilot project while being other ward follow charging at a low price traditional still. It's time, save department of public health, cure the intersection of policy and the intersection of and relevant personnel, say, if you want to realize care price rationally, there are very long waysing will go. Ministry of Public Health cures the policy department and attends to the relevant person in charge of management office and says, as to most medical organizations, utilize the opportunity of the pilot project of high-quality care actively, improve and attend to the service level, it is a question that should pay close attention to at present. Attend to quality to promote, improve and charge to get patients and approval of the society. The reporter witnesses her, one day is only worth 72.2 yuan busily Staff reporter Sun Meng From 40 past 7 on May 11 to 16 o'clock, the reporter follows surgical responsibility nurse intestines and stomach of the People's Hospital of Peking University and takes the post as the day shift of one day on the actor duckweed. The medical ward of intestines and stomach is the pilot ward of the high-quality care of this institute, there are 45 berths. Take the post as the intersection of actor and duckweed as one the intersection of group and group leader, nurse of responsibility, responsible for offering to 15 patients and attending to with other two nurses, and guide the operation of these two nurses. The following are some working contents of taking the post as actor duckweed which reporters intercept: 7: 40,Sweep the bed. 8: 29,Attend to and relieve. 8: 38,Send medicines, mix the liquid. 9: 07,Begin the intravenous infusion. 9: 10,29 intravenous infusion, patient of bed, neighbor bed make the intersection of nurse and the intersection of report and the intersection of bed and patient this that oral cavity attend to, in weight tongue fur have, the tongue still points out covers. Take the post as the intersection of actor and duckweed, advise nurse this in charge of doctor the intersection of situation and report. 9: 12,The nutriology dept. has sent 30 beds of patients' diabetic liquid food here, take the post as the actor duckweed and carry the meal in front of patient's bed, explain the diabetic patient's postoperative attentive matters eaten to the patient while assisting patients to take food. 9: 15,The head nurse tells 32 beds to accept a new patient. Take the post as the actor when the duckweed comes to the ward, this bed leaves hospital the patient is waiting for relatives to connect, she go on, leave hospital guidance to patient again. 9: 19,Put 32 sheet location in order with another nurse. 9: 25,The new patient is admitted to hospital. Take the post as the intersection of actor and duckweed, weigh, take blood pressure for him, go on, admitted to hospital propaganda and education, including being recommend the intersection of ward and environment, in charge of doctor and nurse, eat time, visit system of looking after a patient by staying with him in hospital, teach patients why use etc. water cards and meal card. 10: 00,Postoperative 34 beds of patients go back to from ICU, take the post as the actor duckweed and place the sick bed for the patient with another nurse, offer the heart electricity guarding, oxygen intake, check patient's mind, skin and pipeline state, tell patients postoperative notes ' Diet, move about, cough expectoration, method,etc. that function temper) ,And teach it to use and ease pain the pump. 10: 29,Inspect the patient in charge ofed, assist 34 beds of patients to stand up and pat carrying, expectoration, the patient expectorates two mouthfuls of white and sticks the phlegm. Assess patient's analgesic effect. In the 3 hour, follow, take the post as the intersection of actor and duckweed shuttle between each reporter of ward both feet turn sour mouth to be dry, but during this, she has not drunk the water, has not been to the toilet once. Will come down in one day, except dinner time of 40 minutes at noon, will not stop the work in the hand when taking the post as the actor duckweed. She says, this does the skill which a nurse has practised for many years, there is no operation patient on the same day, the work load still can be regarded as the smaller one. The reporter has done one to count roughly, in the working time of 8 hours, she puts 15 pieces of location sheets (2 times of one day) in order altogether ,Send oral medicine for 5 patient ' 2 times or 3 times) for one day ,It is 11 patient's intravenous infusion, install the infusion pump for 2 patients, come in and go out for 3 the institute patient does the propaganda and education, 2 want patient of operation do preparation in front of the skill the next day ' Including preparing against covers, matching the blood, cover to try) And Xuan Jiao, sucks for 8 times, cuts the toenail twice, makes the bed once for patient's atomization, it is worth for 2 times recording patient's blood pressure, help patient's expectoration twice, stand up, pat carrying, table, sending meals, pouring the urine, drawing curtains In taking the post as the actor 15 responsible patients of the same day of duckweed, 4 are patients needing first grade to attend to. "According to the regulation of the hospital, first grade attends to and needs to inspect a patient once per hour, wash the face, wash the foot, comb one's hair for the patient every day, make oral cavity is attended to, the pipeline is attended to and the perineum is washed, put the location of sheet in order twice in one day, stand up and rub one's back with a towel and go on and cough effectively twice in one day, wipe the bath on bed 2 times in one week, and monitor the patient's life physical sign, treating, using medicine,etc. according to the doctor's order. According to the stipulations of price, it is 9 yuan every day that the grade that first grade attends to attends to the fee. Charged extraly except some therapeutic nursing, the other work includes in 9 yuan. " The office actor says duckweed. The north It is big surgical head nurse Li Jia of the People's Hospital intestines and stomach says to reporters, this institute launches the pilot project of the high-quality care, the clinical care is really done more sturdily, the nurse's work load is much larger. "For example, we required basic care including attending to, perineum of oral cavity that the nurse must offered to attend to and wash the stomach tube etc. in the past. Now, the intersection of drainage and liquid, urine of patient nurse pour, hospital require nurse observe the intersection of patient and first situation of meal under operation still, in addition, stand up, strike and carry, wash hair, wash the foot too? Border invades curtain Chen Qian 5 �� Wu of tiny fragments of stone, coal, etc of �� of worried health of Yong of the third constellations Zhyuan coughs ��'s fervent border and strikes partner's standard to imitate! ? Reporter regard as, in take the post as actor in ten or twenty kinds of care offered, treatment that charge attend to project have intravenous infusion 2, atomization suck each time 2, prepare against the intersection of skin and 5 each time, draw blood 1 yuan, skin try on 0.5 yuan each time each time each time, in addition, the grade of sharing equally on her head attends to the fee of 21.2 yuan. Be regarded as, her work of one day can only earn 72.2 yuan. The reporter knows in the same hospital, if the impatient hires one and is partial to workers, every day's expenses cost more than 70 yuan too, but can only offer simple life to attend to. View Why without accompanying and attending to " Much said but little done " See CCTV reports BJ Union Hospital,etc. has begun not to accompany and attend to the pilot project in the ward, the news has shown such details which robs the eyeball as a nurse washes the face, washes the foot as the patient. Search for, will find this kind have, accompany and attend to ward even if what something new it is early at home on the net. But what operated abroad better had not accompanied and attended to the ward, why is difficult at home to take root? First of all, compared with domestic and too low nurse's berth this is relevant. The investigation done toward over 400 hospitals of the whole country of Ministry of Public Health shows, it is 0.331 on average in the domestic medical organization ward the nurse and berth proportion, the lowest one is only 0.261, can't still reach the requirement for 0.41 that Ministry of Public Health put forward in 1978. In this case it is impossible for nurse to do to every patient well attending to, have to do those clinic that must make sure to attend to, for example examine coming in and going out amount of blood pressure, record,etc.. Others wash face, wash foot, the intersection of person who go to toilet and life, attend to, has to let relatives solve. Secondly, relate to medical system. The present nursery work is too tedious, even deviate from needing clinically gradually, too many document work has taken up limited nursing resources. In fact, not only those copy clerks not essential, many jobs can well be stripped and gone out to be finished by other departments. For example, the ones that remain in most hospitals and is finished by every ward nurse hang the bottle and adding medicines and working, and already the pharmacy dept. mix the liquid centre to finish better in the aseptic condition in unison in some hospitals, this has not only guaranteed the quality of the liquid, react after reducing the infusion, but also it is used in the clinical time when attends to to increase the nurse. Third, charge with the nursing generally on the low side at present inseparably. In " the nursery work does not earn money, hire the nurse to sustain economic losses more more " Idea drive under,some hospital, for lasting cost, be implemented by " the dual track systemmed " at personnel system management at nurse ,Namely employ the nurse with the treatment by way of casual labour. A large number of system of appointment nurses enter clinically, the unofficial nurse in-staff gets the unequal pay for the equal work. As the nurse's legitimate rights and interests are encroached on, attending to quality will inevitablely present the decline too. I think at least in the intersection of nurse and berth than reach 0.71 generally, the intersection of hospital and operational mode get before the deep reform, it will be difficult to popularize that this kind has not accompanied and attended to the operation mode of the ward. --Select from some net friend blog and chain 1 Beijing part attend to the intersection of project and the intersection of expenses standard and the intersection of charging item and the intersection of price and project, prove neonatal dipping, oil the intersection of bath and 3.00 persons if fetus lipoprotein many and bloodstain large, it takes 10 minutes at least, all internal organs function of the neonate is not complete in development, the infusion needing to observe 2.00 yuan for a patient of persons of intravenous infusion of the condition closely takes 25 minutes from planning to failing, other each liquid need, take medicine check, while being double, the executor takes 5 minutes to sign returning, atomization sucking, ultrasonic atomization that and it is free of charge that frequent mixing the liquid and changing the infusion is sucks the patient that the ward atomization of 2.00 yuan persons sucked, later needed to strike and carrying and assisting to arrange the phlegm, 4.00 yuan of blood transfusion / 200 ml that it is free of charge that but strike and carry needs 2 nurses to finish from choosing blood to giving patients each link of blood transfusion. Single to take 8~15 minutes to fetch the blood, from checking to blood transfusion to operate doubly after get back to the ward, take up a nurse's resource corpse and deal with 40.00 yuan each in the mortuary, if invite the master worker there to scrub and charge 500 yuan, if please put on the clothes and charge 500 yuan again, and 40 yuan of the nurse's operation. The proportion is 251 to charge. But it wipes bath to be free of charge at the bed of patient in hospital wash stomach 15.00 persons, wash at least 30 minutes such as stomach while being ordinary manually, if dichlorvos is poisoned needs and washed the stomach many times repeatedly in a large amount, charge it is 15 that press, rescue, need many persons of nurse participate in cooperation finish vein draw blood 1.00 persons long-term patients by 15.00 persons outside the heart too, old patient, neonate and little infant of the pediatrics do the vein to puncture, difficult success, technology expects very much. The cover is inner, the cover is played, 0.50 yuan persons of intramuscular injection (select from and " unify the medical expenses standard of services in Beijing ", the project explains and offers by nursing dept. of the People's Hospital of Peking University) Chain 2 The intersection of Beijing and the intersection of medical organization and care no charging item ' 78 items) 1.Basic nursing project ( 21 items) : Attend to (put the location of sheet in order) the morning Attend to at night ' Put the location of sheet in order) Stand up, make, carry at the bed wiping bath wash hair, wash foot shave, trim the nails, have a hair-cut oral cavity attend to The perineum washes the nursing skin care of stool incontinence Change 3M and stick to the nastal feed of membrane and send oral medicine to medicines Adding the medicine infusion of the small pot changes the infusion and pulls out the infusion 2. Plan event in front of skill ' 4 items) : The enema pharmaceutical enema of glycerine examines the belly of abdominal girth and pigeonholes and measures the electricity of heart to monitor the observation 3. Angry dishes of management project ' 17 items) : Instruct patient employ breathing function person who do exercises cooperate with doctor trachea intubate cooperate with doctor tracheostomy person who breathe pipeline install person who breathe pipeline remove and sterilize trachea in the intubate Sleeve pipe sterilize and change, expand the intersection of lung and loose the intersection of gasbag and gasbag examine, pigeonhole, pull out the intersection of trachea and intubate have trachea intubate person oral cavity attend to by the bed making the intersection of chest and blocks of angry wet to take trachea way A needle pulls out and presses and transfers to the patient and accompanies and examine and suck the phlegm by the trachea intubate manually 4. The drainage tube attends to the project ' 3 items) : Change the drainage tube and pull out various drainage tubes and keep the 24-hour urine sample 5. Specially gynaecology and obstetrics The department attends to the project ' One) : Press the bottom of the palace 6. The neonatal training is attended to ' 8 items) : Check, charge, give neonatal neonate have a bath neonate print footprint instruct relative umbilicus portion to attend to neonate wear, undress neonate weigh and record print the intersection of heel and the intersection of blood and block and sign Paste outwards the institute transfers to the neonate 7 ICU training attends to the project (5 items) : The blood is strained the pipeline is installed and the blood is strained by the upper lathe the blood strains and gets off the plane by the pre- puncher to pull out the artery and examine and press the tube to change by the suit bed of the pressure 8. Other trainings attend to the project ' 3 items) : Four bandeaus ask the scrotum bellyband to wrap up the wound to cooperate with the doctor to hold the peritoneum to dialyse, manage 9. Go through formalities of leaving hospital / producing (2 items) : " in hospital the questionaire " to leave hospital and take medicines to instruct the patient how to fill in 10. Life physical sign monitor event ' 6 items) : Copy the intersection of body temperature and the intersection of patient and list this send thermometer charge thermometer get rid of thermometer soak, sterilize thermometer draw the body temperature form 11. Attend to, record, write ' 6 items) : Attend to, record, write ' The superfine is attended to) Attend to, record, write ' First grade is attended to) Attend to, record, write ' Second is attended to) The record writes and puts patient's case history of leaving hospital in order to remember coming in and going out amount to relieve 12. Give medicine event ' 2 items) : Get medicines and retreat in the medicine blood bank to fetch the blood


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