德国医改给中国医改的四点启示

2018-04-28 佚名 健康界

中国医改应学习德国医改的经验,在改革过程中要专注于自身的医院管理。

中国医改应学习德国医改的经验,在改革过程中要专注于自身的医院管理

最近,中国医院管理群和医生群对中国医改的讨论,有两种认识和倾向似乎比较占上风:一种是对中国医改总采用喊口号似的推进!这种方法,表面上看挺优,但事实上,没有改革的态度与方法,可能并不可取;另外一种对于中国医改进程,更多的是一种抱怨。将一些存在问题看得很严重,似乎中国医改正在越改越难。而这种畏难情绪与认识,也值得我们高度关注。而今天,我再次捧读《德国医院管理4.0》一书,获得很多启示和联想!在此,再做一点回馈。

第一,医改要调整医疗资源和医疗布局,这是大势所趋。

过去的十年,德国政府致力于全国医疗资源的大调整,几乎减少了百分之二十五左右的公立医院。许多人说在德国,几乎每年都会有几十家公立医院正在消失。而德国的私人医院,却在急速地增长。德国的医改让医院更有生命力。在减少的公立医院中,一部分转变成护理院、社区卫生所等,他们正在改革中演变医疗职能。

第二,德国医改不仅减少和控制了医疗资源,而且还有效地调整了结构

医疗服务能力在医改中不降反升。在十年的医改中,德国的公立医院从两千一百九十七家减少到两千零四十五家。公立医院的床位数从五十四万张减少到五十万张。但公立医院总的诊疗人数,却从每年一千七百二十万增加到每年一千八百三十四万。这被许多国家认为是一个非常了不起的改革成效。

第三,医改必须通过科学管理和医疗管理的工具来实现改革的目标和找准突破口。

德国在医改中是选择了DRGs来进行改革的突破的。在引入DRGs之前,德国的医院诊疗病人数和医疗收入,都呈现出略有下降的趋势。而自从引入DRGs以后,则诊疗病人相关的数据和收入则发生了明显的改变和增长。德国的医改通过DRGs,不仅控制了医疗质量、医疗成本,并且让医改的总目标得到明显的推进!

德国政府认为:由于DRGs在医院的认真开展与应用,使得德国医疗费用略有增长,是与医院诊治疾病的需求的改变和增长有关的,而并不是由于医院的乱收费、乱检查与乱治疗等。他是与人口的老龄化、医学科技进步和诊疗方式的改变以及国民对于健康的重视、卫生投入的增加所产生的。

第四,德国的医改,告诉我们医院在医改中要专注于自身的医院管理

德国在医院改革中并没有将医改的政策、医保的政策作为医院管理的核心内容,而是要求医院在医疗主业进步和在医院的运营管理上要科学化、有创新,要走信息化的发展之路。这使得医院的主业进步,也成为国家医改的重要内容。将医院管理的主业进步,当作是国家医改的核心内容之一,这也是对中国医改和医院管理者非常有启发与帮助的。

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  2. [GetPortalCommentsPageByObjectIdResponse(id=2011694, encodeId=3ea92011694b3, content=<a href='/topic/show?id=97ed21e3449' target=_blank style='color:#2F92EE;'>#中国医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21734, encryptionId=97ed21e3449, topicName=中国医改)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=af60254, createdName=mhm289, createdTime=Thu Oct 04 03:04:00 CST 2018, time=2018-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313822, encodeId=1761313822e2, content=好文章.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaELCAs1uRBgDoWqJaBltta2Y7fTibyM6wYf94osSMg5CCm9oy7JrdcXPqh1DrCdn5IxO4BE8ZLEiaQXQ/0, createdBy=978a1675334, createdName=xiaogan8479, createdTime=Thu May 10 13:48:58 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1286985, encodeId=767f1286985ae, content=<a href='/topic/show?id=ebac3442063' target=_blank style='color:#2F92EE;'>#医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34420, encryptionId=ebac3442063, topicName=医改)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3e9205, createdName=tidiq, createdTime=Mon Apr 30 06:04:00 CST 2018, time=2018-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1394339, encodeId=2f3d139433972, content=<a href='/topic/show?id=6fa7508342c' target=_blank style='color:#2F92EE;'>#德国#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50834, encryptionId=6fa7508342c, topicName=德国)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=48732500158, createdName=12498c32m68暂无昵称, createdTime=Mon Apr 30 06:04:00 CST 2018, time=2018-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310480, encodeId=fda43104802a, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sun Apr 29 22:14:07 CST 2018, time=2018-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310136, encodeId=59c83101363d, content=好知识值得拥有的, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sat Apr 28 16:41:20 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310115, encodeId=4cc331011514, content=这样才是真正的改革.而不是大刀一切下去.不顾医学生的死活.不尊重知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2018/04/28/b98d19df2b2b101797f1ee2c271263af.jpg, createdBy=134a1605093, createdName=Isaacgong, createdTime=Sat Apr 28 15:28:08 CST 2018, time=2018-04-28, status=1, ipAttribution=)]
    2018-05-10 xiaogan8479

    好文章.谢谢分享

    0

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    2018-04-30 tidiq
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  5. [GetPortalCommentsPageByObjectIdResponse(id=2011694, encodeId=3ea92011694b3, content=<a href='/topic/show?id=97ed21e3449' target=_blank style='color:#2F92EE;'>#中国医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21734, encryptionId=97ed21e3449, topicName=中国医改)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=af60254, createdName=mhm289, createdTime=Thu Oct 04 03:04:00 CST 2018, time=2018-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313822, encodeId=1761313822e2, content=好文章.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaELCAs1uRBgDoWqJaBltta2Y7fTibyM6wYf94osSMg5CCm9oy7JrdcXPqh1DrCdn5IxO4BE8ZLEiaQXQ/0, createdBy=978a1675334, createdName=xiaogan8479, createdTime=Thu May 10 13:48:58 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1286985, encodeId=767f1286985ae, content=<a href='/topic/show?id=ebac3442063' target=_blank style='color:#2F92EE;'>#医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34420, encryptionId=ebac3442063, topicName=医改)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3e9205, createdName=tidiq, createdTime=Mon Apr 30 06:04:00 CST 2018, time=2018-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1394339, encodeId=2f3d139433972, content=<a href='/topic/show?id=6fa7508342c' target=_blank style='color:#2F92EE;'>#德国#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50834, encryptionId=6fa7508342c, topicName=德国)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=48732500158, createdName=12498c32m68暂无昵称, createdTime=Mon Apr 30 06:04:00 CST 2018, time=2018-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310480, encodeId=fda43104802a, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sun Apr 29 22:14:07 CST 2018, time=2018-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310136, encodeId=59c83101363d, content=好知识值得拥有的, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sat Apr 28 16:41:20 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310115, encodeId=4cc331011514, content=这样才是真正的改革.而不是大刀一切下去.不顾医学生的死活.不尊重知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2018/04/28/b98d19df2b2b101797f1ee2c271263af.jpg, createdBy=134a1605093, createdName=Isaacgong, createdTime=Sat Apr 28 15:28:08 CST 2018, time=2018-04-28, status=1, ipAttribution=)]
    2018-04-29 大爰

    学习了谢谢分享!!

    0

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    2018-04-28 虈亣靌

    好知识值得拥有的

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=2011694, encodeId=3ea92011694b3, content=<a href='/topic/show?id=97ed21e3449' target=_blank style='color:#2F92EE;'>#中国医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21734, encryptionId=97ed21e3449, topicName=中国医改)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=af60254, createdName=mhm289, createdTime=Thu Oct 04 03:04:00 CST 2018, time=2018-10-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=313822, encodeId=1761313822e2, content=好文章.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/PiajxSqBRaELCAs1uRBgDoWqJaBltta2Y7fTibyM6wYf94osSMg5CCm9oy7JrdcXPqh1DrCdn5IxO4BE8ZLEiaQXQ/0, createdBy=978a1675334, createdName=xiaogan8479, createdTime=Thu May 10 13:48:58 CST 2018, time=2018-05-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1286985, encodeId=767f1286985ae, content=<a href='/topic/show?id=ebac3442063' target=_blank style='color:#2F92EE;'>#医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=34420, encryptionId=ebac3442063, topicName=医改)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b3e9205, createdName=tidiq, createdTime=Mon Apr 30 06:04:00 CST 2018, time=2018-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1394339, encodeId=2f3d139433972, content=<a href='/topic/show?id=6fa7508342c' target=_blank style='color:#2F92EE;'>#德国#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=50834, encryptionId=6fa7508342c, topicName=德国)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=48732500158, createdName=12498c32m68暂无昵称, createdTime=Mon Apr 30 06:04:00 CST 2018, time=2018-04-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310480, encodeId=fda43104802a, content=学习了谢谢分享!!, beContent=null, objectType=article, channel=null, level=null, likeNumber=52, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Sun Apr 29 22:14:07 CST 2018, time=2018-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310136, encodeId=59c83101363d, content=好知识值得拥有的, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mONcle9pic3zMoyicyo6ia9f4IuLQAwZoxD6Hx4ibd5CMcOCYhStY6oDibbKK6O2X8iaicldO5ib8j1iapOIobIKCGiczU2A/0, createdBy=56251941490, createdName=虈亣靌, createdTime=Sat Apr 28 16:41:20 CST 2018, time=2018-04-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=310115, encodeId=4cc331011514, content=这样才是真正的改革.而不是大刀一切下去.不顾医学生的死活.不尊重知识, beContent=null, objectType=article, channel=null, level=null, likeNumber=61, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2018/04/28/b98d19df2b2b101797f1ee2c271263af.jpg, createdBy=134a1605093, createdName=Isaacgong, createdTime=Sat Apr 28 15:28:08 CST 2018, time=2018-04-28, status=1, ipAttribution=)]
    2018-04-28 Isaacgong

    这样才是真正的改革.而不是大刀一切下去.不顾医学生的死活.不尊重知识

    0

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