段涛:院长日记 之 谈谈医改IV-论三甲公立医院的“倒掉”

2016-01-06 段涛 段涛大夫

有朋友提醒我说“谈谈医改”漏了IV,直接跳到了VI,赶紧补上一篇,谈谈大家都不满意的三甲公立医院。 里外不是人的三甲公立医院 不知道三甲公立医院是招谁惹谁了,好像大家对其都不满意。 相关政府部门对三甲公立医院不满意,认为“看病难,看病贵”是三甲公立医院造成的,是需要被改革的对象。从TA们的角度来讲,最好是三甲公立医院既不用向政府财政要钱,还能满足人民群众日益增长的需求

有朋友提醒我说“谈谈医改”漏了IV,直接跳到了VI,赶紧补上一篇,谈谈大家都不满意的三甲公立医院。

里外不是人的三甲公立医院

不知道三甲公立医院是招谁惹谁了,好像大家对其都不满意。

相关政府部门对三甲公立医院不满意,认为“看病难,看病贵”是三甲公立医院造成的,是需要被改革的对象。从TA们的角度来讲,最好是三甲公立医院既不用向政府财政要钱,还能满足人民群众日益增长的需求。

患者对三甲公立医院不满意,认为三甲公立医院门难进,脸难看,是导致“看病难,看病贵”的根源。从TA们的角度来讲,最好是到三甲医院看病容易,特别是看专家容易,看病便宜,最好是看病不花钱。

民营医院对三甲公立医院不满意,认为三甲公立医院搞市场垄断,人才垄断,断了民营医院的财路和生路。从TA们的角度来讲,最好是三甲公立医院能把最好的专家和市场拱手让给自己。

三甲公立医院的员工也对自己的医院不满意,除了每天看门诊做手术累个半死还老是被患者投诉以外,还要加码教学科研任务,还要申请该死的国家自然科学基金,写该死的SCI文章。从TA们的角度来讲,最好是少干活,多拿钱,每天美滋滋地喝喝咖啡。

现在就连互联网公司也开始对三甲公立医院不满意了,认为三甲公立医院和三甲公立医院的院长是互联网医疗创新最大的障碍和阻力,因为这些互联网医疗公司想要患者的信息拿不到,想让三甲公立医院的医生去他们的诊所多点执业院长们不同意。从TA们的角度来讲,最好三甲公立医院的院长们能把患者和患者信息拱手送到TA们的平台,把药物处方推送到TA们的第三方电商平台,能把好医生送给TA们的执业平台,把最烂的医生留在三甲公立医院。这多好呀,这多爽呀,既创新领了风骚,又有了很好的商业模式,还可以马上就有大量的现金流!接下来很快就可以B轮C轮IPO到香港或美国证交所去敲钟了!

你们有什么既能又能还能还TMD能的,让所有人都满意的医改解决方案吗?既然大家都对三甲公立医院不满意,要么把三甲公立医院关了?既然大家都对三甲公立医院不满意,要么大家都去一级医院看病?都去私立医院看病?都去外国或合资医院或诊所看病?

打不死骂不死的三甲公立医院

其实你我心里都明白,无论你喜欢不喜欢,无论你怎么骂怎么折腾怎么改革,三甲公立医院就像打不死的“小强”,生命力顽强着呐:你见,或者不见,我就在那里,不悲不喜。

三甲公立医院不会自己倒掉,但是三甲公立医院的毛病需要治,真正能够打破三甲公立医院垄断地位的措施有两个:解放医生和解放患者信息。医改的政策想要落地,目标想要实现,就得让医生流动起来,让患者信息流动起来。

解放医生

现在的三甲公立医院尾大不掉,存在很多制度性,结构性,和历史性的矛盾和问题,改革起来比较困难。对于现状,既不能不管,也不能去强行革三甲医院的命,可以通过去中心化来破除这些沉疴。自由执业可以让医生流动起来,让医院成为平台,而不是医生的拥有者。

三甲公立医院不会自我革命,需要借助市场的力量,从外部推进整个医疗生态圈的变革。移动互联网技术给了医生自由执业的翅膀,移动医疗创新公司的搅局和诱惑给了医生新的平台和机会。

可以通过移动医疗创新公司,资本以及保险公司这些“门口的野蛮人”进行Destructive Reconstruction(破坏性重建),去建立更加合理,更加人性化,效率更高,更有生命力的,政府医生患者都满意的,新的组织形式和新的平台。

这种重建要让市场这无形的手去规划,要让患者用脚去投票,要形成大小不一,形式多样的,合理的,既有竞争,又有合作的,健康的医疗机构生态圈。

医生的自由执业是这种破坏性重建的前提,多点执业只是临时过渡的方法。

解放患者信息

医改的目标应该是打破垄断,打破僵局,让医疗资源共享,医务人员共享,医疗信息共享。

如果医生可以以自由执业的形式解放出来,患者的信息依然留在医院内部无法得到解放的话,还是会造成大量的重复化验检查,重复劳动,浪费大量的医疗资源,效率还是会十分低下。

移动互联网技术和IT技术为患者信息的解放创造了很好的条件,结构化电子病史,云端储存,移动互联网技术,患者对自己医疗信息的所有权是患者信息解放和共享的前提,技术已经成熟了,患者何时可以得到自己的医疗信息呢?

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    2016-08-26 前进,傻瓜

    赞赞赞,无限的赞同~现在规培研究生待的省中,具体哪省就不说了,真心烂,坑人的事太多

    0

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Apr 20 22:14:00 CST 2016, time=2016-04-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1286538, encodeId=603a1286538ef, content=<a href='/topic/show?id=ebac3442063' target=_blank style='color:#2F92EE;'>#医改#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, 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=Fri Jan 08 02:16:00 CST 2016, time=2016-01-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1552282, encodeId=9385155228290, content=<a href='/topic/show?id=a8d5196997c' target=_blank style='color:#2F92EE;'>#三甲#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19699, encryptionId=a8d5196997c, topicName=三甲)], attachment=null, 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Wed Jan 06 20:16:00 CST 2016, time=2016-01-06, status=1, ipAttribution=)]
    2016-08-26 Mr.Li先生

    静观其变

    0

  4. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Wed Jan 06 20:16:00 CST 2016, time=2016-01-06, status=1, ipAttribution=)]
    2016-04-20 1de7460am01(暂无匿称)

    前半部分精彩

    0

  5. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Wed Jan 06 20:16:00 CST 2016, time=2016-01-06, status=1, ipAttribution=)]
    2016-01-08 tidiq
  6. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Wed Jan 06 20:16:00 CST 2016, time=2016-01-06, status=1, ipAttribution=)]
    2016-01-08 陈吴1239
  7. [GetPortalCommentsPageByObjectIdResponse(id=1635908, encodeId=68e1163590806, content=<a href='/topic/show?id=a2ac6348397' target=_blank style='color:#2F92EE;'>#段涛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63483, encryptionId=a2ac6348397, topicName=段涛)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cd7e22540886, createdName=ms1065684921169360, createdTime=Sat Feb 13 01:16:00 CST 2016, time=2016-02-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=105161, encodeId=af3b105161ca, content=赞赞赞,无限的赞同~现在规培研究生待的省中,具体哪省就不说了,真心烂,坑人的事太多, beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20160818/IMG57B544AD015F83083.jpg, createdBy=41b01937517, 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Wed Jan 06 20:16:00 CST 2016, time=2016-01-06, status=1, ipAttribution=)]
    2016-01-07 木醇阳

    0

  8. 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authenticateStatus=null, createdAvatar=null, createdBy=88e914287502, createdName=陈吴1239, createdTime=Fri Jan 08 02:16:00 CST 2016, time=2016-01-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=52667, encodeId=aff05266e4c, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151027/IMG562EB376ED6788263.jpg, createdBy=e6ea1659259, createdName=木醇阳, createdTime=Thu Jan 07 08:26:00 CST 2016, time=2016-01-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=52509, encodeId=221552509b5, content=赞一个, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Wed Jan 06 20:17:00 CST 2016, time=2016-01-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=52507, encodeId=321e5250e47, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Wed Jan 06 20:16:00 CST 2016, time=2016-01-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=52508, encodeId=361b5250818, content=牛, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Wed Jan 06 20:16:00 CST 2016, time=2016-01-06, status=1, ipAttribution=)]
    2016-01-06 wzf990214

    赞一个

    0

  9. 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authenticateStatus=null, createdAvatar=null, createdBy=88e914287502, createdName=陈吴1239, createdTime=Fri Jan 08 02:16:00 CST 2016, time=2016-01-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=52667, encodeId=aff05266e4c, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=97, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151027/IMG562EB376ED6788263.jpg, createdBy=e6ea1659259, createdName=木醇阳, createdTime=Thu Jan 07 08:26:00 CST 2016, time=2016-01-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=52509, encodeId=221552509b5, content=赞一个, beContent=null, objectType=article, channel=null, level=null, likeNumber=157, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Wed Jan 06 20:17:00 CST 2016, time=2016-01-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=52507, encodeId=321e5250e47, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=59, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Wed Jan 06 20:16:00 CST 2016, time=2016-01-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=52508, encodeId=361b5250818, content=牛, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/mStl88fu4NfNLvzZhgPxRiaKicWybj5Q5KN7PWibALciaJ4W5bZwTlDSFRibFu87125pCq0IXePrC0mpbiasADRqL4NcjUoyQCT9De/0, createdBy=7c7e1636498, createdName=wzf990214, createdTime=Wed Jan 06 20:16:00 CST 2016, time=2016-01-06, status=1, ipAttribution=)]
    2016-01-06 wzf990214

    0

  10. 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