The plight of township health centers and the weakening of medical service capacity

In recent years, in the field of primary medical and health care, in accordance with the general requirements of "maintaining the basics, strengthening the grassroots, and building a mechanism", township health centers have significantly improved, but their medical service capacity still needs to be continuously improved in the future
.
01.
Dilemma: Weakening of medical service capacity The author found that the medical service capacity of township health centers has not improved significantly, and even has a development dilemma that has been continuously "singed down" by the industry and abroad.
The reasons are summarized as follows: First, the infrastructure is "congenitally insufficient" Although the infrastructure and appearance of most township health centers have changed significantly in recent years through the state's "strengthening grassroots" capital investment and construction, there are still some township health centers with limited self-development capacity, infrastructure and inspection facilities.
Equipment is outdated
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For example, some wards have old hospital conditions and poor hygiene, which cannot meet the needs of patients in the new era for medical treatment and living habits; some township health centers only have blood routine and electrocardiogram for auxiliary examinations, while others such as B-ultrasound and CR have equipment but No one is used as a decoration, which cannot meet the medical needs of the grassroots; most of the central town health centers such as CT and transcranial Doppler, which are commonly used, are not available
.
In the long run, patients can only go to large hospitals in urban areas for examination, which increases the burden on the masses
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Second, the shortage of talents is weak.
Some township health centers have problems such as shortage of talents, empty staff, and talent gaps
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After understanding, the author found that it is mostly related to the working environment, remuneration and development space
.
For example, the rapid expansion and development of large hospitals in urban areas makes it difficult to keep the real talents at the grassroots level.
Health poverty alleviation, family doctor signing, epidemic prevention and control, vaccination, going to the countryside, inspection, supervision , creation, evaluation activities.
.
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make the grassroots medical staff overwhelmed, and some people choose to leave the grassroots
.
The third is the lack of motivation for performance appraisal.
The performance appraisal gap of some township health centers is not large.

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The enthusiasm and initiative of the medical staff has declined, and some specialty departments such as surgery, obstetrics, and ENT, which had performed well in the past, have gradually shrunk and closed, and the convenience and satisfaction of the grassroots people have declined
.
Fourth, the new crown epidemic has normalized since the outbreak of the new crown pneumonia epidemic at the end of 2019 and later.
A large number of medical staff in township health centers have been transferred to "two stations and one mouth", hospital pre-examination and triage points, isolation points, etc.
to measure body temperature, Check the "two codes", nucleic acid sampling, flow adjustment and other work
.
Later, the new crown vaccination, which combined the efforts of the entire township health center, made the deployment of personnel in the township health center, which was in short supply in remote mountainous areas, stretched
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At the same time, due to the 48-hour nucleic acid certificate required by patients to purchase "four types of drugs" during the epidemic, the number of inpatients and outpatients in township health centers has been further reduced
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Fifth, focus on prevention and neglect diagnosis and treatment.
Some township health centers focus most of their efforts on public health services and do not pay enough attention to clinical aspects
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For example, dispatching clinical medical staff spends a lot of energy to go to the countryside for health check-ups, family doctor contracts, health poverty alleviation, public health and other related work
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Frequent dispatches make it difficult for clinicians to concentrate on basic medical services, and the decline in clinical medical business even makes it impossible to see a doctor normally, unable to meet the medical needs of the grassroots
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Human energy is limited, and the public health and medical services of township health centers need to achieve and promote each other
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02.
Breaking the situation: 5 points to get out of the predicament suggest that the medical service function of township health centers is gradually weakened.
How to solve the medical service dilemma of township health centers, the author puts forward the following suggestions: First, improve the infrastructure environment of township health centers and actively improve the quality of township health centers Courtyard, living, sanitation and medical treatment environment, gradually transform the business premises of township health centers, and gradually purchase and update medical equipment and facilities
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For example, improving the office conditions of the medical and nursing clinics, improving the ward environment, and installing toilets in the patient's hospital room as much as possible; purchasing economical and practical high-tech equipment, so that the common people can do CT and other advanced equipment inspections and some such as "gravel, traction, etc.
at a lower cost at home.
" , physiotherapy" and other related treatments, to ensure that "sickness is not in town"
.
The second is to attract and cultivate talents in various ways through recruitment by public institutions, rural order-oriented medical student training, and targeted recruitment of medical personnel.
deserve it”
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Strengthen the counterpart assistance of the higher-level hospitals.
The higher-level hospitals select the backbone of the business to do a good job of teaching and guiding the old ones to lead the new ones.
The grass-roots medical personnel are selected to go to the higher-level hospitals for further study, so as to solve the problem of talent gap and make the grass-roots talent team develop soundly
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Relax the recruitment conditions, and through open recruitment, those who have obtained the qualifications of practicing assistant physicians or above will be included in the establishment of township health centers, and health professionals and technical personnel will be gradually allocated
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Give policy preference to medical staff in township health centers in terms of professional title promotion, salary treatment, performance distribution, etc.
, care for the physical and mental health of medical staff, enhance the sense of professional honor of medical staff through various forms, and create a good society in which doctors and health are respected.
ethos
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The third is to reform the performance distribution mechanism.
The township health centers implement the public welfare first-class financial supply and the public welfare second-class public institution management, and implement a performance-based salary distribution system based on workload and service quality
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On the basis of the stable implementation of performance-based wages, it can be combined with the characteristics of medical staff positions to explore the extraction of employee welfare funds and reward funds from the approved balance of income and expenditure, and appropriately increase the proportion of rewarding performance-based wages
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Income distribution should focus on key positions, business backbones, talents in short supply and those who have made outstanding contributions, so as to reasonably widen the income gap, and truly reflect more work and better pay
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Appropriately increase township subsidies, and reward those who have long-term medical careers at the grassroots level and those who have made outstanding contributions
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Fourth, rational use of the advantages of medical insurance The emergence of medical insurance has alleviated the problem of expensive medical treatment for the peasants to a certain extent.
Compared with hospitals at or above the county level, townships and towns have the advantages of close geographical location, low threshold, high reimbursement ratio, and low diagnosis and treatment costs.
advantage
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For example, the threshold line is 1,000 yuan for county-level hospitals and 300 yuan for township health centers; the reimbursement rate is 85% for township health centers and 75% for county-level hospitals; the cost of treatment and inspection is low, and the same disease is reimbursed at the county level.
The cost of hospital inpatient treatment is roughly 3-5 times that of township health centers, or even higher
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Township health centers should pay full attention to their own advantages in medical insurance, adapt to the needs of the masses for medical treatment nearby, do a good job in publicity work, and use their own advantages to attract patients to seek medical treatment in terms of improving service quality and level
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Some central town health centers with better conditions can develop into second-level hospitals or become county-level hospital branches to solve the problem of drug restrictions in first-level hospitals
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Fifth, build characteristic departments Township health centers can make full use of existing talents and equipment or introduce talents and equipment to create special departments, such as traditional Chinese medicine halls, orthopedics, pediatrics, gynecology, dermatology, stomatology, etc.

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Some township health centers make full use of the opportunity of the country to vigorously develop suitable technologies for traditional Chinese medicine, and build traditional Chinese medicine halls to promote simple and inexpensive traditional Chinese medicine suitable technologies, such as Chinese herbal pieces, acupuncture, massage, cupping, scraping, sticking, etc.
, which are very popular at the grass-roots level.
The masses are welcome
.
Some township health centers vigorously develop their own specialty specialties, such as the Shegang Township Health Center in Liuyang City, Hunan Province.
The development of orthopaedic specialty medical service business far exceeds that of some urban tertiary hospitals, which fully proves that as long as they develop with heart, township health centers can also be comparable.
big hospital
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According to the growing health needs of the masses, some township health centers have carried out cancer cell detection, thrombolytic therapy, and the combination of medical care and health care.

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Sixth, improve service level Township health centers should improve their competitiveness in terms of equipment, technology, service, and strategy, and conduct timely return visits to discharged patients to understand their satisfaction with treatment, recognize their own shortcomings, and improve their ability to diagnose and treat diseases
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It is also possible to carry out convenient pick-up and drop-off for the left-behind elderly in some remote villages and groups
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Taking advantage of family doctors, health checkups and other opportunities to go to the countryside to go to the villages for publicity, shorten the distance and relationship with the masses, strengthen their own capacity building, and become a place where the farmers can "have medical care", provide high-quality services for the rural masses, and strengthen their sense of medical gain
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In short, township health centers should continue to make continuous efforts from the above 6 aspects to solve the problems of medical service development of township health centers, reduce the economic burden of diseases of the masses, and meet the needs of farmers for medical treatment
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The majority of farmers can enjoy the benefits and benefits brought by the equalization of basic public services and medical services at their doorsteps
.