China's health care system and the education system is the most talked about industry, it seems inconceivable in germany. However, this is t
China's health care system and the education system is the most talked about industry, it seems inconceivable in germany. However, this is the fact that the cruel facts! As a medical worker, we are constantly thinking about the problem. Until today, the University of Heidelberg in Germany Mannheim medical school visited six months, have a certain understanding of the German health care system of the old capitalist countries, part I think I have the answer. Through some of the following comparisons, I think we can find out where the gap is.
A bustling, and a deserted house
Like our hospital outpatient service market, early in the morning has been crowded, statistics of leaders at all levels also lost in outpatients, one of the important indicators of the end of the year this is the comparison of each hospital, because this hospital in order to explain the high popularity, a deeper means with good economic benefit. And I'm in Mannheim, but found that the hospital no specialized hospital outpatient department, only set up in each department ward or ITM (Mannheim tumor consultation center of the few) ordinary outpatient and emergency department and expert outpatient service (Praxis), waiting at only a very small number of patients in the waiting. A doctor a day to see 3-5 patients, they do not have a patient? This is not the case. Patients of their wards are full. Why?
With the helicopter rescue team and the emergency center own Mannheim hospital, especially helicopters, basically every day to perform shuttle emergency patients, the main hospital of a helicopter apron above the elevator to the top floor, can quickly transfer the emergency treatment of patients. In China, many hospitals declared emergency helipad, but never saw the helicopter landed and took off, this is why?
The hospital has two kinds, one is the comprehensive hospital, a hospital (almost all with the nature); the former is a relatively small number, is the University Hospital, located in the country and the state capital city of about more than and 20, the strength of the latter should be called "quasi accurate point hospital: department setting is not complete, often only a few specialized, only the strength of the strong to survive, poor performance may revoke. Our hospital is a clinical medical college of University of Heidelberg Affiliated Hospital of University of Heidelberg, Mannheim, departments complete, each department is equipped with strong laboratory which is the transformation of Medical Center (TMR).
German patients are not directly to a specialist hospital to see a doctor, even if it is, can only look at the emergency room, the doctor did not make an appointment is not seen. In the urban and rural areas is the number of Praxis and Praxis also known as specialist community physicians, community doctors are general practitioners, there are specialists, they undertake the first patient almost all; they have strict qualifications, but also by the medical insurance coverage, the patient to the clinic medical expense reimbursement by the government. Community doctors initially diagnosed that needs to be sent to the hospital when treatment will contact the hospital, a hospital specialist visits, patients go to the hospital or university affiliated hospital treatment, patient medical records are made by community doctors were recorded through the network or fax to the doctor at the higher level. This is the reason why we are seeing a deserted house in the hospital. And the number of experts is limited to ensure quality.
In our country, the medical access system is not complete, a large number of community doctors, low level of illegal medical practice is not uncommon, poor reliability of community health care in almost all patients are willing to, directly to the hospital, even if it is a disease to run large hospitals, which created a community hospital or at the grassroots level the hospital and the hospital is difficult to continue, be in full swing ending, the inevitable result is a waste of medical resources, decrease medical quality and potential health risks.
Perhaps the way to reform the health care reform is right: the emphasis on basic health care, increase community hospital construction and support efforts. I think it is more important to deepen the construction and supervision practice access system, improve the level and quality of service of primary health care, which is really able to shoulder the sacred duty of primary care, to alleviate the pressure of large hospitals, the rational allocation of medical resources. As a health care expert said: big hospital patients can be reduced to judge whether the success of health care reform indicators".
Two, medical insurance: low intensity coverage and high intensity universal health insurance
China's medical insurance is one of the highlights of today's health care reform, indicating that the decision-making level has been noted that the importance of health insurance in the medical and health system construction. At present, China's medical insurance is to promote the implementation of the target is full coverage, including remote mountainous areas, but we note that the current health insurance is actually low strength under the premise of wide coverage, relative to the demand of national medical terms, China's budget is inadequate!
The German health insurance is the best in the world, health insurance is mandatory, universal health care, low income from government subsidies, where the entry of foreigners must have insurance, visa or not. Germany to see Praxis, regardless of illness to community hospital or to the hospital, will be reimbursed by at least 90%, 10% (5% private undertaking by the employer, there are 5% patients, and I assume) are only after treatment with the insurance company to pay, is very convenient, which includes medication and treatment costs all, unlike in China, there are many drugs can not be reimbursed, with only his own pocket. (the German health insurance is very complex, interested see special report) of course, everything has two sides, the strength of full coverage of health insurance even is one of the most developed countries of the world Germany is a bit difficult to sustain, it is said that the health budget budget occupy more than 11% of Germany, the German government is currently drawing the mode of operation, reduce the intensity of brewing medical insurance (mainly physical beauty, such as cancellation of insurance), increase the commercial insurance in the medical intervention, whether Congress can only wait and see.
In three, the doctor-patient relationship: meat in the anvil and life entrusted
There will also be medical disputes in Germany, but this is a matter between the insurance department and the patient's lawyer. And I found the patient to the doctor's words like as executive decree, never ask a few why, they put the doctor as his own life protection. In this environment, doctors will be treated as their friends or relatives. Who can refuse to give life to you?
We were before going to the hospital first has put itself as the anvil on the meat, the hospital is a butcher, this assumption allows the patient in hospital is everywhere, even with modern means to take a lot of "material", if not satisfied with the results will meet all this Dao Rong, compared to Germany we, the doctor-patient relationship is not fit to be seen in the.
I think the reasons for this situation are manifold, there are problems with the quality of the people, the problem of the medical system itself, there is a negative problem of negative media rendering, as well as the problem of the health system.
Four, Hospital Authority: "what" and "experts", concise and miscellaneous
The German hospital staff rarely, hospital administration is relatively simple: the highest leadership is not called the dean of the hospital, called the supervisor or CEO is more appropriate, the president under the 2 Committee, a medical Specialized Committee, an Economic Commission, the Commission's chief responsible person is equivalent to vice president. Dean is a professional enterprise management or economics, the chief responsible person in charge of the general director of the Department of Specialized Committee, the economic committee by a professional economist or accountant as the chief person in charge. Because the hospital is the government's financial support, so a lot of things can not do the principal, such as infrastructure, equipment, etc., the president must report to the government or investors to convince them to achieve the purpose. Hospital infrastructure, information systems, equipment maintenance, supplies supply, washing and cleaning, canteens, drugs and other social, hospital leaders do not need direct management. So it is very simple.
This is not the same as our country, our hospital directors are generally "experts", that is to say, the president itself is a medical expert, which in our opinion is reasonable, called "expert tube". While Germany is just a layman in charge of experts". In fact, gehangrugeshan, medical experts and management experts are two different things, I don't know who is right and who is not.
German hospitals do not have a "party" management, but they have more than one". The nature of our hospital is a public institution, and the influence of "party" and "government" is existed. In addition to the "politics" in Germany, there are "teaching"". Each hospital has a special church, and stressed that the president must be religious, the church thought through the dean to implement management, the church for the hospital donation will be issued to the hospital by the president under the economic commission.
Five, doctor level
The level of hospital doctors in Germany is not the study of the United States, but compared with us. Department Director (Director) only one, is the only person in charge of the Department, with the highest authority in the Department; professor can have more than one, but due to the rank of Professor harsh conditions, generally only affiliated hospital departments that may have more than one professor (2-3) and other quasi specialist hospitals generally have no or only a a professor; Department of doctor level can be divided into: Director (ChiefArtz), intermediate (German physician named OberArtz referred to as OA), ordinary Specialist (German Title Artz), and physician assistant (equivalent to the training of physicians, training period of 2 years, not a formal establishment). There is no deputy director and deputy chief physician level.
The director is the academic authority and the management decision maker and the final decision maker. Each department director is equipped with a full-time secretary, Director General Department of 2-3 large Secretary Secretary responsible for the Department of the Director under the authority of the internal and external affairs and director of the expert outpatient appointment, doctors working arrangements (a Monday schedule), printing, finishing part of the hospital director and intermediate doctors surgery records is also responsible for the resident medical records printing and so on, the secretary is very busy, I found the Secretary of each action quickly, especially clear ideas.
The German hospital hierarchy, subordinates must obey their superiors instructions and arrangements, different levels of income is far from the doctor. Only the director and professor are eligible to receive surgery, thus greatly increasing the economic income of the Department and the director himself.
Our doctor grade is clear, but the authority and economic income and they want to go far, the decision department affairs seems director of the hands, but the final decision in the hands of the leadership of the hospital, director of the decision-making power is less.
Six, German doctors and Chinese doctors
(a) doctor training
The German doctor and similar culture in our country, they can be admitted to the university after graduating from high school in medical colleges, the general structure of 6 years, in the process they must pass 3 strict examination to graduate, after graduation can go to the hospital, can read contact tutor for about 2 years, writing thesis can obtain M.D. the degree of PHD/MD; after graduation must accept the training of qualified hospital physician training for 2 years, can become a regular physician after passing the examination, the doctor called Assist Arzt. German doctors are MD, but not necessarily PhD. This is somewhat similar to the way our physicians train, but different from the American model.
The training of doctors and general practitioners training in university hospital is relatively strict, other hospitals do not, the doctors to subordinate the guidance of a doctor gave me the feeling is not very much in place, and the young doctor to psychology does not seem strong, relatively passive. The same year doctor operating level obviously than us, but we obviously better relative theoretical structure.
Across the country, a large number of community health practitioners in the city of Germany and the opening of the business card is also very difficult to. Want to become a practitioner must be at least 5 years of work in the hospital to apply for a license, to achieve the level of OA physicians do not need examination can be opened. Practitioners must be signed with the government department of medical management, improve the procedures and health care sector to hook.
(two) treatment of doctors
In fact, the German physician treatment is not good (of course, this is not the United States, Britain, Japan). Although the German people have great respect for the doctor, although the government for government budget for medical input of more than 11%, while the labor intensity of the German doctor is very high, the sense of responsibility is also very strong, but in recent years, the German doctor's income is not high. The world's highest paid doctors are American doctors, German doctors in European doctors belong to low-income groups, even lower than Italy, spain. There are a lot of German immigrants to the United States, the British doctor to be a doctor, so that the German health industry may houjifaren. 2005, in 2006 the outbreak of the doctors association organized demonstrations, the government has made some compromises to improve a bit, but relative to its per capita income in the country, the treatment of German doctors is also general.
At present the doctor college German hospital annual income of about 4~4.5 million euros (after tax), the average level of community doctors are close to this level, converted into about 400 thousand yuan, with their CPI, equivalent to about 250 thousand RMB. If the German doctor's income level is low, but compared with our country, our doctor's income and what?
(three) the labor intensity of doctors
The intensity of the labor intensity of each department in Germany is also very different, the intensity of surgical labor is also a great surprise, but like the Department of radiotherapy. General surgery unit 8 (DST) work, the hospital doctor is 7:30 on the shift, before eight dealt with affairs any time into the operation room ward, began operation, until 4 pm from work, but surgeons are often unable to work on time. This labor intensity in the German industry should be among the best. The young doctor on duty after the rest just theoretically exist, in fact, I have never seen a young doctor one day announced that the rest of the Oberarzt and Chiefarzt Saturday Sunday rest, and this is similar to our country doctor.
Although the establishment of the best and most extensive medical network and information, a lot of work efficiency, but the doctor is still running like a machine, can not stop. Here the control patients medical writing residency rarely, generally a resident tube about 10 beds, even the contents of medical records is not much, basically are electronic medical record form, because patients with shorter hospitalization time, medical writing consumed a lot of time, plus the dressing, check, doctor-patient communication, patient outside the hospital consultation and so on, 8.5 hours a day working time is not sufficient.
(four) communication between doctors and patients
German doctors attach great importance to doctor-patient communication, and it has developed a very good doctor-patient dialogue habits, which is worth learning.
When the early rounds, the nurse put early in the doorway waiting for medical cart. Their hospital is very quiet, almost no one to accompany. The doctor never report in front of the patient history analysis of the disease, doctors and patients are completely equal, each other is very polite, the doctor entered the ward inspection of each patient before and after to shake hands with the patient, more importantly, the doctor entered the room to call out the name of the patient, as they had done in the doorway these preparations. Enter the room first knock on the door, to see the patient first called his name and say hello, for the disease, diagnosis and treatment of metasomatic matters, and very patiently listen to patient complaints and requirements, the doctor-patient relationship is very harmonious.
In Germany, the vast majority of patients are to listen to the doctor's advice, of course, for some of the treatment effect is expected to be ill, the doctor will discuss with patients and their families, by their decision. In case of emergency, the doctor will according to their own experiences and ideas to the rescue, after informed consent in completing the signing procedures. This is inconceivable in our country, it is not advocated, in case of treatment failure, the loss is certainly a doctor.
I don't think we can understand the difference just as a cultural difference. Many of the advantages of German doctors are worth learning from.