在医疗改革的浪潮中，每一个细微的调整都可能牵动亿万民众的心弦。近日，三明医改的领军人物詹积富在首届甘肃医保飞天论坛上的发言，如同一石激起千层浪，引发了业界的广泛讨论。他坦言，三明医改的成功经验虽值得借鉴，但绝不能盲目照搬，必须根据当地的经济状况和平均收入情况来核定工资，这一观点直击医改的核心问题——如何平衡公平与效率，如何激发医务人员的积极性，而又不增加患者的负担。
三明医改，以其大刀阔斧的改革举措和显著的成效，成为了全国医疗改革的标杆。然而，正如詹积富所言，每个地区都有其独特的经济背景和社会环境，简单的复制粘贴显然无法达到预期的效果。医疗改革不是一场简单的数学游戏，而是需要深谙地方实际，因地制宜，精准施策。
以医生的工作量和收益为例，上海财经大学原卫生政策与管理研究中心主任俞卫教授的见解，无疑为我们提供了另一维度的思考。他指出，同样是主任医师，接诊普通病人与接诊疑难病人的工作量和风险性截然不同，但如果收益相同，这无疑是对医生专业技术和辛勤付出的极大不公。这种不合理的收益分配机制，不仅会严重打击医务人员的积极性，更可能迫使那些技术精湛、经验丰富的医生流向私立医院，从而加剧医疗资源的不均衡分布，最终推高看病成本，让普通民众望医兴叹。
医院内部不同科室之间的差异同样不容忽视。有的科室工作量大、风险高、技术含量重，而有的科室则相对轻松。如果采用一刀切的绩效考核方案，不仅无法真实反映医生的劳动价值，更可能滋生“吃大锅饭”的懒惰思想，导致医疗资源的浪费和医疗质量的下滑。因此，建立一套完整、公平、科学的绩效考核体系，显得尤为重要。
那么，如何构建这样一套体系呢？首先，必须深入调研，充分了解不同地区、不同科室的实际情况，确保考核标准的合理性和针对性。其次，要引入多元化的考核指标，既要考虑工作量和工作强度，也要考虑风险性和技术含量，还要兼顾患者的满意度和医疗质量。最后，要建立健全的激励机制，让医生的收益与其付出成正比，让优秀的人才得到应有的回报，从而激发整个医疗行业的活力和创造力。
医改之路，任重而道远。我们需要的是不断探索和创新，而不是盲目跟风和简单复制。只有因地制宜，精准激励，才能让医疗改革真正惠及亿万民众，让每一个生命都能在健康的阳光下自由绽放。让我们携手共进，为构建更加公平、高效、优质的医疗服务体系而努力！
作者简介：梁世杰 中医高年资主治医师，从事中医临床工作24年，积累了较丰富的临床经验。师从首都医科大学附属北京中医院肝病科主任医师、著名老中医陈勇，侍诊多载，深得器重，尽得真传！擅用“商汤经方分类疗法”、专病专方结合“焦树德学术思想”“关幼波十纲辨证”学术思想治疗疑难杂症为特色。现任北京厚德为怀医生集团渐冻症研究中心主任，北京树德堂中医研究院研究员，北京中医药薪火传承新3+3工程—焦树德门人（陈勇）传承工作站研究员，国际易联易学与养生专委会常务理事，中国中医药研究促进会焦树德学术传承专业委员会委员，中国药文化研究会中医药慢病防治分会首批癌症领域入库专家。荣获2020年中国中医药研究促进会仲景医学分会举办的第八届医圣仲景南阳论坛“经方名医”荣誉称号。2023年首届京津冀“扁鹊杯”燕赵医学研究主题征文优秀奖获得者。事迹荣登2024年第四季刊《当代科学家》杂志。
The road to health care reform: tailored to local conditions, targeted incentives
In the wave of health care reform, every small tweak may touch the heartstrings of hundreds of millions of people. Recently, Zhan Jifu, a leading figure in Sanming medical reform, spoke at the first Gansu Health Insurance Fair Forum, like a rock stirring thousands of waves and prompting extensive discussion in the industry. He admitted that while the successful experience of Sanming medical reform is worth learning from, it must not be blindly copied. The idea that salaries must be determined according to local economic conditions and average incomes goes to the heart of the reform - how to balance fairness and efficiency, how to motivate health care providers without increasing the burden on patients.
Sanming Health Care Reform, with its sweeping reform measures and remarkable results, has become a benchmark for national health care reform. However, as Zhan Jifu said, each region has its own unique economic background and social environment, and simple copy and paste obviously cannot achieve the desired effect. Health care reform is not a simple mathematical game, but it needs to understand local realities, adapt to local conditions, and take precise measures.
Taking the workload and benefits of doctors as an example, the insights of Professor Yu Wei, former director of the Center for Health Policy and Management Research at Shanghai University of Finance and Economics, undoubtedly provide another dimension of thinking. He pointed out that the workload and risks of treating ordinary patients are very different from those of treating difficult patients, but if the benefits are the same, it would undoubtedly be a great injustice to doctors' expertise and hard work. This irrational revenue distribution mechanism will not only seriously discourage health care providers, but may also force those skilled and experienced doctors to go to private hospitals, thus exacerbating the uneven distribution of health care resources, and ultimately driving up the cost of medical treatment, so that the general public can not afford to see the doctor.
The differences between different departments within the hospital cannot be ignored. Some departments have a large workload, high risks and heavy technical content, while others are relatively easy. If a one-size-fits-all performance appraisal scheme is adopted, it will not only fail to accurately reflect the labor value of doctors, but will more likely breed lazy thinking of "eating a big pot of rice," resulting in the waste of medical resources and the decline of medical quality. Therefore, it is especially important to establish a complete, fair and scientific performance appraisal system.
So how do you build such a system? First, we must conduct in-depth research to fully understand the actual situation in different regions and different departments to ensure that the evaluation standards are reasonable and targeted. Second, a variety of evaluation indicators should be introduced, taking into account both the workload and the intensity of the work, as well as the risks and technical content, and also considering patient satisfaction and medical quality. Finally, it is necessary to establish a sound incentive mechanism so that doctors' benefits are proportional to their pay, and good talents are duly rewarded, thereby stimulating the vitality and creativity of the entire healthcare industry.
There is still a long way to go on health care reform. What we need is continuous exploration and innovation, not blind copying and copying. Only by adapting to local conditions and providing targeted incentives can healthcare reform truly benefit hundreds of millions of people, so that every life can flourish freely under the sunshine of health. Let us work together to build a more equitable, efficient and high-quality health care system.
Author Bio: Liang Shijie is a senior medical practitioner in traditional Chinese medicine. He has been engaged in traditional medicine clinical work for 24 years and has accumulated a wealth of clinical experience. Following Chen Yong, chief physician of liver disease at Beijing Traditional Medicine Hospital, affiliated with Capital Medical University, and renowned old Chinese medicine, he has been treated for many years and received great attention. He specializes in the treatment of difficult diseases using "conversational traditional therapy" and special treatments combined with the academic ideas of Jiao Shude and Guan Yubo's ten-level diagnosis.He is currently the director of the Center for Diffusion Research of Dr. Houde Wei Group in Beijing, a researcher at the Shude Tang Institute of Chinese Medicine, and a fellow at the new 3 + 3 project of traditional Chinese medicine flame inheritance in Beijing - a scholar at the inheritance work station of Jiao Shude's protégés (Chen Yong),He is a standing committee member of the International Expert Committee on E-learning and Health Care, a member of the Jiao Shude Academic Heritage Special Committee of the Chinese Association for the Advancement of Chinese Medicine Research, and the first cancer specialist to be included in the chapter of the Chinese Pharmaceutical Culture Research Association. Won the 2020 China Association for the Promotion of Traditional Chinese Medicine Zhongjing Medical Branch held the eighth session of the Medical Saint Zhongjing Nanyang Forum "Classic Prescription Famous Doctor" honorary title. The winner of the first Beijing-Tianjin-Hebei "Pingui Cup" Yanzhao Medical Research Essay Award in 2023. The story was featured in the fourth edition of Current Scientist in 2024.
