Someone once said: God drew two doors on human notebooks, one called the "Triple Gate" and the other called "Rashomon". He used one to establish "locking" rules and the other to change " Break” the rules.
The "rehabilitation industry", as one of the most valuable undertakings in the next ten years and an important choice target for hospital development and transformation under the background of new medical reform , has not been spared and is trapped between the two doors...
一重Door, rehabilitation training system, prescription power pending?
The allusion of "Three Gates" comes from "The Doctrine of the Mean". The original text is "There are three gates in the world, and the few are too few!".
roughly means: The king believes that as long as he can do the three important things of governing the world: drafting etiquette, formulating laws, and studying writing standards, even if he has basically fulfilled his responsibilities as a king, there will naturally be no major faults.
The implication is to show the importance of rules. As the saying goes, everything develops without rules, which coincides with the current situation of the rehabilitation industry mentioned in this article.
At the two sessions , Ling Feng, a member of the National Committee of the Chinese People's Political Consultative Conference and chief expert of neurosurgery at Xuanwu Hospital of Capital Medical University, suggested: Establish a rehabilitation training system and strive for prescription rights
"It is recommended to revise the relevant regulations in a timely manner to include "medical, pharmaceutical, nursing, and technical ” 4 categories were changed to 5 categories of duties: “medicine, medicine, nursing, technology, and health”. At present, there is a lack of a unified training plan for the training of rehabilitation therapists, and a unified standardized training system for rehabilitation therapists needs to be established; the rehabilitation therapist should not be a mechanical executor. During the rehabilitation training process, the rehabilitation therapist interacts with the patients every day. The person with the most interactions applies for the right to prescribe medical advice from a rehabilitation therapist. "
The regulation and training system and the right to prescribe in the rehabilitation industry are the core contradictions of the industry.
"Without the right to prescribe, rehabilitation doctors are just robots! "
" When a patient asks for medical knowledge, emotionally I want to teach him everything I can, but rationally I can't because it's illegal! "
" Rehabilitation chose to be patient-friendly, but it did not choose to be doctor-friendly! "
...
At present, most rehabilitation doctors come from neurosurgery, cardiology, traditional Chinese medicine and orthopedics. They graduate with a clinical medical degree and can obtain a practicing physician certificate and have the right to prescribe.
But they are really professional in learning Rehabilitation therapy students do not have this treatment. After four years of "torture" by women and children inside and outside, they will obtain a science degree. You must know that this degree cannot obtain a medical practitioner certificate, let alone professional registration and certification. Right to prescribe.
Some students have passed the postgraduate examination and studied postgraduate courses in rehabilitation medicine and physical therapy, but according to the 2014 reference conditions for the occupational medicine qualification certificate, they are still not qualified for the reference. That is to say, even though you graduated from medicine. Master's degree , but it is a bachelor's degree that determines whether you can qualify as a doctor, which breaks the heart of countless rehabilitation students. As the direct executor of the rehabilitation treatment project, rehabilitation therapists really need to provide direct treatment to patients.
2021 Rehabilitation Therapist Collective Initiative
In 2021, the National Health Commission, National Development and Reform Commission, Ministry of Education, Ministry of Civil Affairs, Ministry of Finance, National Medical Insurance Administration, State Administration of Traditional Chinese Medicine, China The Disabled Persons' Federation has formulated the "Opinions on Accelerating the Development of Rehabilitation Medical Work", which is mainly to improve the rehabilitation service system, strengthen rehabilitation team building, improve rehabilitation service capabilities, and promote reform and innovation in the rehabilitation field and high-quality rehabilitation services. The "Opinions" predict that by 2022, a reasonable number and high-quality rehabilitation professional team will be established, with 6 rehabilitation physicians and 10 rehabilitation therapists per 100,000 people.By 2025, there will be 8 rehabilitation physicians and 12 rehabilitation therapists per 100,000 people. Ultimately, diversified rehabilitation services and multi-field rehabilitation services will be realized, allowing the people to enjoy comprehensive and full-cycle rehabilitation medical services. The 2022 deadline has arrived. I wonder if the pending rehabilitation training system and prescription rights will be finalized this time.
Double door, where is the future of rehabilitation therapists?
Before the two sessions, Zeng Fang, a member of the National Committee of the Chinese People's Political Consultative Conference and president of Chengdu University of Traditional Chinese Medicine, offered suggestions: Incorporate new majors such as traditional Chinese medicine rehabilitation into the professional classification catalog for the public recruitment examination
"Incorporate new majors such as traditional Chinese medicine rehabilitation into the majors for the public recruitment examination" In the classified catalog, it is consistent with the education department in setting up professional catalogs, and forms a long-term linkage mechanism to solve the worries about the employment of newly established professional graduates."
National People's Congress representative Zhou Yanfang suggested: Accelerate the inclusion of rehabilitation therapists into the national profession. Classification Code
"Enter rehabilitation therapists into the new version of the National Practicing Code, improve the occupational classification of rehabilitation therapy personnel, and incorporate it into the unified national practice classification framework; establish a professional qualification access system for rehabilitation therapists at the national level to promote the standardized construction of the rehabilitation service system; improve Smooth promotion channels for rehabilitation therapists to meet the rapid development needs of rehabilitation services. "
According to data released in 2016, there are only 1.4 rehabilitation professional and technical talents per 100,000 people in my country, which is far lower than more than 15 per 100,000 people. Physiotherapist , international standard for 8-10 occupational therapists.
Data released by the China Disabled Persons' Federation shows that in 2018, the total number of disabled people in my country exceeded 85 million, accounting for approximately 6.09% of the total national population that year. Only 10% of disabled people can receive rehabilitation medical services.
The "China Medical Reform Joint Research Report" released by the National Health and Family Planning Commission and other departments in 2016 pointed out that the number of people with chronic diseases in my country has reached 300 million, and only 4.66% of the people have chronic disease prevention literacy; 12.42 million strokes Three-quarters of patients have varying degrees of disability and all require rehabilitation treatment.
However, in China, when talking about rehabilitation therapists, many people will immediately equate them with "physiotherapist", "masseur or massage therapist" and "technician". This is due to historical reasons. Because rehabilitation medicine is an emerging discipline that started late in our country, there are many weaknesses and even gaps in the country. The sources of the team of rehabilitation therapists are complex, varied, and uneven. The personal career prospects of rehabilitation therapists are even more complicated. Still unknown.
As for this, the author does not know whether the suggestions of “incorporating new majors such as traditional Chinese medicine rehabilitation into the professional classification catalog for public recruitment examinations” and “accelerating the inclusion of rehabilitation therapists in the national occupational classification code” mean that rehabilitation is in the selection of patients. After being "friendly", why did you also choose to be "friendly" to the doctor?
triple door, when will rehabilitation expenses be included in medical insurance reimbursement? Is Healthy China just a piece of empty talk?
National People's Congress representative Lei Dongzhu made suggestions: Autism rehabilitation expenses should be included in medical insurance reimbursement, and screening should be included in free child insurance screening
"According to data, the domestic autism incidence rate is 0.7%, and children under 14 years old There are more than 2 million patients with autism. However, the only effective rehabilitation treatment for autism costs up to 60,000 yuan per year and cannot be reimbursed by medical insurance. It is recommended that the government increase investment and link up with multiple departments to include autism screening. Free routine screening for child care, and establishing a system of "early screening, early diagnosis, and early intervention" for rescue rehabilitation and life-course support for children with autism. At the same time, autism rehabilitation training fees are included in the scope of special disease reimbursement management."
Ma Xiuzhen, member of the National Committee of the Chinese People's Political Consultative Conference, vice chairman of the CPPCC Ningxia Hui Autonomous Region, and director of the Autonomous Region Health Commission, suggested: Develop the rehabilitation medical industry and promote the construction of a healthy China
"Optimize and adjust the layout of rehabilitation medical care and promote the transformation of some general hospitals into rehabilitation specialist hospitals. , promote the construction of rehabilitation medicine departments in secondary and tertiary hospitals; standardize the training of rehabilitation talents based on demand, and carry out rehabilitation-related professional academic education, continuing education, on-the-job training, etc. in a planned and step-by-step manner; further increase the number of rehabilitation projects included in medical insurance project to establish a reasonable medical insurance payment system for post-acute rehabilitation care. ”
Psychological rehabilitation is the measure and work content of comprehensive rehabilitation. Guided by psychology, through psychological diagnosis, treatment and training of disabled people, it improves their cognitive functions, emotional disorders and bad behaviors, so that they can correctly treat disabilities and their Impact, maximize self-esteem, self-confidence, self-reliance, and self-reliance.
Take autism as an example: At present, the global average prevalence rate reported by the World Health Organization (WHO) is 62/10,000, which is equivalent to one in every 160 children. Generally speaking, the best intervention period for autism is before the age of 3. The younger the age, the greater the plasticity of brain development. Discovery and early intervention are the most important basic strategies for the rehabilitation education of autistic children.
Therefore, “autism rehabilitation expenses are included in medical insurance reimbursement, and screening is included in free child insurance screening. "It can also be said that it is the most straightforward suggestion and question for a healthy China.
text / Dania
