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The ancients said that those who are not talented and immortals cannot be a doctor, and those who are not virtuous and Buddha cannot be a doctor. Since ancient times, people have higher requirements for doctors than ordinary people.

In the past, these requirements were more of invisible moral norms; now, these contents have formed texts and have been triggered into documents.

On November 16, the National Health Commission, the National Health Insurance Administration and other three departments issued the "Nine Guidelines for Integrity in Medical Institution Staff". This document, known as "Nine Guidelines", "Nine Guidelines" or "Nine Guidelines" in the industry, was officially announced as the "upgraded version" of the previous version as early as April this year.

The belated "Nine Corresponding" is an upgraded version

On December 26, 2013, the former National Health and Family Planning Commission jointly formulated the "Nine Nosenses" for strengthening the construction of medical and health practice styles" (called "Nine Nosenses" in the industry), including: 1. No linking the personal income of medical and health personnel with the income of drug and medical examinations; 2. No commission is allowed to be issued; 3. No illegal charges are not allowed; 4. No illegal acceptance of social donations; 5. No illegal participation in sales activities and illegal release of medical advertisements; 6. No unified prescriptions for commercial purposes; 7. No illegal purchase and use of pharmaceutical products; 8. No kickbacks are not allowed; 9. No red envelopes are not allowed to be accepted for patients. At the same time, it is required to include the implementation status in the important content of annual assessment of medical institutions and personnel, medical ethics assessment and regular assessment of doctors, as an important basis for professional title promotion and evaluation of excellence.

However, many events have since shown that the implementation of the "Nine Nos" is not optimistic.

Regarding the population and behaviors that the "Nine Prohibitions" have not been covered by the "Nine Prohibitions", the relevant departments have issued "patches".

For example, at the beginning of 2014, the former General Office of the National Health and Family Planning Commission issued the "Notice on Carrying out the Work of the Agreement on the Non-Receipt and No-Sending "Red Envelopes" between Doctors and Patients" (Guo Health Office Medical Letter [2014] No. 107). At the same time, it also issued a reference text of the "Agreement on the Non-Receipt and No-Sending "Red Envelopes" between Doctors and Patients" requiring medical institutions to provide the "Agreement on the Non-Receipt and No-Sending "Red Envelopes" between Doctors and Patients" to the patient or the patient representative within 24 hours of the patient's admission, and carefully answer their questions. Medical institutions are required to include the agreement signed by both doctors and patients in the medical record management and do a good job in archiving and preservation in accordance with relevant regulations.

In fact, before the "Nine Prohibitions" were issued, in June 2012, the former Ministry of Health, the former State Food and Drug Administration and the State Administration of Traditional Chinese Medicine organized the formulation of the "Code of Conduct for Personnel of Medical Institutions". This code of conduct includes 60 articles in total. It clearly stipulates that the norms apply to rural doctors registered in village-level medical and health institutions, interns, further training personnel in medical institutions, personnel who have signed labor contracts but have not yet registered for practice, and outsourcing service personnel, etc., and according to the nature and occupational category of work they are engaged in in medical institutions, the standards shall be implemented in accordance with the corresponding personnel classification.

However, due to the lack of operating rules and no active follow-up, the above documents have not been well implemented and implemented.

On April 25, 2021, the National Health Commission and nine other departments jointly issued the "Key Points for Correcting Unhealthy Work in the Field of Pharmaceutical Purchase and Sales and Medical Services in 2021". This notice will crack down on insurance fraud and rectify "red envelopes" and "kickbacks" as the focus. It clearly states that medical chaos such as receiving "red envelopes" should be continuously rectified, and the high-pressure situation of cracking down on "kickbacks" behavior should be maintained. At the same time, it is proposed to further improve the behavior management system. Based on the current party regulations and laws and regulations, upgrade and improve

The "nine prohibitions" of medical and health care, in response to the prominent manifestations of the current industry chaos, and provide corresponding penalty recommendations, we will guide local and local health administrative departments and medical and health institutions at all levels to formulate specific measures to implement the upgraded version of the "nine prohibitions" to ensure that policies are refined at all levels and are implemented and effective. In the division of key tasks, it is clear that the National Health Commission will take the lead and the member units of the mechanism will jointly promote and issue the upgraded version of the "nine prohibitions" of medical and health care with a wider coverage and stronger operationality, which will be completed before the end of June.

Although the actual release time was several months later than the plan, as long as the quality is high enough and meets the expectations of the people, it is not a problem to be a little later.

How far is the "nine accurate" level higher than the "nine unpredictable"?

First, in terms of coverage, it obviously meets the requirements of "wider".

The "Nine Nos" mainly involves managers, doctors, and pharmacists in medical institutions. For example, "the personal income of medical and health personnel is not allowed to be linked to the income from drugs and medical examinations, the commission is not allowed to be issued, the social donation funding is not allowed to be illegally accepted, the fees are not allowed to be charged, and the medical advertisements are not allowed to be published in violation of regulations" is aimed at hospital management; "the unified party for commercial purposes is not allowed to accept kickbacks, patients are not allowed to accept 'red envelopes', the participation in sales activities is not allowed to be purchased and used in violation of regulations", mainly targeting doctors and pharmacists. The "Nine Nos" cover not only managers, doctors and pharmacists, but also cover all staff in medical institutions, including but not limited to health professional and technical personnel, logistics personnel, and other social practitioners who provide services in medical institutions and are managed by medical institutions.

Second, from the perspective of operationality, it obviously meets the requirements of "strengthener".

For example, "Nine Correspondence" directly integrates the unreasonable income problem in the first six articles of "Nine Correspondence" into one, namely:

Remuneration is legally obtained by work and no commercial commissions are accepted. Remuneration is obtained by work in accordance with the law and regulations. It is strictly forbidden to use the convenience of practice to issue commissions; it is strictly forbidden to conduct unified prescriptions for commercial purposes; it is strictly forbidden to arrange patients to purchase medical consumables and other products from other medical institutions in the medical alliance where the hospital is located, and designated retail pharmacies included in the "dual channel" management of medical insurance, it is strictly forbidden to arrange patients to purchase medical consumables and other products; it is strictly forbidden to sell goods or services to patients and seek personal gain from them; it is strictly forbidden to accept fees related to prescription and dispensing of Internet companies.

Not only is it rich in content, but it is also more operational.

Compared with the "Nine Non-Certainty", the "Nine Standards" add some rules that are currently common.

For example, Article 2: Strictly abide by the principle of integrity and do not participate in fraud and insurance fraud. Use the medical insurance fund reasonably in accordance with the law and regulations, abide by the medical insurance agreement management, and inform medical insurance patients whether the medical services provided are within the payment scope stipulated by medical insurance. It is strictly forbidden to induce others to impersonate names or falsely seek medical treatment, purchase medicine, provide false proof materials, collude with others to issue false expense documents and other means to defraud and embezzle medical insurance funds.

For example, Article 3: Do not implement excessive diagnosis and treatment according to regulations. Strictly implement various rules and regulations, and patients should be explained in the diagnosis and treatment activities. It is strictly forbidden to over-treat and over-examination for the purpose of simply increasing the income of medical institutions or seeking personal gain, which will increase unnecessary risks and expense burdens to patients.

Article 5: Abide by confidentiality standards and do not disclose patient privacy. Ensure the security of patient's hospital information. It is strictly forbidden to collect, use, process, transmit, disclose, and sell personal information provided by patients in medical institutions and medical information generated.

Article 6: Obey the needs of diagnosis and treatment and do not make profits to refer patients. Provide medical information and use medical resources objectively, fairly and reasonably according to the needs of patients. Except for normal referrals within the medical alliance, it is strictly prohibited to guide patients to a designated medical institution for medical treatment through online or offline introductions for the purpose of seeking personal interests.

Article 7: Maintain the order of diagnosis and treatment and do not undermine the fairness of medical treatment. Adhere to the principle of equality and jointly build a fair medical environment. It is strictly forbidden to use medical resources such as number sources, bed sources, scarce medicines and consumables, or to receive benefits such as examinations and surgery, which will harm public and private health.

Therefore, although the number of lines from "Nine Non-Certification" to "Nine Non-Certification" remains unchanged, it obviously meets the requirements of the upgraded version. If the "Nine Non-Certification" is version 1.0, then the "Nine Non-Certification" belongs to version 2.0.

In addition to consolidating responsibilities, the implementation of the "Nine Guidelines" also requires the issuance of detailed rules

In order to ensure that the "Nine Guidelines" can be implemented, the documents of the three ministries and commissions also put forward five requirements.

First, strictly implement the main responsibilities. It is clear that the leadership teams of health administrative departments at all levels and medical institutions at all levels and types shall bear the main responsibilities of implementing the "Nine Guidelines".

The second is to carry out in-depth study and training. It is required that health and health administrative and medical insurance departments at all levels and medical institutions at all levels and types should include the "Nine Guidelines" in pre-job education, business training, pre-job promotion training and other professional training activities at all levels to ensure that all coverage is covered, all mobilize and all staff are aware of it.

The third is to effectively strengthen supervision and implementation. Health and health administrative and medical insurance departments at all levels are required to establish a normalized supervision mechanism in accordance with the "Nine Guidelines".

Fourth, we must resolutely investigate and punish violations. We require health and health administrative departments at all levels to effectively play the role of the leading unit of the joint mechanism for correcting unhealthy practices in medical purchase and sales and medical services, strengthen coordination and cooperation with relevant departments such as medical insurance, and severely investigate and punish violations of the Nine Guidelines. For medical and health personnel who violate the Nine Guidelines, relevant departments shall impose administrative sanctions on the circumstances, according to the severity, and refer to the penalty according to the severity, and those who violate administrative regulations shall be transferred to the discipline inspection and supervision agencies for handling in accordance with the discipline; for suspected crimes, they shall be transferred to judicial authorities for handling in accordance with the law. Typical cases must be reported regularly.

Fifth, strengthen rigid constraint assessment. All localities should include the implementation of the Nine Guidelines in the review and evaluation of medical institutions and the important content of hospital inspections. The implementation of the Nine Guidelines in the annual assessment of medical and health personnel, the important content of medical and health personnel, the evaluation of medical ethics and regular assessment of doctors, and are linked to personal treatment. We must strictly implement accountability. For those who fail to thoroughly implement the Nine Guidelines, in addition to holding the parties responsible, the relevant personnel of health, medical insurance departments and medical institutions should also be held accountable depending on the severity of the circumstances.

It can be seen from this that the document is still relatively solid in the implementation of the "Nine Guidelines". However, to be truly implemented more, detailed rules need to be issued. For example, the document mentioned "not implementing excessive diagnosis and treatment, and not referring patients for profit", so what is overdiagnosis and what is profit-making referring patients? These still need to be clarified, otherwise it is very easy to have "misjudgment" and "incorrect injury" during the implementation process.

Brigham Women's Hospital, Boston, USA, announced that the first intranasal vaccine for Alzheimer's disease has entered a human clinical trial. It is reported that 16 participants in this clinical trial, aged between 60 and 85, will receive two doses of nasal vaccine within a week.

Xiaohui, a 15-year-old high school girl in Xiamen, Fujian, has been suffering from abdominal pain since the second year of junior high school and has a fever. Her family always thought she had stomachache and asked her to take stomach pain medication or anti-inflammatory injections. A month ago, Xiaohui developed symptoms again, but this time she touched something round on her right belly. Then her family took her to Zhongshan Hospital Affiliated to Xiamen University for examination and was diagnosed with solid pseudo-**tum of pancreas, with a tumor of 7 cm.

Professor Liu Pingguo, director of the Department of Hepatobiliary and Pancreatic Surgery, said that the proportion of female tumors in this tumor is significantly higher than that of men, and is also called "daughter tumor". Although it is not as terrible as pancreatic cancer, if it is not detected and treated early, it will cause metastasis and invade other parts. It is understood that Xiaohui recovered very quickly after the operation and had returned to school to study a few days ago.

Recently, Nursing Xu reported online that she was forced to embrace and harassed by Liu, an emergency department doctor in Anyue County, Ziyang City, Sichuan Province during the standardized training of her hospital at Anyue County Traditional Chinese Medicine Hospital. After she reported the situation to the relevant departments, the health and health department organized mediation and filed a case to deal with the matter.

After investigation, when Liu was on duty with Xu in early 2020, the problem of Xu's bad behavior was true. Anyue County Traditional Chinese Medicine Hospital raised serious criticism and education on this matter. On September 17, 2021, Xu and Liu negotiated on the matter at the Office of the Anyue County Health and Family Planning Bureau and reached an agreement. On November 17, the relevant person in charge of Anyue County Traditional Chinese Medicine Hospital responded to Hongxing News that the hospital had previously handled Liu's bad behavior towards Xu and the patient's family.

At present, Liu is not at work and is under investigation and handling by the Discipline Inspection Commission. The Anyue County Commission for Discipline Inspection and Supervision also confirmed that the Commission for Discipline Inspection and Supervision is currently investigating and handling the matter.

At Ningxiang People's Hospital in Hunan Province, there is a baby named Xiao Ba who was born nearly 4 months earlier. When he was born, he was only as big as an adult's slap, his skin was frozen in clear gelatin, and his weight was only 810 grams. Due to premature birth, Xiao Ba's breathing was weak and his life was in danger. After treatment by the hospital, he became more and more dangerous. At present, Xiao Ba's vital signs are stable, his breathing is stable, and there are no complications. His weight is growing day by day.

In order to reduce the waiting time for patients in line, a "credit medical care" service model of "diagnosis and treatment first, then payment" is being piloted and promoted in Shijingshan District, Beijing. It is understood that patients can enjoy an initial credit limit of 2,000 yuan, register, check, inspect, and get medicine based on their credit. They can pay from the credit limit first. After the medical treatment is over, the patient will pay the fee uniformly, and can pay the mobile payment within 48 hours on site or within 48 hours. As of now, 14,000 people have tried credit medical services, shortening the medical treatment time by an average of 60%.
Chapter completed!