Public opinion over the “800 km of charges for the trans-provincial transfer of ambulances” has still not subsided。
On 8 april, the doctor contacted the private medical ambulance of nanchang chai hospital in jiangxi hospital for children's hospital, who was in serious condition and had to be transferred to shanghai for treatment. The family paid $28,000 for the transfer and subsequently challenged the charges without details and invoices。
On 18 june, the jiangxi provincial health board issued a circular to the effect that the jiangxi provincial children's hospital was accompanied by two medical personnel accompanied by vehicles and carrying equipment and medicines related to the use of the ecmo (the epidural lung oxidation, commonly known as the artificial lung). The investigation found that there were problems of unreasonable charges at nanchang hospital, which had been ordered by the health and health administration to refund unreasonable charges and to suspend medical transit services。
It stated that further investigation and verification of incidents would be carried out jointly with the relevant functional units and that violations would be seriously investigated if found。
As the details of the events were disclosed, public opinion on social platforms reversed. In addition to the accusations made against the "go-to-go" ambulance, there are a number of netizens who claim that the use of the ecmo equipment is costly, “ecmo rings in gold” and even that a cyberstorm has been launched against the families of infected children, calling it a realistic version of “farmers and snakes”。
In response, on 24 june, relatives of sick children reported that ecmo equipment had been used in the jiangxi children's hospital before the transfer, at an average cost of $176 per hour and had not been replaced with the vehicle; $28,000 had been used only for the vehicle and had been transferred to the driver's personal account; the jiangxi children's hospital had subsequently indicated to them that the hospital had no connection with the transfer party, had not benefited from it, had not been able to provide price details and invoices。
The first aid worker (alias) at the shanghai medical emergency centre has been working for more than 10 years and has been involved in trans-provincial transfers on several occasions. He states that cases such as severe illness, which is close to a thousand kilometres in transit, are not uncommon, such as shanghai, where vehicles are sent to fujian quan county to carry out operations directly with a medical team at the local icu and then to bring a sick child to shanghai, at a total cost of 30,000。
In his view, the statements made by some netizens about the cost of running the ecmo equipment and the cost of its loss are clearly contrary to medical common sense. The technical threshold for the use of ecmo equipment was high, it was not possible to replace it before it entered the car, and there were no surgical conditions in the vehicle; as for the invoice dispute, he had stated that some private ambulances would issue freight tickets and would not include the full cost, even if medical invoices were issued, because some of the charges were not clear。
Behind the controversy is the supply and demand dilemma that cannot be bypassed in the field of non-first aid transit. The prime minister told the press that some local finances could not afford ambulances and that the entry of private forces did ease the huge market demand, but that the lack of supervision, the absence of fee rates and the emergence of trans-shipments were also a source of confusion, and that it was urgent for the authorities concerned to adopt a uniform rule that “this thing must be taken over”。
The following is an open and open dialogue:
Cost of trans-shipment
News: what are the main cases of non-first aid long-distance trans-shipment at your emergency centre
Q: we work more with pediatrics. Within the long triangle, like nantung and suzhou, a car can run three times a day. Essentially, doctors and nurses at the paediatric hospital in shanghai went directly to the field ward with the equipment and operated on the spot in their icu. With 3 general chief medical staff, 2 first aid workers and 8 compressed oxygen, up to a maximum of 12, we have measured the amount of oxygen and electricity consumed by the ecmo equipment, basically within a 1,000-kilometre radius of the sea perimeter。
As to the reason why many hospitals have been contacted in shanghai, mainly because doctors are mostly trained in shanghai, especially in paediatrics. Some patients have exhausted all local medical means, but the doctors believe that shanghai is accessible and that the financial situation of their families is affordable, and that they will be connected to shanghai. After communicating, we'll send a car for surgery and refer the children to shanghai。
News: what is the average cost of a child suffering from a serious disease, transiting about 1,000 kilometres away
The cost is two-dollar, like sending a car directly from shanghai to fujian springs, completing surgery in quanzhou and transferring the child to shanghai. In the past, the cost of the car was $11 per km and $22,000 per 1,000 km, and the cost of the doctor's visit plus the cost of surgery was around $30,000. Now the bus fare is about $13 a kilometre。
As far as we go (the first aid centre), a broken patient was transferred from the gansu spring to shanghai, 2,800 kilometres one way, and two first aid workers were rotated for more than 30 hours。
News: during this incident, equipment ecmo was one of the main points of contention. What do you think about what people on the internet call the "ecmo" and the "golden two" and "emo" with the ambulance
Sense: most of the use of ecmos is already infected with the lung, and they develop into respiratory failure disorders, so that the infection can be controlled, the patient's lungs and heart can rest and other organs can be oxygenated. If the ecmo was to be used, it would have been used before it had entered the car, because it could not have been shut off; and since the vehicle had no conditions for surgery, it had been prepared in vain。
And i don't believe that the private ambulance team will buy an ecmo, that it's a very high-level ecm operation, and that they can't do it with a doctor. The so-called “car fares” of hospital and car doctors are the cost of equipment and loss for some private ambulance teams。
The words “the sound of the ecmo, the gold, the gold, the gold,” which were put in china 10 years ago, could have been said. The first batch of ecmos were imported and are now of domestic origin。
Some hospitals are still motivated by the transfer, precisely because they can get more pay from here。
"profit" ash production
News: do you have any details of the charges you're making at the emergency centre
Psychic: we all have a list of similar contracts before we go out, signed one by one. You can't accept it, we can't go out, and some of our money is received in advance and settled. Some patients with a breathing machine have to be accompanied by a doctor, even if they pay for their visits。
The establishment is simple, and the rates have been reported by the price authority and the health commission, and every penny collected has nothing to do with the individual. Operating fees and consultation fees are priced in the code and bills will be placed on the billing list. Medical equipment is in principle free of charge。
News: how do you see the process of transferring patients from private ambulance teams
Psychic: they should have a similar list, but there is no guarantee that the invoices will not be given, not even a fee rate in the first place, and that they will be taxed at least 11 per cent. As far as i know, almost 30 per cent of the transit charges are for the hospital, and the profits from the billing are low. As a matter of fact, the ecmo equipment in the car was also in the hospital, and the private ambulance team was out of the car, which was pretty deep embedded in the hospital. The hospital is their food and clothing parents. The hospital can call others. Why must they? Just help the hospital, take the money。
Of course, private ambulances, especially in hospitals, can be ticketed, with freight tickets and better medical invoices, but some of them (commissions) are not an ambulance's expense
There was also a standard referral fee, which could not be tens of thousands, and a tax audit would certainly not be able to account for it, but he could not make it clear that it amounted to a table, which was already ash. At the legal level, there is no contract for you to write a ticket and no one can protect the interests of many parties。
News: in your opinion, what are the advantages and disadvantages of the inclusion of “private forces” in non-first aid transit
Psychic: the market is huge, but without a clear regulatory body, it is inevitable that it will be a market of bullying and the transmission of benefits. In the field, there were even two private ambulance forces “robbery” in front of the hospital。
It's a very profitable ash. Based on their fees, they are basically able to do one third of the cost, two thirds of the profit, and they find themselves a small hospital with some simple equipment, have contacts with nurses and doctors in the hospital, and usually give up treatment for these vehicles, so that they can return to their rural home, where the hospital will introduce them, part of the transit fee is a commission。
"to get on the stage."
News: what are the problems in the field of non-first-aid trans-shipments that, in your opinion, reflect behind the events of “an ambulance trans-shipment charge of $28,000”
(b) psychiatry: some local finances cannot afford many ambulances, and the state has no standards and is largely hospital-based。
You call 120, you go to any hospital when you're here, you're out of luck, you can't see it, you can't turn it out. Hospital-based ambulances are generally reluctant to travel long distances, amounting to a lack of vehicles to pull patients to their own hospitals。
In shanghai, the patient is not particularly at risk, we have the principle of immediate relief, save your life, then you choose to transfer to a hospital for 37 bucks within 3 km. If you don't get home on first aid, you can climb up to the 6th floor to the 7th floor。
Some provinces have better finances and have their own ambulances, but only in exceptional circumstances. In one city, for example, a medical first aid centre has a similar long-distance shift, which is expensive but also priced。
News: how do you respond to the gap in long-distance transit at your emergency centre
Psychic: there can be no absence, but there can be no unlimited supply. We have about a thousand cars in the first aid centre, 10 of them for a long run, and we have a lot of work to do at gansu, so we basically have to make an appointment two or three days in advance。
News: how is it different from home and abroad that you were involved in the first aid transit to many parts of the country and abroad
The national emergency system does not yet have a uniform national emergency code and no standards. Shanghai is the closest model to a foreign country, with independence and financial support. Hong kong learns the same thing in europe, with laws endorsed, 120 in the fire department, and they don't have first-aid white cars, with the relevant standard charges; the united states gives you the first chance to know how much money you charge, then the state pays how much, and you buy your own insurance。
News: what about social awareness
Psychic: some even think that why collect money? Many patients complained about 120 charges, but it was not clear that they were costly, and that it would cost a million dollars for an ambulance to be fully refurbished from the landing, excluding medical equipment。
There is also a shortage of doctors in the first aid centres, who cannot afford free tuition and lower scores, thus leaving young people without them。
Many of the ambulances are now silent and uncritical, as there have been complaints of loud noise。
For example, the patient in the car is in serious danger, there's a traffic accident in the red light, and the ambulance is responsible, but whose interests are more important? Unlike the fire act, it is clear that the fire brigade went out and had a traffic accident with any social vehicle, with full responsibility, but none。
News: what are your immediate problems in the field of non-first aid transit
It is important to have it on the table。
(singing in french)
The press, chan jie chan, editor, peng xiao
