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zoom RSS 患者から攻撃をうける医師たち/中国医療事情 瀋陽

<<   作成日時 : 2010/08/13 23:46   >>

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 多くの中国人の患者はもっと誠実で良質な医師を求めているが、約800万人の人口を持つ瀋陽の27公立病院に現実に必要であったものは警察官だった。不満を持つ患者や親戚の攻撃から医師を守るには、入口だけでなく副管理者に警官を配置する。
 中国の病院は働く場所としては危険が多い。保健省の統計では、2006年に患者家族により5,500人以上の医療従事者が傷害を受けた。6月だけで、山東省で肝癌で死亡した患者の息子に医師が刺殺され、山西省では患者の放火により医師3人が重傷火傷を負い、福建州の小児科医は新生児の死亡で怒った親戚に追われて5階から転落した。最近1年でみると、死亡した患者家族が医師に喪服着用を強制して病院入口を抗議封鎖したことがある。4年前に、82ドルの手付け金を支払えずに3才の子どもが治療を断られ死亡したことから、2,000人の人々が病院で暴動を起こした。
 医学的奇跡を期待して遠方からやって来て治療に貯金を使い果たしてしまう貧しい家族の非現実的な期待の結果、しばしば医療者・患者関係に起こる問題であるという。中国の医療制度に対する広範な不満も反映している。かつて政府は、安い費用で基本的な医療を提供しようと共産主義のリーダーシップで提供しようとしたが、1990年代に撤退し、新しい市場経済の下で病院の自活に任せた。
 2000年にWHOは、中国の医療制度は世界の191ヶ国中188番目という最も不公平なシステムだと位置づけた。病気になっても2/5の人は治療を受けず、健康保険があるのは1/10であった。
 しかし、ここ7年間で、政府保険プランと病院建設に数百億ドルを投入し、世界銀行は3/4以上が現在保険保証されていると概算しており、地方での入院患者数は5年で倍増したという。それでも中国全体で見ると医療の質は低く、OECDによれば、医師のほぼ半数は高卒までの学歴であるという。
 プライマリケアが不十分のため、都市では軽い病気でも高価な料金の公的な病院に押し寄せ、病院患者の1/5が風邪やインフルエンザで、患者の1/2〜1/3が正当でない理由で入院しているという。患者は必要のない外科手術の危険を負い、子どもの1/2は帝王切開で生まれている。必要のない処方がなされている。薬剤売り上げは病院の2番目の収入源であり、医師の過量な処方と検査が給与に結びついている。
 専門家の中には、新たな政管保険が中国人の負担を減らすというより増大させることを恐れている。家計の医療費支出は2003年の8.7%から2008年に8.2%に減ったが、改善ではないかもしれない。
 医師は患者と同じくらい不幸であり、低賃金で働かされ、信用されていない。北京大の調査では、1/4はうつに苦しみ、患者から尊敬されていると思っている医師は2/3未満である。
 6月に、福建省の病院が死亡した患者の家族に31,000ドルを支払ったことで、100人を超える医師と看護士が座り込みをした。家族が医師を人質にとり、従業員にビンを投げつけ5人が負傷したことで医師たちは怒っていた。
 瀋陽では問題を防止するためセンターを設立した。昨年、患者と医師の間で152の「厳しい衝突」があったと報告された。第5病院で1月に大きな襲撃事件があり、患者の親戚が棒とモップで医師や看護士になぐりかかった。
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中国の医療改革に注目が集まる/中国医療事情
http://kurie.at.webry.info/200810/article_47.html
中国医療制度への激震/中国医療事情
http://kurie.at.webry.info/200806/article_36.html
健康中国2020計画/中国医療事情
http://kurie.at.webry.info/200806/article_30.html
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Chinese Hospitals Are Battlegrounds of Discontent
Du Bin for The New York Times
http://www.nytimes.com/2010/08/12/world/asia/12hospital.html
By SHARON LaFRANIERE
Published: August 11, 2010

画像The China Medical University Hospital No. 1 in Shenyang. Violence at city hospitals led officials to consider hiring police officers.

SHENYANG, China ― Forget the calls by many Chinese patients for more honest, better-qualified doctors. What this city’s 27 public hospitals really needed, officials decided last month, was police officers.


And not just at the entrance, but as deputy administrators. The goal: to keep disgruntled patients and their relatives from attacking the doctors.

The decision was quickly reversed after Chinese health experts assailed it, arguing that the police were public servants, not doctors’ personal bodyguards.

But officials in this northeastern industrial hub of nearly eight million people had a point. Chinese hospitals are dangerous places to work. In 2006, the last year the Health Ministry published statistics on hospital violence, attacks by patients or their relatives injured more than 5,500 medical workers.

“I think the police should have a permanent base here,” said a neurosurgeon at Shengjing Hospital. “I always feel this element of danger.”

In June alone, a doctor was stabbed to death in Shandong Province by the son of a patient who had died of liver cancer. Three doctors were severely burned in Shanxi Province when a patient set fire to a hospital office. A pediatrician in Fujian Province was also injured after leaping out a fifth-floor window to escape angry relatives of a newborn who had died under his care.

Over the past year, families of deceased patients have forced doctors to don mourning clothes as a sign of atonement for poor care, and organized protests to bar hospital entrances. Four years ago, 2,000 people rioted at a hospital after reports that a 3-year-old was refused treatment because his grandfather could not pay $82 in upfront fees. The child died.

Such episodes are to some extent standard fare in China, where protests over myriad issues have been on the rise. Officials at all levels of government are on guard against unrest that could spiral and threaten the Communist Party’s power.

Doctors and nurses say the strains in the relations between them and patients’ relatives are often the result of unrealistic expectations by poor families who, having traveled far and exhausted their savings on care, expect medical miracles.

But the violence also reflects much wider discontent with China’s public health care system. Although the government, under Communist leadership, once offered rudimentary health care at nominal prices, it pulled back in the 1990s, leaving hospitals largely to fend for themselves in the new market economy.

By 2000, the World Health Organization ranked China’s health system as one of the world’s most inequitable, 188th among 191 nations. Nearly two of every five sick people went untreated. Only one in 10 had health insurance.

Over the past seven years, the state has intervened anew, with notable results. It has narrowed if not eliminated the gap in public health care spending with other developing nations of similar income levels, health experts say, pouring tens of billions of dollars into government insurance plans and hospital construction.

The World Bank estimates that more than three in four Chinese are now insured, although coverage is often basic. And far more people are getting care: the World Bank says hospital admissions in rural counties have doubled in five years.

“That is a steep, steep increase,” said Jack Langenbrunner, human development coordinator at the World Bank’s Beijing office. “We haven’t seen that in any other country.”

Still, across much of China, the quality of care remains low. Almost half the nation’s doctors have no better than a high school degree, according to the Organization for Economic Cooperation and Development. Many village doctors did not make it past junior high school.

Primary care is scarce, so public hospitals ― notorious for excessive fees ― are typically patients’ first stop in cities, even for minor ailments. One survey estimated that a fifth of hospital patients suffer from no more than a cold or flu. Chinese health experts estimate that a third to a half of patients are hospitalized for no good reason.

Once admitted, patients are at risk of needless surgery; for instance, one of every two Chinese newborns is delivered by Caesarean sections, a rate three times higher than health experts recommend.

Patients appear to be even more likely to get useless prescriptions. Drug sales are hospitals’ second biggest source of revenue, and many offer incentives that can lead doctors to overprescribe or link doctors’ salaries to the money they generate from prescriptions and costly diagnostic tests. Some pharmaceutical companies offer additional under-the-table inducements for prescribing drugs, doctors and experts say.

An article in November in The Guangzhou Daily in southeastern China cited one particularly egregious example of unnecessary treatment: a patient paid roughly $95 for a checkup, several injections and a dozen different drugs, including pills for liver disease. He had a cold.

The Health Ministry has ordered hospitals to reduce prices of specific drugs 23 times in a decade, but the World Bank says hospitals have responded, in part, by ordering higher-priced alternatives.

Some experts fear that the newly opened spigot of government insurance money will inspire further excesses, rather than reduce the financial risk of illness for most Chinese. Indeed, one study shows only a slight drop in the share of household spending devoted to health care ― 8.2 percent in 2008, down from 8. 7 percent in 2003.

“Their protection may not really be improving with insurance,” said Mr. Langenbrunner of the World Bank. “That is the scary part.”

Doctors seem as unhappy as patients. They complain that they are underpaid, undervalued and mistrusted. One in four suffers from depression, and fewer than two of every three believe that their patients respect them, a survey by Peking University concluded in October.

In June, more than 100 doctors and nurses in Fujian Province staged their own sit-in after their hospital paid $31,000 to the family of a patient who died. The doctors were upset because after the patient died the relatives took a doctor hostage, setting off a bottle-throwing melee that injured five employees.

Like some other cities, Shenyang has been seeking ways to ward off disturbances, including setting up hospital mediation centers. Still, the city reported 152 “severe conflicts” between patients and doctors last year.

At Hospital No. 5, the memory of a January attack remains fresh. After a doctor referred a patient with a temperature to a fever clinic ― standard practice in China ― frustrated relatives beat the doctor and several nurses with a mop and sticks.

Now a banner strung across the hospital’s main lobby exhorts: “Everyone participate in the sorting out of the law and order problem!”

Li Bibo, Helen Gao and Xin Hui contributed research from Beijing, and Wang Xiao from Shanghai.


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