Study On The Illegal Medical Practice And Its Supervision In Shanghai

[OBJECTIVE]At present, Shanghai, as one of China's economically developed large cities, has relative adequate medical resources and high standards of medical care compared to other regions on the one hand and faces the contradiction between the increase of vulnerable population and limit of medical resourses because of influx of the population on the other hand. The later is also the breeding ground of illegal medical practice. Because of the system and mechanisms of medical care, medical institutions pay attention to the economic interests in medical care, commercial and market-orientation tend to be evident, the income of medical personnel directly links to the income of medical services. This also contributes to illegal medical practice of medical institutions and their staff.Although government departments at all levels make more efforts to remedy illegal medical practice and the management of medical care are improved, but illegal medical practice has not been fundamentally solved and effectively improved. One of the reasons is the low cost for illegal medical practice and the high cost for supervision by health administration departments. In addition, the lag of medical administrative laws and regulations also result in "the difficulties in supervision according the the laws and regulations" or even "no laws and regulations based for the supervsion". For example, there are no sufficient clear standards and norms and there are no sufficient and effective supervision tactics.The purpose of this study is to illustrate the importance and urgency to combat the illegal medical practice through the analyses of status, causes, harmness and supervision of the illegal medical practice in Shanghai, to find the roots of illegal medical practice through the analyses of statistic data and typical cases, in order to find the key points of supervison and provide the information for relevant measures, and to explore a long-term supervision model that is adaptive to our country.[CONTENTS AND METHODS]This study analyzed the current situation of illegal medical practice, law enforcement of illegal medical practice and the causes of illegal medical practice.The main methods for data collection included literature review of the reference related to the illegal medical practice and the study on it in our country over the past 10 years (2000-2010), statistical data collection on illegal medical practice, supervision of illegal medical practice and complaints of "Yituo" in Shanghai in 2008, and statistical data collection on medical practice without licenses in Shanghai from 2005 to 2009. Individual interviews were also used to collect the data on the cuases of illegal medical practice and the supervison status of illegal medical practice in Shanghai.[RESULTS]1. Formation of comprehensive management mechanismThrough these years of playing non-work ways and means of the relevant departments in working to achieve the three changes, from the health sector alone to multi-sectoral comprehensive shift from government regulation alone to government regulation, industry self-regulation, social supervision with change management to education from a focus on punishment, punishment, both whole chapter organizational change, the phenomenon of practicing medicine without a license has been checked, on the norms play a multiplier role in the health care market.Work in the fight against illegal medical practice to promote work, on the one hand strengthen the publicity work, targeted information to potential clients without a license to practice against, the right way chemists and guide the masses to conscientiously resist and practicing medicine without a license in reporting; On the other hand increase the investigation and punishment, and continuously improve filing penalty rate. Practicing medicine without a license while strengthening the legal system places primary education, eradication of practicing medicine without a license living space, basically put the city's illegal immigrant community practice to carry out acts listed.2. Lag of the laws and regulations related to medical administrationIn recent years, the development of medical services market, with a few medical institutions are driven by high profits, publication of false medical advertising, medical practice using non-medical personnel, clinics and activities go beyond the scope of registration, over-check over-treatment or even cheat by issuing false inspection reports patients and other illegal activities have occurred, seriously disrupting medical services order. Through the remediation work in recent years, medical institutions and medical personnel and law-abiding awareness and self-awareness was increased gradually regulate all kinds of illegal activities, medical institutions to use non-medical personnel to practice the basic correcting violations, physicians practicing in different places, medical institutions beyond the scope of practice and other issues have also been effectively checked; medical institutions significantly increased awareness of practicing law.But also the lack of supporting laws and regulations of some norms, standards, interpretation, resulting in the existence of some violations, "according to the law is difficult" and "no legal basis" of the situation. Such as the treatment subjects (in particular, two subjects) the content and setting standards for multi-site physician (professional) registration requirements, "Yituo" rectification of the legal basis, etc., recommended daily number of key and difficult problems of law enforcement work, pay close attention to revision, enrichment, improve relevant laws and regulations and improving the relevant norms, standards and improve supervision and enforcement of operation.3. Enhancement of supervison on medical practiceShanghai Health supervision agencies through strengthening the supervision of medical practice operations team training and guidance focused on the daily supervision of law enforcement practice, combined with joint law enforcement and thematic urban exchanges, constantly sum up experience in law enforcement, exchange of methods to city and district medical practice monitoring the enforcement capability of law enforcement personnel have increased. In the 2006-2009 period, the number and intensity of medical practice than ever before punishment has improved greatly. But the main focus of medical pratice oversight of agencies, departments and projects, clinics, medical technicians are monitoring the situation to obtain health permits, is a generalized "practicing medicine without a license" catergory. For medical services is the practice of the process of specification, can be based on the lack of clear standards, specifications, and the lack of law enforcement practice and seems to be rather weak, such as excessive examination, diagnosis and treatment of inappropriate treatment of fraud in violation of norms as well as patients rights and interests of serious harm to patients the hot and difficult issues the lack of effective remediation measures.