If this consumable can be purchased in pharmacies and there is no big problem in use, not purchasing it in the hospital can reduce unnecessary disputes.textShinaedWang Xiao
On a trip to Japan, Wang Mu (pseudonym) returned with five leather nails on his head.
She lost her short-term memory due to her brain, and because these five leather nails had solved a case, she learned the full picture of the incident from the mouth of a doctor in a Japanese hospital more than ten hours later.
While catching a train in Kamakura, she slipped and fell, bleeding from the back of her head, and was taken to a nearby hospital by ambulance. Japanese doctors cleaned her wound and stitched it up with leather nails.
This kind of leather nail is similar to the nail of a stapler, and the ** nail is put together. After inquiry, she learned that she could go to the hospital to remove the nails after 10 days.
The doctor in Tokyo told her that it was a very simple operation that could be done by any hospital. However,Wang Mu, who returned to Beijing, found a third-class public hospital such as Beijing Chaoyang Hospital and a high-end private hospital such as United Family for these five leather nailsGot the same reply: nail removal is possible, but the hospital does not have a nail remover.
Why is there no such a good product in hospitals?Wang Mu felt helpless.
FinanceGreat Health" learned that because of this skinNailsNot in the Medicare Directory. This is related to the fact that there is still no unified medical insurance catalogue of consumables in various provinces and ChinaPreviously, the National Health Insurance Administration issued the "Notice on Doing a Good Job in the Payment and Management of Medical Consumables for Basic Medical Insurance" (hereinafter referred to as the "Notice") mentioned that by 2025, the provincial basic medical insurance medical consumables catalogue will be formulatedAt the same time, the state will gradually formulate a unified national medical insurance catalog.
Jin Chunlin, director of the Shanghai Municipal Health and Health Development Research Center, analyzedIf there is a unified medical insurance catalog of consumablesHospitals will be more motivated to purchase consumables in the catalogIt's also smootherIt can reduce a lot of uncertainty
To this day, recalling the whole process, Wang Mu still feels "unbelievable".
Early in the morning of June 23, 2023, Wang Mu, who was traveling in Japan, woke up in the hotel, everything was as usual, except for a vague memory, she was lying on a bed, and suddenly opened her eyes to see someone wearing ** clothes, wanted to sit up, and was pressed back to the bed. This is the only memory Wang Mu has left after he fell the night before.
Her hair was sticky, Wang Mu went to take a shower, wanting to wash her hair, and when she rubbed her hair, she touched a few hard lumps in her scalp, metallic, but there was no pulling or pain. She took a picture of ** with her mobile phone, only to realize that she had a leather nail on her scalp. She couldn't think of anything, and her first reaction was to be afraid.
Trying to calm herself, she began to look for clues, and found a medicine bag from Kamakura Hospital in Japan, which contained ointment, and the instructions said anti-inflammatory and other information. At this time, a ** call, a lady who spoke Chinese claimed to be a staff member of this hospital, telling Wang Mu that he needed to go to the hospital to make up the ** fee.
Wang Mu subconsciously felt that this was a fraud** and wanted money. But when I think about it, this is the only clue related to my experience last night, or should I go and see what happened. After repeatedly confirming the address of the hospital, she came to the hospital to see ** and the doctor, and learned from the doctor what happened the night before.
The night before, due to the slippery road in the rain, Wang Mu fell on the way to catch the tram, and the back of his head was broken and began to bleed. The people at the station gave first aid**, and Wang Mu was taken to Kamakura Hospital. Because the skull is spherical and non-flat, there is tension after the wound is openedIntegumentWhen it was opened, the emergency doctor urgently treated the bleeding and woundsNails were chosen because they are more secure and comfortable than traditional stitchingIt is also faster to operate, and is suitable for dealing with emergency injuries
Wang Mu's short-term amnesia is related to the brain. The doctor told that the head wound does not need special treatment, and there is no delay in washing the hair, mainly to prevent scratching and infection, and the skin nails can be removed after 10 days. This time, she spent a total of 70,000 yen (about 3,500 yuan) on the emergency treatment.
Ten days later, Wang Mu, who was in Beijing, went to the hospital to remove the nails, but what she didn't expect was that the process was full of twists and turns.
In the surgical clinic of Chaoyang Hospital in Beijing, the doctor looked at Wang Mu's wound and although he felt that the matter was not difficult, he did not remove the nails. "I've seen this thing, and we've dismantled it here. The doctor mentioned to Wang Mu that there was ** dismantling this kind of leather nail the day beforeBut because the hospital doesn'tProcurementNail dismantler, Wang Mu needs to buy one himself.
Wang Mu then inquired with ** and was told that there was a pharmacy opposite the hospital. She found this nail remover at the drugstore, which resembled office supplies, resembling small scissors and had a round, blunt end. "18 yuan", seeing the selling price, Wang Mu muttered in his heart, "Is it too simple", after all, this is to "break ground" on the head, what if it is not dismantled and infected.
She still wanted to find a hospital that could have this kind of consumables. So, she called the China-Japan Friendship Hospital and United Family **, but was told that there was none. After going to many hospitals to no avail, Wang Mu bought an 18 yuan nail remover with apprehension, returned to Beijing Chaoyang Hospital, and came to the ** station to prepare for nail removal.
Wang Mu lay on the table, ** brushed his hair away, and after disinfection, he picked up the nail remover, only to hear a few crisp "clicks", and in less than a minute, five nails left Wang Mu's scalp.
The process of nail removal is really simple, put the tip of the nail remover under the U-shaped nail, maintain the upward lifting force at the same time, press the nail remover handle, the U-shaped nail is bent outward from the center line, and it is easy to remove. "It doesn't hurt at all". Wang Mu recalled. At this time, she was seeing another patient also holding a nail remover ready to find a nail to be lifted.
As a suturing method, the nail operation is very fast, which can quickly save the suturing time, and at the same time, the use of hemostats or tweezers to assist the valgus skin edge when nailing the skin nail helps to close and prevent the inversion of the skin. Therefore, in clinical practice, many patients are sutured with leather nails. Leather nails are also more suitable for superficial trauma with flaccid skin during activities such as the knee.
Compared with the pain when removing the sutures, the removal of the nails is quite comfortable in Wang Mu's opinion. She wondered why so many large hospitals didn't purchase such a useful and in-demand device.
Although Wang Mu inquired about several public and private hospitals that did not purchase nail removers, there are also hospitals in Beijing that have this product. A staff member of Beijing Luhe Hospital told Finance and Health that there is such a nail remover in the dressing room of the outpatient clinic, which can provide nail extraction services.
Outside of Beijing, such as the Fifth People's Hospital of Wuxi City, Jiangsu Province, and the People's Hospital of Ya'an City, Sichuan Province, they have also included nail removers in the hospital procurement list. In the public bidding announcement for the third batch of medical consumables and emergency reagents released by the latter in October 2023, the outpatient office purchased ** nail remover, with a project number of 202304256 and a maximum price of 30 yuan each. The object is described as the removal of the skin nail after the wound is sutured.
Why do some hospitals have such a simple and effective consumable, and some don't?How can a consumable enter the hospital's procurement system?
Finance and Health" learnedFirst of all, the hospital needs to have a special management organization to manage what kind of consumables can enter the hospital.
According to the relevant regulations, hospitals above the second level should set up a medical consumables management committee, and other medical institutions should also set up a medical consumables management organization. The Medical Consumables Management Committee is composed of senior professional titles from relevant clinical departments, pharmacy, medical engineering, nursing and other departments, as well as heads of finance, medical insurance, information, discipline inspection and supervision, auditing and other departments.
This management organization is responsible for the selection and development of the first catalog of medical consumables. For the specific purchase of consumables, it is necessary to use the department to submit a project application to the relevant functional departments, and the functional departments will organize the demonstration and project approval.
When the project is initiated, it includes various technical parameters (including professional qualifications) and basic information such as evaluation methods, implementation of funds, and project categories. When the application procedures are complete, an in-hospital review will be conducted to decide whether to purchase and which type to procure.
Jin Chunlin, director of the Shanghai Health and Health Development Research Center, understands that the procurement process of consumables in the hospital will be relatively relaxed compared with drugs, and the review process can be started after the clinical demand is raised.
The procurement process for general consumables is that the procurement department will report the medical consumables varieties that need to be purchased in the next year to the procurement office before November 30 each year, and the procurement department or department will submit the procurement application form to the procurement office for preliminary review.
The First Affiliated Hospital of Xi'an Jiaotong University, a tertiary hospital, will set up different management organizations according to the different types of consumables purchased and the amount of purchases.
Consumables are divided into specialized consumables and general consumables, the former is composed of the head of the use department and economic expertstoThe latter has to estimate the annual procurement volume, and the larger the procurement volume, the more members of the expert groupFor example, within 1 million yuan, the number of experts selected is 3;1 million to 5 million yuan, the number of experts is 5 or more, and when 5 million yuan or more, the number of experts is 7 or more.
However,The question is,Now the medical insurance catalogue of consumables is different in various places, and some places even do not have itMedical Insurance CatalogThere are many factors that hospitals consider in the process of purchasing consumables. For example, in the case of a certain amount of medical insurance, which consumables are introduced and which consumables are not introduced, will it bring positive feedback to the hospital.
Each hospital measures differently, which also leads to some areas where some hospitals purchase and some do notJin Chunlin said.
PreviouslyDifferent places have their own medical insurance catalogs of consumables, so that in a province, different municipal consumables catalogs are completely unrecognizable, and some even to the county level medical insurance are separately admitted. EvenInChinaIn multiple medical insurance co-ordination regions, the same medical consumables have completely different pricing, medical insurance reimbursement, and patient-paid expenses.
For example, some cities have adopted a more relaxed "filing system", that is, hospitals need to use a certain consumable, and they can be reimbursed by filing with the municipal medical insurance department, which means that even in the same city, the medical consumables that can be reimbursed in different hospitals are different.
Jin Chunlin believes that if it is under a unified medical insurance catalog, the enthusiasm of each hospital to purchase will be higher and smoother. Now there is no unified catalog, whether a consumable can be reimbursedThe jury is also inconclusiveFor some hospitals, if this consumable can be bought in pharmacies and there is no big problem in use, the hospital will not purchase it to reduce unnecessary disputes.