Qi Weiwei1. Low-income households and five-guarantee households regard the hospital as their homeZhonglu is in his early 50s, because his mind is not very bright, and he does not look good, he has not been able to get a wife, and he is an old bachelor in the village. Although there are 5-6 old singles in the village, he is the most active one in the village, and he will take the initiative to help when he sees someone in the village who is busy farming, building houses, and running wine, and likes to wander around the village to find someone to chat, so he can often be seen in the village. Every time we meet him, he always takes the initiative to say a few words to us. However, in recent years, he has rarely been seen in the village, and when they asked him about his condition, they said that he had been taken to the hospital by the township health center to "enjoy his blessings". It turned out that in the past few years, Zhonglu was rated as a low-income household during the targeted poverty alleviation, and his life has changed dramatically since then. Before the targeted poverty alleviation policy, Zhonglu mainly relied on planting a few acres of land and doing odd jobs in the surrounding area to make a living, plus the care of the villagers, life was also passable. After targeted poverty alleviation, ** built a new house for him, and gave him living expenses (including a subsistence allowance of more than 200 yuan per month) every month, and since then he has stopped farming and doing odd jobs, and has lived in the township health center for a long time, becoming a VIP patient in the township health center. According to the villagers, Zhonglu has always been in good health, no illness or pain, and he has been living in the hospital for a long time, on the one hand, because the township health center repeatedly came to do ideological work and asked him to go to the hospital, and also sent a special car to pick him up and forth, he was embarrassed to refuse; On the one hand, the township health center provides food and accommodation, and there is a subsidy of more than ten yuan per day. The food in the hospital was slightly unpalatable to his liking, and he dared to directly scold the director of the township health center, and the director had to come forward to explain to him in person. Living in the hospital not only guarantees and income, but also has a higher quality of life than ordinary villagers, in the words of the villagers: "I sleep in a bed without illness or pain, and I live like a fairy." "The phenomenon of long-term long-term residence in hospitals by healthy five-guarantee and low-income households like Zhonglu is very common in the local area, especially the number of five-guarantee households. Therefore, I specially asked a rural doctor who was more familiar with the situation of these five-guarantee households, and made detailed statistics on the hospitalization of the five-guarantee households in the administrative village. This administrative village has more than 2,000 people, more than 600 households, the whole village area of nearly 2,000 acres, more than 2,000 acres of cultivated land, 14 villager groups, and more than 10 households with five guarantees. The following table shows the specific hospitalization situation of the five guarantee households in the administrative village before 2023. 
Judging from the statistics, most of the five-guarantee households in the village have been hospitalized, and more than half of the five-guarantee households in good health but have lived in the hospital for a long time account for more than half of the statistics. There are 14 villages and communities in the town, and if you count about 10 five-guarantee households in each administrative village, then there are about 100-200 five-guarantee households in the town, and there may be hundreds of five-guarantee households in the town who live in hospitals for a long time. It is these five-guarantee households that support the township health centers and the county's private hospitals. Second, the hospital is unprofitable and cannot afford to be earlyIt is understood that the township health center belongs to the difference appropriation unit, the financial allocation only accounts for 30% of the annual budget funds, and the remaining 70% needs to be self-raised by the township health center, and the self-raised fund income is the main medical service income. However, in recent years, with the rapid urbanization of the rural population, the migration of young and middle-aged laborers, and the migration of children to study in the cities, young women or grandparents to accompany the students, the number of people living in rural areas for a long time has become smaller and smaller, and the number of people going to township health centers for medical treatment has decreased rapidly. Without patients going to the doctor, the township health centers will have no medical income, and it is very difficult to maintain the basic operation of the township health centers by relying only on financial allocations and public health service income. For example, there are more than 50 medical staff in a township health center, and the doctor's monthly salary is only about 3,000 yuan when there are few patients, and sometimes even the salary cannot be paid; In the case of a large number of patients, the monthly salary of doctors can reach 6,000-7,000 yuan, so the hospital has a huge incentive to generate income. As a result, township hospitals have pinned their income generation on rural five-guarantee households and low-income households, especially those with nearly full reimbursement for hospitalization, which has become a fragrant bun for township health centers. The private hospitals in the county are also playing the idea of low-income households and five-guarantee households. So, how do these hospitals use the subsistence allowance and the five guarantees to generate income? The first step is to solicit customers. According to the medical insurance reimbursement policy, the five-guarantee households can go to the designated primary medical institutions of the medical insurance**, that is, the five-guarantee households can go to any of the designated medical institutions of the medical insurance**, for example, the five-guarantee households in the village were taken to the private hospitals in the county and the two township hospitals in turn to be hospitalized before his death. In order to pull these five-guarantee households to their own hospitals, township hospitals and county private hospitals have tried all kinds of methods. One is to give kickbacks to rural doctors. Because of the need for work, the village doctor often visits the village, and is very familiar with the situation in the village, and is familiar with the basic situation of the low-income and five-guarantee households in the village. As a result, hospitals are competing to find rural doctors to cooperate, and incentives are used to incentivize rural doctors to introduce five-guarantee households to their hospitals** through kickbacks. According to the village doctor, 2-3 hospitals came to him for cooperation, and they all promised to get a rebate for the success of the introduction, and one of the private hospitals offered a rebate of 400 yuan for each five-guarantee household introduced. Second, doctors go to the village and enter the household. The hospital will obtain the list of people from the low-income and five-guarantee households in each village through various means, and then go to the villages and households to give health lectures and do ideological work at the homes of these low-income and five-guarantee households, and even coax and deceive them to take them to the hospital for hospitalization. For those "stubborn" low-income households and five-guarantee households, the hospital repeatedly came to the door to do ideological work, shush the cold and ask for warmth, and finally pulled them to the hospital. Fa Shun, a five-guarantee household in the village, has always been in good health, lives in his nephew's house, helps his nephew work, and the hospital has come to the house many times to do ideological work to let him go to the hospital, but he refuses; The hospital repeatedly sent a car to pick him up, and he scolded those who came to pick him up for nothing, and in the end he couldn't resist being taken to the hospital. He complained to the villagers: "I don't want to go (to the hospital), and it is useless to pick me up and scold (the person who came to take him to the hospital)." "The third is the introduction of acquaintances. Most of the doctors and staff of township hospitals are from their own counties or townships, and their social networks are in the local area, and they have acquaintances in the local area. The second step is to retain people with benefits. Good people who are not sick or in pain are generally reluctant to stay in the hospital for a long time, but the hospital has its own set of means to leave these five-guarantee households and low-income households. The first is to provide thoughtful service. For example, there is a private car. All the low-income households and five-guarantee households did not take the initiative to go to the hospital on their own, but the township health center (county private hospital) drove the car to the door of the house to pick them up, and when they came back, they had a special car to deliver them to the door. Yang Lai, a 5-in-10 resident in his 80s, proudly told the villagers: "If you don't take (the hospital), you won't go (to the hospital)." There is also the provision of intimate life services. Low-income households and five-guarantee households not only do not need to pay a penny for hospitalization, but the hospital also provides free board and lodging; The standard of meals is the same as that of hospital staff, with meat and vegetarian dishes; The beds they sleep in are made and changed regularly, which is much cleaner and more comfortable than if they were at home alone. If the life service is not good, you can also ask the doctor directly. Wubao Hu Huiyue often dislikes the poor life and service of the hospital, thinking that the hospital relies on him to generate income, so he wants to eat and drink well to entertain him, and if he doesn't like him, he scolds the doctor and the dean. The second is economic compensation. Some low-income and five-guarantee households have been spoiled by various preferential policies of the state, and they have become more and more shrewd and mercenary, and they will not do things without benefits and benefits. In order to retain them, the hospital not only provides free food and lodging, but also gives a certain economic subsidy for each day of hospitalization, such as 15 yuan a day. The third step is to exploit the loopholes in the system. In order to prevent medical resources, the state has formulated a series of binding system regulations, but hospitals can always cover up their illegal operations through superficial compliance to achieve the purpose of arbitraging national medical funds. For example, the medical reimbursement system stipulates that there is a reimbursement limit for hospitalization of low-income households and five-guarantee households, and the expenses exceeding the reimbursement amount shall be borne by the low-income households and five-guarantee households, but the actual operation is that the self-paid part of the low-income households and five-guarantee households is solved by the hospital operation, and they do not need to spend a penny for hospitalization. For example, the system stipulates that ordinary patients should not be hospitalized for a maximum of 15 days (or 7 days), and the actual operation of the hospital is to discharge them after 15 days (7 days) of low-income or five-guarantee households, and then take them back to the hospital after a week of discharge, and so on. For another example, patients who are hospitalized need to have detailed records of medical records, medications, **, etc., which is also difficult for hospitals. Because every adult has more or less this or that small problem, but most of these small problems have little impact on people's physical health, and there is no need for **, therefore, it is not difficult for the hospital to find out a little problem from these low-income households and five-guarantee households. The medical records of these hospitalized low-income and five-guarantee households are all about some common chronic diseases such as lumbar and cervical spondylosis, hypertension, and diabetes. For the five-guarantee households and low-income households with minor problems, minor illnesses should be treated as major diseases, and all arrangements will be made for hospitalization and injections; For low-income households and five-guarantee households who are not sick or painful, they will be given some drugs that do little harm to the body, such as glucose, normal saline, and blood circulation and stasis; Prescribe some drugs that have health care functions. Zhonglu, a low-income household, often escapes from the hospital, not because he is afraid that glucose is not good for his health, but because he is really afraid of injections. Step 4: Generate income. The ultimate goal of a series of operations in a hospital is to generate revenue. Doctors interviewed at township health centers revealed that as long as there are low-income and five-guarantee households who go to the health center for medical treatment and hospitalization, they will have a way to generate income. It is understood that the hospital mainly generates income in the following ways: First, overreporting medical service fees. On the basis of the actual medical services provided, the medical service fee is overstated, such as the patient only has 1 bottle of infusion, and 3 bottles are written on the bill on the cost list. The second is to falsely report medical service expenses. A medical service is not provided to the patient, but there is a medical service on the bill, for example, the patient is not admitted to the hospital but has a record of hospitalization. The third is excessive medical treatment. Common chronic diseases are based on the criteria of major illness**, and the **space is maximized. Fourth, creating something out of nothing. For people who are not sick or in pain, they will carry out health care**, prescribe some health care drugs, glucose, etc. Because the low-income households and five-guarantee households do not spend money on hospitalization, the hospital also includes food, accommodation and pick-up, and the service is meticulous and thoughtful, so they do not care whether the hospitalization bill is reasonable and leave it to the hospital to handle it. Even if the five-guarantee households and low-income households know that the hospital is using them to obtain national medical funds, because it is the state's money, not their own money, they do not care, and they will cooperate with the hospital to obtain national medical funds. For example, Huiyue, the five guarantee households in the village, clearly knew that the hospital relied on him to generate income, and often used this to blackmail the hospital to meet his various needs, and the hospital did not dare to offend the God of Wealth and tried its best to meet his requirements. Third, it has had a negative impact on rural societyThe behavior of some hospitals (health centers) using low-income households and five-guarantee households to obtain national medical insurance funds is widespread throughout the country, and the fundamental reason for this phenomenon in the country is institutional reasons, which will be elaborated in a separate article. What this article will discuss is the bad impact it has on the entire rural society: first, it has caused an imbalance in the social mentality. In the past, there were only five guarantees in rural areas, and the five guarantees were mainly the elderly who had no children and no support in rural areas, and the state provided them with old-age security, and at the same time, the society also assumed certain responsibilities for their old-age care, but they only provided the most basic old-age security. As a result, their quality of life is much lower than that of ordinary villagers, and they belong to the really difficult group in the village. After the targeted poverty alleviation policy, the state has further subdivided the rural poor groups, which are divided into low-income households and five-guarantee households. Some of the low-income households are indeed poor due to family changes or physical disabilities, and a considerable number of them are poor due to personal laziness. For example, the villager Yueyuan, because he never had a wife when he was young, after the age of 40, when he saw that there was no hope of finding a wife, he began to give up on himself and live a life of drinking and drunk. After being rated as a poor household, after receiving a monthly subsidy of more than 200 yuan, he lost the motivation to work and wandered around the village all day long. Elderly people who have no children after the age of 60 can be rated as five-guarantee households. Some of these five-guarantee households are demented and stupid in the village; Some of them were lazy and lazy when they were young, and the villagers avoided them. For example, when he was young, he was lazy and lazy, stealing chickens and dogs, and being abducted and deceived by the pit, which was notorious in the whole town, and the villagers avoided him. The woman around the second furnace has never been broken, but has never been married and had children, after reaching the age of 60, he was transferred to a five-guarantee household, with a monthly living allowance of 500-600 yuan, which is more secure than the life of the elderly with children in the village, and now he has found a new girlfriend in the county, often goes to the county to live, and lives quite chic. These low-income households and five-guarantee households not only have a variety of policy subsidies, but also the hospital also gives them special care, the hospital is free of charge when they are sick, and there is a hospital for professional care and pension when they are old, which is impossible for ordinary villagers to have, which makes many farmers who have worked hard all their lives feel unfair and full of dissatisfaction with the current policy. The villagers sarcastically said, "They are heroes of the country and have made significant contributions to the country, how can they be so blessed if they do not have major contributions?" Some villagers said, "The hospital supports them, and it's all the state's money, and it's useless to be angry." Second, it has extinguished the enthusiasm of farmers to pay medical insurance. In practice, low-income households and five-guarantee households do not pay medical insurance, but they are the people who give the most priority to medical services and consume the most medical resources, which makes villagers who do not go to the hospital all year round but have to pay medical insurance every year feel dissatisfied. "We pay (medical insurance), and they (low-income households, five-guarantee households) spend it, and they don't want to pay it. According to the village cadres, the number of farmers paying medical insurance has been declining year by year in recent years, and the insurance rate in some villages is less than 50%; The work is becoming more and more difficult to do, and the collection of medical insurance has become the most headache for cadres at the two levels in rural areas. 
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