Further deepening of medical reform: allowing more people to enjoy national-level medical services nearby
At the beginning of this year, Yangyang, who just turned one year old, can stand against the wall and call her mother.
Like other babies, Yangyang's smooth growth has brought a lot of joy to the family.
At that time, no one would have imagined that this little being who was struggling to grow had a tumor about 15 centimeters in diameter—about three or four times the size of Yangyang's heart.
This is one of the characteristics of childhood cancer, even if the tumor has grown very large, the child will not be uncomfortable.
Until the cancer cells spread to the bones, major organs, etc., the child will not have pain and impaired organ function.
Waiting until this time to go to the hospital for examination may delay the best time for treatment.
In early February, Yang Yang went to the hospital for a skin allergy.
The doctor noticed that Yangyang's belly was larger than that of an ordinary child, and suggested an examination.
The results of the color Doppler ultrasound showed that there was an "abnormal mass occupying space" in Yangyang's stomach.
The color Doppler doctor speculated that it was neuroblastoma, which cannot be cured in Puyang City, Henan Province, where Yangyang is located.
Because the tumor was too large and considering the possibility of malignancy, a local doctor suggested giving up treatment.
Neuroblastoma is known as the "king of childhood cancers". It is a highly heterogeneous disease. Most of them are found in the middle and late stages, with a high degree of malignancy. It is also the most common extracranial solid tumor in children. Children under the age of 2, especially infants and young children under the age of 2.
This tumor mostly originates from the sympathetic nervous system and adrenal glands near the spine. It is deep and difficult to detect at an early stage.
Yangyang was the only child of Wang Jianyu and his wife, and they couldn't accept the doctor's advice to give up treatment.
Wang Jianyu said that even if there is a 1% hope, he will do his best to save the child, "as long as he can save his life."
Like those parents who were cornered by disease, Wang Jianyu came to Beijing Children's Hospital to seek the last hope.
The hardships of seeking medical treatment in a different place can only be deeply understood after experiencing it.
At that time, when Wang Jianyu and his wife took their children to see a doctor in Beijing, they only ate two meals a day: breakfast and supper provided by the hotel.
Yangyang's next medical expenses may be hundreds of thousands or even millions of yuan. This ordinary young couple began to save money for their children from the gap between their teeth.
The inpatient beds of Beijing Children’s Hospital are very tight. The B-ultrasound, bone marrow cytology, contrast-enhanced CT, PET-CT, blood drawing and other tests that Yangyang needs to do when they go to the doctor can only be done in the outpatient clinic, which means that the examination fees are all at their own expense.
According to Wang Jianyu's recollection, about 20,000 to 30,000 yuan were spent on inspection and registration in Beijing for about 10 days.
During his stay in the hotel, Wang Jianyu began to prepare to rent a house near the hospital. After all, it was a long-term battle from chemotherapy, surgery to postoperative chemotherapy.
Beijing Children's Hospital is located in the West Second Ring Road, where the land is expensive. There is also a "Financial Street" nearby. The monthly rent for a one-bedroom within 1.5 kilometers of the hospital is more than 7,000 yuan.
When Wang Jianyu found Cheng Haiyan, the deputy chief physician of the Department of Oncology at Beijing Children's Hospital, he specifically asked the doctor about the approximate diagnosis and treatment time, because he planned to sign a rental contract with the intermediary the next day.
At that time, Wang Jianyu had spent 40,000 to 50,000 yuan in the past 10 days, including transportation and accommodation expenses, which is equivalent to their family's income for half a year.
It was an accident that Cheng Haiyan received Yangyang in the outpatient clinic.
In December last year, Cheng Haiyan was hired as the Distinguished Director of Oncology Surgery of Henan Children's Hospital for a term of six months.
During the six months, Cheng Haiyan needed to work in Henan Children's Hospital.
In early February of this year, due to the epidemic, Cheng Haiyan was unable to return to Zhengzhou, Henan Province on time, so he temporarily returned to Beijing Children's Hospital for a consultation, so he met Wang Jianyu's family.
Hearing that Wang Jianyu wanted to rent a house, Cheng Haiyan suggested that he can go back to Henan to see a doctor.
Before Cheng Haiyan, two top experts from the Department of Oncology of Beijing Children's Hospital went to the Department of Oncology of Henan Children's Hospital to provide assistance. They not only carried out a series of difficult and complex tumor operations, but also improved the local children's tumor diagnosis and treatment level.
In a few days, Cheng Haiyan will continue to visit Henan Provincial Children's Hospital, which can basically ensure the homogeneity of the medical level in the two places.
He can be diagnosed and treated by experts from Beijing Children's Hospital in the province, and Wang Jianyu does not need to stay in Beijing.
That night, the couple took Yangyang back to Henan.
Within two days, Yangyang began receiving treatment at Henan Provincial Children's Hospital.
Here, Yangyang conducts various inspections after being hospitalized, which not only saves a lot of trouble, but also the cost of inspections can be reimbursed through medical insurance.
What's more convenient is that Wang Jianyu rented a two-bedroom apartment 6 kilometers away from Henan Provincial Children's Hospital, and the monthly rent was less than 1,800 yuan.
At a distance of 6 kilometers, Wang Jianyu drove to the hospital in about 10 minutes.
The child was diagnosed with tumor when he was just 1 year old, which is indeed unspeakable pain for a family, but medical treatment has become relatively convenient and cheap, bringing comfort to their lives.
Three batches of national regional medical centers have 50 hospitals
On the morning of May 23, Cheng Haiyan completed the inspection at the Department of Oncology of Henan Children's Hospital.
There are only 2 to 3 beds in each ward of the surgical oncology department here, and there are independent bathrooms, which is much better than the 8 beds in each ward of Beijing Children's Hospital.
Yangyang has completed four courses of preoperative chemotherapy here, and the tumor in his stomach has shrunk by about half.
On May 26, Cheng Haiyan will perform tumor resection for Yangyang.
Yang Yang was finally confirmed to be neuroblastoma stage IV, which is the most severe stage, after needle biopsy and systemic evaluation at Henan Children's Hospital.
However, because it has only metastasized to the lymph nodes and has not yet metastasized to the bone and bone marrow, Cheng Haiyan said, it is a less severe type in the fourth stage.
Yangyang's tumor encapsulates more than 10 important blood vessels such as abdominal aorta, superior mesenteric artery, celiac trunk, and bilateral renal arteries and veins.
Cheng Haiyan told reporters from China Youth Daily and China Youth Daily that the operation is expected to take 8 to 10 hours. Because the tumor has many blood vessels, it is necessary to remove these important blood vessels one by one without damage when removing the tumor. The roots are stripped out.
The location of blood vessels in each child will be slightly different, and because the tumor wrap will also push and change the original position of the blood vessels, the blood vessels will eventually crisscross the tumor like a flyover.
In addition, children's blood vessels are thinner than adults', and the blood vessels that need to be stripped may only be three or four millimeters in diameter, and the blood vessel walls are thinner, like the film in the eggshell.
How to remove the tumor without damaging these blood vessels with a sharp scalpel puts forward very high requirements on the doctor's level.
Cheng Haiyan still remembers the shock when he first watched Teacher Corey strip blood vessels as an assistant more than 10 years ago: tumor surgery can be so refined!
After more than 10 years of clinical training in Beijing Children's Hospital, Cheng Haiyan has mastered this surgical technique.
Now, she has brought this technology and the diagnosis and treatment standards for children's tumors to Henan Province.
While helping many children like Yang Yang who have been given a "death verdict", it also helped improve the diagnosis and treatment capabilities of local doctors.
Cheng Haiyan came to Henan to help, precisely because the National Regional Medical Center was established here.
Henan Provincial Children's Hospital is now also the National Children's Regional Medical Center, the National Children's Medical Center Branch Center, and the Beijing Children's Hospital Zhengzhou Hospital. It is one of the first construction units of the National Regional Medical Center.
In addition to oncology surgery, experts from more than ten departments of Beijing Children's Hospital also came to Henan to help.
In 2020, the number of outpatient and inpatient visits to Beijing Children's Hospital in the entire Henan Province dropped significantly, with a 63.1% drop in outpatient visits and a 51.3% drop in inpatient visits.
The National Regional Medical Center is an important task planned, deployed and made by General Secretary Xi Jinping personally. Its core content is the expansion of high-quality medical resources and the balanced regional layout.
In July 2019, the ninth meeting of the Central Comprehensive Deepening Reform Committee reviewed and approved the pilot work plan for the construction of national regional medical centers.
Sun Zhicheng, head of the Social Development Department of the National Development and Reform Commission, explained: "A very important purpose of the National Regional Medical Center is not to let the common people go to Beijing and Shanghai to see a doctor. Nearby enjoy the national medical level.”
"The root cause of the problem of difficulty in seeing a doctor in my country is the contradiction between supply and demand. The total amount of medical resources in my country is insufficient, high-quality resources are scarce, and the distribution is not reasonable enough, especially the local grassroots medical service institutions are relatively weak." March 8, 2019 , Ma Xiaowei, director of the National Health and Health Commission, answered reporters' questions about the difficulty of seeing a doctor in the "Minister's Channel" of the National Two Sessions.
When talking about ways to solve this problem, Ma Xiaowei put the construction of a number of national medical centers and regional medical centers in the country as the first item, "Improve the diagnosis and treatment of difficult and severe diseases in various places, ease the medical pressure in Beijing, Shanghai and Guangzhou, and make the medical treatment pattern. It can be changed so that each province and each region can solve their own difficult and critical problems."
Recently, "The Third Batch of National Regional Medical Center Construction Project List" has been announced, and 24 hospitals including Peking University First Hospital Ningxia Women's and Children's Hospital, Beijing Tiantan Hospital Affiliated to Capital Medical University, Anhui Hospital, and Peking University Cancer Hospital Inner Mongolia Hospital have been included. .
So far, the National Regional Medical Center has included 50 hospitals.
In March 2021, General Secretary Xi Jinping re-emphasized when he inspected Fujian that it is necessary to continue to deepen the reform of the medical and health system, distribute high-quality medical resources in a balanced manner, improve basic infrastructure conditions, and provide reliable protection for people's health.
The National Regional Medical Center is an important part of our country's medical reform work.
According to Li Bin, deputy director of the National Health and Medical Commission, in the "14th Five-Year Plan" and beyond, it is necessary to build national medical centers and regional medical centers, which will become an important engine for promoting national medical progress.
my country's medical reform is in the right direction and has achieved remarkable results
For Wang Jianyu and his wife, Yangyang's health is their greatest wish.
As General Secretary Xi Jinping said during his inspection at the Shaxian General Hospital of Sanming City, health is the most important indicator of a happy life.
The medical and health system is an important force to protect people's life and health.
Since the 18th National Congress of the Communist Party of China, the CPC Central Committee with Comrade Xi Jinping as the core has proceeded from the overall development of the party and the country, adhered to the people-centered development philosophy, and integrated the deepening of medical reform into an important part of comprehensively deepening the reform to make overall planning and planning. Fully advance.
Wang Hesheng, deputy director of the National Health Commission and deputy director of the Secretariat of the State Council's Medical Reform Leading Group, said: "We adhere to the public welfare nature of basic medical and health care, and closely follow the institutional guarantee of strengthening people's health. The overall efficiency of the health governance system has been enhanced, the allocation of medical and health resources has been optimized, the quality and level of medical and health services have been improved, the capacity of medical security and drug supply has been strengthened, the comprehensive supervision of the industry has been standardized, and basic medical care with Chinese characteristics has been gradually established and improved. Health system, people's health level has been significantly improved. Practice has proved that the direction of medical reform is correct, the path is clear, the measures are effective, and the results are remarkable."
"In a sense, the day when the hierarchical diagnosis and treatment system is realized is when the reform of my country's medical system succeeds." Ma Xiaowei said.
At present, my country's hierarchical diagnosis and treatment has achieved phased results.
After the construction and development during the "Thirteenth Five-Year Plan" period, the first diagnosis at the grassroots level has been effectively promoted. By the end of 2020, the contracting rate of family doctors for key groups has increased from 28.33% in 2015 to 75.46% in 2020. reached 94%, an increase of 10 percentage points over the same period in 2015.
"Two-way referral" is more orderly, especially the number of patients who are referred down has increased year by year, with an average annual growth rate of 38.4%.
The rapid and slow division and treatment have achieved initial results, with 120 types of ambulatory surgery pilot diseases, and more than 14,000 "five centers" have been built.
(The "five centers" refer to the stroke center, the chest pain center, the trauma center, the critically ill maternal care center, and the critically ill child and neonatal care center - reporter's note)
In view of the outstanding problem of shortage and uneven distribution of high-quality medical resources in my country.
The "Thirteenth Five-Year Plan for the Establishment of National Medical Centers and National Regional Medical Centers" released in 2017 has further improved the allocation of high-quality medical resources between regions and promoted the sharing of regional medical resources through reasonable planning, capacity building and structural optimization. , promote the homogeneity of medical services, gradually realize regional separation, promote the scientific development of public hospitals, and establish a hierarchical diagnosis and treatment system in line with my country's national conditions.
Yangyang is the beneficiary of the construction of the National Regional Medical Center.
Although Yangyang's tumor has reached an advanced stage, since the overall cure rate of childhood tumors in my country is close to 80%, and the Yangyang tumor has not spread seriously, the overall treatment effect is relatively optimistic.
Before the operation, Yangyang could walk in a walker and learned to call him Dad.
Cheng Haiyan told Wang Jianyu that Yangyang would never remember that he had this disease when he grew up.
Even so, Wang Jianyu and his wife will not talk about their illness in front of their children, let alone cry in front of their children. They want to let their children grow up in sunshine and happiness as much as possible.
(In order to protect the privacy of patients, Yangyang and Wang Jianyu are pseudonyms)
China Youth Daily, China Youth Daily reporter Liu Changrong Source: China Youth Daily