Violence against doctors in China
Violence against doctors in China
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DOI：
10.1016/s0140-6736(14)61439-2
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发表时间：
2014-08
期刊：
影响因子：
--
通讯作者：
Liu Yueju
中科院分区：
文献类型：
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作者：
Liu Yueju
我们感谢《柳叶刀》对中国医院暴力事件的报道。1根据中国医院协会2012年12月至2013年7月的一项调查，2基于30多个省份316家医院的数据，针对医务人员的暴力事件从2008年每家医院20.6起增加到2012年的27.3起。2012年，96%的医务人员遭受过虐待或伤害，39.8%的医务人员计划放弃医疗行业或转行。中国医院暴力事件激增的原因是什么？首先，卫生方面的投资严重不足。中国人口占世界总人口的22%，而中国卫生总支出仅占世界总支出的2%左右。2008年，中国卫生总支出仅占GDP的4.3%，卫生支出占政府支出的10.3%，人均卫生支出为146美元，而美国分别为15.2%、18.7%和7164美元。在中国，每1000名公民中有1.4名医生，而在美国是2.7名。二是医疗费用快速上涨。从2000年到2010年，卫生总支出从人均361·9日元增加到人均1490·1日元，自费卫生支出几乎增加了两倍。3第三，医生的高工作量和低收入不平衡。大约80%的医生称自己工作过度，收入过低。例如，在我的医院，从2001年到2012年，入院人数从14.23亿增加到35.04亿，年均增长率为7.8%。住院人数从2001年的22 406人增加到2012年的70 424人。同期手术数量增加了两倍。然而，12年间医生人数从438人增加到720人，年均增幅仅为4.23%；因此，每名医生每天的工作量从12.94个病人大幅增加到19.39个病人，增加了49.79%。即使在城市，许多医生一个月的收入也只有5000日元（780美元）甚至更少。这种不平衡可能导致医疗差错、腐败以及卫生专业人员与患者之间的沟通不畅。我希望通过加大政府投入，大力推进慢性病一级预防，普及公众健康知识，提高医生的地位，中国的医院变得安全。
We are thankful to The Lancet for covering hospital violence in China. 1 According to a survey by the Chinese Hospital Association between December, 2012, and July, 2013, 2 violence against medical staff has increased from 20· 6 assaults per hospital in 2008, to 27· 3 in 2012, based on data from 316 hospitals in more than 30 provinces. 96% of medical staff have been abused or injured in 2012, and 39· 8% of staff planned to give up the medical profession or switch to another profession. 2 What is the reason for this surge in hospital violence in China? First, there is a serious shortage of investment in health. China’s population accounts for 22% of the world’s total population, whereas China’s total health expenditure accounted for only about 2% of the world’s total expenditure. In 2008, the total health expenditure was only 4· 3% of GDP, health expenditure was 10· 3% of government expenditure, and health expenditure was US $146 per head in China, whereas in the USA these were respectively 15· 2%, 18· 7%, and $7164. The number of physicians per 1000 citizens is 1· 4 in China, whereas it is 2· 7 in the USA. 3 Second, medical costs increased rapidly. The total health expenditure rose from¥ 361· 9 to¥ 1490· 1 per head and out-of-pocket health expenditure nearly tripled from 2000 to 2010. 3 Third, there is an imbalance between high workload and low income for doctors. About 80% of doctors describe themselves as overworked and underpaid. For example, in my hospital, from 2001 to 2012, the number of admissions increased from 1· 423 million to 3· 504 million, an annual average rate increase of 7· 8%. The number of inpatients increased from 22 406 in 2001 to 70 424 in 2012. The number of surgeries tripled during the same period of time. However, the number of doctors increased from 438 to 720 during the 12 years, an annual average increase of only 4· 23%; therefore, the workload greatly increased from 12· 94 to 19· 39 patients per doctor per day, a 49· 79% increase. Even in cities, many doctors earn as little as¥ 5000 ($780) a month or less. The imbalance can lead to medical errors, corruption, and poor communication between health professionals and patients. I hope that hospitals in China will become safe by increasing governmental investment, vigorously promoting primary prevention of chronic diseases, spreading public health literacy, and improving the status of doctors.