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Confusing fees and unqualified platforms. How do “online nurses” work in accordance with the law?
- Categories:Industry Information
- Author:
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- Time of issue:2019-03-21 11:09
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(Summary description)Service prices and service standards are not uniform; the quality of medications is difficult to guarantee; some apps do not have a medical institution license, and many nurses take orders privately on the platform ---
Confusing fees and unqualified platforms. How do “online nurses” work in accordance with the law?
(Summary description)Service prices and service standards are not uniform; the quality of medications is difficult to guarantee; some apps do not have a medical institution license, and many nurses take orders privately on the platform ---
- Categories:Industry Information
- Author:
- Origin:
- Time of issue:2019-03-21 11:09
- Views:
Information
Service prices and service standards are not uniform; the quality of medications is difficult to guarantee; some apps do not have a medical institution license, and many nurses take orders privately on the platform ---
How do "online nurses" work in accordance with the law?
Wang Shuai/Drawing
Place an order on your mobile phone, and you can make an appointment for a nurse's door-to-door injection, infusion, and dressing change. The development of the mobile Internet has brought "online nurse appointments" into people's lives. A few days ago, the National Health Commission officially issued the "Notice on Launching the "Internet + Nursing Service" Pilot Work" and the "Internet + Nursing Service" Pilot Work Plan (hereinafter referred to as the "Program"), which was determined to be in Beijing and Tianjin Six provinces and cities in Shanghai, Shanghai, Jiangsu, Zhejiang, and Guangdong have carried out the "Internet + Nursing Service" pilot program. The pilot period is from February to December 2019. This means that "online nurses" are officially recognized. In fact, many "online nurse appointments" apps have emerged before this, and they have reflected many problems.
There are media reports that many "online nurse appointments" apps have problems such as service prices, inconsistent service standards, and difficulty in ensuring the quality of medications. Some apps have not obtained a medical institution practice license, and many nurses have registered their accounts on the platform to accept them privately. Shan... The reporter found in the investigation that whether these problems can be solved is related to the survival and sustainable development of the emerging format of "online nurses".
understaffed
Charge confusion
Many users have expressed their views on the new service model of "online nurse appointment".
The reporter collected some users' evaluations of the "Online Appointment Nurse" App. Users who gave good comments said, “Nurses can come to see a doctor, which is very convenient”, “It is convenient to register, and one-click appointment registration saves waiting time” “It is very convenient for elderly people with disabilities at home” and “The nurses are dedicated and attentive, and they can also teach people the knowledge of health preservation. "...Comprehensively, it can be seen that many people think that one of the advantages of the "Online Appointment Nurse" App is that it is convenient, time-saving and labor-saving. This is in contrast to the "plan" "for discharged patients or special populations suffering from diseases and inconvenient mobility." The concept of "Nursing Services Provided" coincides with each other.
However, the bad reviews received by the "Online Appointment Nurse" App also reflect some problems to a certain extent. The user "Tang Yan" commented on an "online nurse appointment" app that "the after-sales service is extremely poor, and nurses charge arbitrary fees. She commented: “The nurse called and said that in addition to the fees paid on the platform, they also need to collect money. I want to cancel the order, but the platform still needs to deduct a 30% service fee.” The user "Guyue Zhimeng" said, " No one took the order, but the related expenses have been prepaid. No one took the order, indicating that the staff is still insufficient." Regarding the difficulty of taking the order, the user "sunray982" also said, "The nurse is either too far away or has no time. It’s really too few and too difficult to make an appointment successfully.” The user “lttxc” reflected another problem, “A single transfer of three nurses, personal information was collected offline many times, and the last nurse who took over did not arrive at the appointed time. ."
How does the relevant “online nurse” app respond to the situation reported by users? Regarding the issue of charging fees, the reporter saw in the “appointment notice” in the relevant app that if the service staff accepts the order, the user wants to cancel the order at least in advance Contact customer service within 4 hours. If the order is returned within 1 hour before the start of the service, the platform will charge a 60% service fee; if the order is returned within 2 hours before the beginning of the service, the platform will charge a 30% service fee. This is similar to the situation where passengers have to refund after purchasing a train ticket. It is the same as charging a 10% handling fee for more than 24 hours and less than 48 hours before driving, and a 20% handling fee for less than 24 hours. The "Online Appointment Nurse" App charges a handling fee, which may be due to the consideration that if the order is cancelled too close to the appointment time, it will cause a lot of trouble to the nurses who have already left.
Relatively speaking, it is rare for large cities to take orders without nurses. Regarding the difficulty of taking orders in small and medium-sized cities that are still developing, some platforms are also being improved. In response to users’ complaints about nurses’ slow receipt of orders and arbitrary charges, customer service said that if nurses charge indiscriminately, users can report to the platform.
The platform is not qualified
Suspected of illegal practice
Some netizens also raised the question: Before the release of the "Plan", were those third-party platforms that did not have medical qualifications but provided "online nurse" services legal? Are the nurses who register as individuals on these platforms illegal? ?
Third-party platforms that do not have medical qualifications allow nurses to register to provide services, which may cause third-party platforms and medical institutions and nurses to have responsibilities, rights and rights in medical services, information security, privacy protection, nurse-patient safety, and dispute resolution. The issue of ambiguous obligations may also have a major hidden danger of causing harm to patients.
What kind of platform has medical qualifications is clearly stipulated by the law. Article 9 of the "Regulations on the Administration of Medical Institutions" stipulates that the establishment of a medical institution by a unit or individual must be reviewed and approved by the health administrative department of the local people's government at or above the county level and obtain an approval letter for the establishment of a medical institution; Article 24 stipulates that any unit or individual shall, Without obtaining the "Medical Institution Practicing License", no diagnosis and treatment activities are allowed.
Under what circumstances nurses can carry out medical activities, there are also traces of our country’s laws. Article 9 of the "Regulations on Nurses" stipulates that if a nurse changes the place of practice within the validity period of his practice registration, he shall report to the health authority of the people’s government of the province, autonomous region, or municipality where he intends to practice. According to Article 9 of these regulations, nurses and other personnel who go through the procedures for changing the place of practice shall engage in nursing activities specified in the technical specifications for diagnosis and treatment in this institution.
According to the "Plan", it can be learned that "online nurses" are a way for qualified and qualified hospitals to provide high-quality medical services to patients. Third-party platforms can only cooperate with medically qualified hospitals and other medical institutions. Zhou Hao, a lawyer from Beijing Weiheng Law Firm, believes that nurses' behavior of "accepting private work" is not allowed by the "Plan". The Practicing Physician Law and the "Nurse Regulations" also do not provide that nurses can take orders in their own name. Nurses who register privately to take orders may also be suspected of illegal practice.
Li Hongzhao, a practicing lawyer in Beijing, believes that the third-party platform has not obtained a medical institution practice license and violated the provisions of the "Regulations on the Administration of Medical Institutions" by providing "online appointment nurses" services without authorization, which is suspected of illegal practice. According to Article 9 of the "Nurses Regulations", nurses who register on a third-party platform without authorization should consider that they have added or changed their practice locations without authorization and violated the "Nurses Regulations".
Nurse takes care of private work
Platform bears joint and several liability
Then, if the “online nurse” takes over private work through an unqualified App and causes a dispute, who should be responsible for it?
Many people have misunderstandings, believing that nurses take orders in private and cause disputes. The responsibility rests entirely with the nurses, who should be solely responsible for them. When the reporter mentioned that a third-party platform might be responsible for the nurse’s mistakes, Mr. Wang from Beijing expressed his doubts: Why does the platform provide convenience for everyone to “match the bridge”?
Article 12 of the Electronic Commerce Law, which was formally implemented in January this year, stipulates that if an e-commerce operator engages in business activities and needs to obtain relevant administrative licenses in accordance with the law, he shall obtain administrative licenses in accordance with the law. Article 38 stipulates that for goods or services related to the lives and health of consumers, e-commerce platform operators have not fulfilled their obligation to review the qualifications of operators on the platform, or have not fulfilled their obligations to ensure safety to consumers, causing consumer damage If it is, it shall bear corresponding responsibilities according to law.
Qiu Baochang, president of the Beijing Law Society E-commerce Rule of Law Research Association, said that medical institutions, auction companies and other industries need to obtain administrative licenses. Without permission, third-party platforms are obliged to abide by laws and regulations and prevent e-commerce from selling goods and providing services. In addition, third-party platforms need to perform review obligations for nurses registered on the platform. If a nurse registered on the platform harms the patient because the platform has not been reviewed, the third-party platform needs to bear joint and several liability.
“For medical disputes caused by nurses taking orders privately, the platform side should share joint tort liability with the nurses,” Zhou Hao pointed out. “The Plan also makes it clear that the platform side cannot directly cooperate with individual nurses.”
Qiu Baochang believes that if a nurse is registered on a third-party platform in the name of a hospital and a dispute arises, the doctor serves the patient under the approval of the hospital, which is a duty behavior, and the hospital shall bear the responsibility for the patient. In such cases, whether the platform needs to pay in advance depends on the contract provisions between the platform and the hospital, the platform and the consumer, and the nurses and patients that the hospital provides services. The contract between the parties stipulates that the relevant laws and regulations such as the "Regulations on the Treatment of Medical Malpractice" shall be complied with, and the problem shall be solved fairly and reasonably.
Qiu Baochang said that the platform must take responsibility and abide by laws and regulations. Relevant regulations cannot be ignored because of innovation. The rules of service are well designed, demand and supply are well connected, and the services of “online nurses” must be well connected with the needs of patients in an orderly manner.
"Online Appointment Nurse"
How to set the service price
Regarding the service price of "online nurses", the person in charge of the National Health Commission once stated that service prices are determined by the market, and nurses mainly provide services in their spare time. The "Plan" also retains the "market-adjusted price" mechanism.
According to the reporter's observation, the service prices of multiple "online nurse appointments" apps vary greatly. As far as the "infusion" service is concerned, some apps are priced at 189/time, while others are priced at 289/time. The price of "online nurses" on-site services is also much higher than going to the hospital on their own.
Qiu Baochang said that at the beginning of the pilot program, the "Internet + nursing service" should be regulated by the market and should not be priced by the government.
"Online appointment of nurses" is a personalized demand, people can choose to go to the hospital to see a doctor, or they can choose to have a nurse on-site to provide services. Some people feel that the comfort and convenience of treatment at home is higher than that of going to the hospital on their own, and the time for medical treatment is less than that of going to the hospital, so the service fee is slightly higher and reasonable. Qiu Baochang believes that as long as the price of the service follows the law, the price is clearly marked, and there is no price fraud, then the price negotiated by both parties is higher or lower, which is something everyone recognizes. As long as the law is not violated, relevant departments should not interfere too much.
Xia Xuemin, a guest researcher at the Zhejiang Provincial Public Policy Research Institute, said that during the pilot period, "online nurse appointments" can use government-guided prices; after the pilot is successfully promoted nationwide, market-adjusted prices can be used.
"In pilot provinces, the health department should take the lead in establishing the service catalog and prices of online nurses, and the market supervision department should take the lead in conducting market supervision and inspection, and severely investigate and deal with unqualified, arbitrary fees, and unsafe "network nurses", and prohibit unqualified nurses. Medical institutions provide services." Xia Xuemin specifically introduced.
In addition to clearly marking the price of the "online nurse appointment" service, Xia Xuemin also believes that any individual or organization should not delete bad reviews given by users on the service. Medical institutions and health groups that provide online nurses should have statutory subject qualifications and medical and health practice qualifications, and proactively "bright labels" on prominent places on the Internet pages. Relevant departments should conduct an objective and fair third-party evaluation of the service quality of "online nurses".
Xia Xuemin further added: "The'online nurses' can be included in the medical and health service credit management system, and those who violate regulations and laws will be dealt with in a timely manner, bad information will be recorded in the credit file, and those with serious circumstances will be blacklisted, and the whole society will implement joint punishment. "
is "online appointment nurse"
Provide policy guarantee
In recent years, "Internet +" new service methods such as "online car-hailing", "online housekeeping" and "online nursery" have gradually emerged. While "Internet+" facilitates people's lives, it is also worrying about some practical issues such as whether it can ensure the personal safety of both parties and whether it can protect private information. After the "Plan" is released, can it provide a safety guarantee for people who use "online nurses"?
Currently "online appointment nurses" are in the pilot phase. Zhou Hao believes that users should pay attention to medical safety during the online appointment process. In the process of "online appointment", it is necessary to pay attention to whether the online appointment nurses are qualified nurses sent by regular hospitals, and pay attention to leaving traces during the entire medical process.
According to the "Plan", physical medical institutions that have obtained the "Medical Institution Practicing License" and have provided services such as family beds, rounds, etc., are eligible to rely on the Internet information technology platform to provide "online nurses" services. Li Hongzhao said that in the online appointment process, users should review whether the relevant platform has the corresponding medical qualifications, and at the same time review the qualifications of nurses. "In the national nurse electronic registration system, you can check the qualifications of nurses."
Xia Xuemin introduced that "online appointment nurses" are the latest achievement of the reform of my country's medical and health system, the latest measure for medical resources to further sink to the grassroots level to patients, and the latest response measure for the health department to assume the functions of elderly care services after the institutional reform. , Is also the specific application of the Internet economy in the medical and health field. The issuance of the "Plan" points out the direction for the development of "online nurses", defines the boundaries, and provides policy guarantees.
The National Health Commission takes the lead in establishing a national information management platform for registered doctors and registered nurses to provide legal and effective identity authentication for "online nurses". This move is expected to solve the previous problem of users' troubles with the identity of "online nurses" and reassure users. Xia Xuemin believes that the "Plan" encourages real-name registration through mobile apps, medical institutions or health information platform companies to strengthen security management and control, and use mature human feature recognition technologies such as face recognition to ensure the true and effective identities of both online nurses and patients. Time can be compared with the public security system in real time to eliminate hidden dangers to the greatest extent, and to a certain extent avoid repeating the crime of rape and murder by online car drivers.
"Online appointment of nurses" is an inevitable product of the Internet economy. In order to avoid "flashing", it should be treated with caution and gradually opened up. Zhou Hao suggested that relevant departments may issue detailed rules to improve the detailed rules for the practice of "online nurse appointments", and at the same time include them under the supervision of relevant health departments.
It should be noted that the "Plan" clarifies that the key groups of "online nurses" for on-site services are the elderly, disabled elderly, and patients in the convalescence and terminal stages. At present, there are more than 40 million semi-disabled elderly people in the country, and the team of more than 3.8 million nurses is far from enough. Researcher Xia Xuemin suggested that the health and education authorities should formulate a talent training plan as soon as possible. Just like actively cultivating obstetrics and gynecology talents to cope with the demand for second children, expand the scale of training various nursing professionals as soon as possible, unblock the channels for the promotion of nursing talents, and let the "net" "Nurse appointment" has been better developed.
Su Guangtian Yang Lingling
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