2018年4月30日 星期一

英國內政大臣辭職及其他



在立法會的走廊裡碰到區諾軒議員剛開《廣深港高鐵(一地兩檢)條例草案》委員會。他氣沖沖地說,“D 官員答得太過份了。”英國今天有一位內務大臣,就講大話而被迫辭職。
英國內政大臣盧綺婷因為,在政府是否有“驅逐非法移民的目標數字”,誤導了國會,作假證,而辭職(註九)。首相文翠珊表示理解其理由(but understand your reasons for doing so.),即不作挽留(註十)。 
It is with great regret that I am resigning as home secretary. I feel it is necessary to do so because I inadvertently misled the Home Affairs Select Committee over targets for removal of illegal immigrants during their questions on Windrush. ----- 盧綺婷辭職信

「疾風世代」移民事件簿


1948年「帝國疾風」(註一)號客輪承載了1027名難民到英國,當中約半來自牙買加。這批移民是合法移民,但當局並未發放文件證明他們是英國合法公民,而英國在1962年才制訂移民法。英國的享有合法移民身份,但無法取得身份證明的被統稱為「疾風世代」移民。內政部正準備訂立新的法規,處理「疾風世代」問題和各類因移民問題做成的家暴。
I had hoped in coming months to devise a policy that would allow the government to meet both these vital objectives - including bringing forward urgent legislation to ensure the rights of the Windrush generation are protected. The task force is working well, the residence cards are being issued well within the two weeks promised, and the design of the compensation scheme is making good progress.----- 盧綺婷辭職信

「帝國疾風」醜聞

由於一些難民不適應英國複雜的移民法,估計有12萬英國移民兒童沒有身份證明(註五),尤其是19731月前的一些個案,事主需獲合法移民身份,但沒有向當局申請,也無法提供所有必要文件(註七)
「帝國疾風」醜聞(註二)是指英國在雷厲風行遣返非法移民中,被指責過猶不及,不提供法律援助,以“Go home” vans等手法,誤將審理中的個案、未有正式身份證明的合法居留者遣返原地的事件(註三),或錯誤地被褫奪福利。英國郵報報導,移民局承認的確有錯誤遣返(註四)。盧綺婷答覆,在8千個「帝國疾風」兒童(即合法移民)個案中的已翻閱的7千個,沒有發現有錯誤遣返或被移民拘留(註六)
政府承認這是醜聞,盧綺婷答允完成調查後向國會報告。
Amber Rudd:“As I said to the hon. Gentleman yesterday at the Select Committee hearing, as a result of the Windrush scandal, we are going back to 2002 to look at whether there have been any inappropriate deportations, and when we have that information, I will come back to the Committee.

事件起因

Amber Rudd: We do not have targets for removals.
盧綺婷在特別委員會作證時,表示她沒有向各區施加壓力,要它們交人蛇數(註八),而移民局工會反證,他們由於交不足數,唯有找一些最弱勢的砌生豬肉(the “low-hanging fruit”)
盧綺婷被特別委員會主席追問,有否與文翠珊討論每年計劃遣返的目標數字?她答:“冇”。
Q97 Chair: Have you asked the Prime Minister to get rid of the net migration target?
Amber Rudd: I have not discussed that with the Prime Minister.
因而,整個焦點轉移為,政府有否“遣返計劃的目標數字”?


國會聽證會

426日,內相盧綺婷被下議院緊急質詢,因為傳媒公開了政府內部文件,顯示盧綺婷的確有目標數字,並曾寫備忘錄給首相文翠珊(11)
盧綺婷被質問,“內政部下達每月抓8337非法移民的目標,還在各地區的辦事處的海報上記載,你是否需要辭職?”
the target this month was 8,337, with targets on posters in regional centres.
盧綺婷的所謂向國會道歉只有一句,“很不幸,我疏忽了,我應該注意到這件事的。
(Unfortunately, I was not aware of them, and I want to be aware of them, which is why I am now putting in place different measures to ensure that that happens.)
這半小時的國會辯論決定了盧綺婷的命運。盧綺婷辯解,這指標只是為了考核公務員的成積,但沒有被反對派接納。
The document stated that his agency had “set a target of achieving 12,800 enforced returns in 2017/18 … this will move us along the path towards the 10% increased performance on enforced returns which we promised the Home Secretary earlier this year”.
英國的下議院的兩派攻訐與香港的差不多。盧綺婷不斷換移視線──“打擊非法移民應與保障合法移民分辨開”。保守黨則攻勢反對派不支持政府為了公民利益的工作。反對派列舉政府的不人道對待新移民(12)
但英國的保守黨比香港的保皇黨好得多,它也要求政府將移民看作人,而不是數字──(and ensure that immigrants, migrants, are seen as people and not numbers?) (13)

其他

英國新鮮熱辣的政壇事件和應著香港的。我們看到一個成熟的民主體制如何運作,和民主的好處。
筆者認為需要向許智峯問幾個問題:
1.      假若對方是男性,在同樣的情況下,你會否有同樣的反應?
2.      假若事情發生在立法會的門外,你會否有同樣的反應?
3.      你認為,在沒有即時危險的情況下,搶對方手機和檢查其手機內容是否犯法?
許智峯行為明顯地與性別無關,而整個話語界的焦點放在這裡,令人扼腕!

備註

註一

The ship docked at docked at the Port of Tilbury, near London, on 21 June 1948,[15][16] and the 1027 passengers began disembarking the next day. The generally accepted figure for the number of West Indian immigrants on board is 492. The ship also carried 66 Polish people who had traveled to Jamaica from Siberia via the Pacific, and who also intended to settle in the United Kingdom.
The arrival of the ship immediately prompted complaints from some members of parliament, but the first legislation controlling immigration was not passed until 1962.

註二


The Chagossian community is relatively small. Roughly 3,000 live in the UK and several thousand more live abroad, which might be why they are often overlooked – but their story is equally tragic and has echoes of the tragedy of the Windrush generation.
The Chagos Islands are a UK Overseas Territory, like the Falklands or Gibraltar. They are members of the Commonwealth – that place where equality and democracy are promoted. That place where we are supposed to take care of each other. But in the 1960s and 70s, the islands’ inhabitants were violently removed by the UK government and discarded on the docks of Mauritius and the Seychelles. The UK government had leased Diego Garcia, the archipelago’s largest island, to the US military.

註三

24 April 2018                     Volume 639
Richard Burgon (Leeds East) (Lab)
The Windrush scandal is one of the cruellest examples of unaccountable state power targeting the vulnerable, defenceless and innocent that I can remember. Senior figures describe our immigration law as complex and unintelligible to everyone but working specialists, so I was disappointed to hear the Home Secretary say yesterday that people affected by the Windrush scandal will have “no need for lawyers”. I am sure that the Justice Secretary will understand why those words will not do, so will he guarantee today that all those who have been put into this kind of situation will have access to the necessary legal advice to help them when they need it most?

Tom Brake (Carshalton and Wallington) (LD)
The Windrush scandal and the heartbreaking stories that the Home Secretary referred to a few moments ago are a direct consequence of the hostile immigration environment of the then Home Secretary and now Prime Minister. It started with the “Go home” vans and ended with the threatened deportation of British citizens. Can the Home Secretary guarantee that as the “hostile environment” is dismantled, hundreds of British citizens such as my constituent Mrs A, who came here as a child in 1960 from India and is currently stateless, will finally—no ifs, no buts—be granted British citizenship?

Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)
This is not about illegals; it is about British citizens and people with a legal right to be here, and it goes well beyond the Windrush generation. How many cases are known to Ministers and officials of people who have been wrongfully deported or wrongfully detained? I know for a fact that there are cases in both categories—I met some of the individuals yesterday. How many are there in each category?

Amber Rudd
As I said to the hon. Gentleman yesterday at the Select Committee hearing, as a result of the Windrush scandal, we are going back to 2002 to look at whether there have been any inappropriate deportations, and when we have that information, I will come back to the Committee.

註四

The government is under intense pressure to end the 'inhumane' betrayal of migrants who came here with their parents after the Second World War and never became naturalised British citizens.
Tens of thousands who arrived as children from the Caribbean are said to have been 'treated like criminals'.
The 'horrendous' treatment of Windrush immigrants has included some being wrongly deported, a minister admitted today.

Immigration minister Caroline Nokes said she had been 'appalled' by the cases - but said she did not know how many had been ejected in error.
By James Tapsfield, Political Editor For Mailonline
Daily Mail
12:45 16 Apr 2018, updated 13:59 16 Apr 2018

註五

Wednesday 25 April 2018   3.30 pm
Special Committee
Home Affairs - Oral Evidence Session
Adrian Berry, Chair, Immigration Law Practitioners’ Association Lucy Moreton, General Secretary, The ISU Satbir Singh, Chief Executive, Joint Council for the Welfare of Immigrants Rt Hon Amber Rudd MP, Home Secretary Glynn Williams, Director General responsible for Border, Immigration and Citizenship
Location: The Grimond Room, Portcullis House
Windrush children
Q45 Stuart C. McDonald: You also mentioned children. I read there had been an estimate back in 2012 that there were something like 120,000 undocumented children in the country, who were either born here or had been here for lengthy periods of time. They would all have some sort of route to regularise their status. Again, if they are unable for whatever reason to regularise their status the hostile environment presumably will end up impacting on them as well.

註六

Wednesday 25 April 2018   3.30 pm
Special Committee
Home Affairs - Oral Evidence Session
Chair: “ Do you have further answers now about what the scale of the problem is, how many Windrush children, for example, might have been detained and for what periods of time, whether any may have been deported and how many may have been subject to reporting requirements?”
Amber Rudd :Perhaps I may address the key question that I have been asked a number of times, which is, “Has anybody been deported?” The answer to that is, “Not as far as we can see at the moment”. We have gone back to 2002. We have 8,000 records of people who could have been in a group should they have been deported. It is a fairly extensive process, some of it being checked by hand, and everybody has been working on it over the past eight or nine days. We have got through 7,000 and at the moment we have not found anybody who we believe has been removed because of that. I recognise that obviously we need to finish that process. When it is finished, I will be speaking to my Permanent Secretary about finding out about independent assurance. I recognise that we also need to give people confidence in the facts as we have found them. We have not quite finished that process yet and it is ongoing. “

註七

Amber Rudd: This is the core of the problem, which is that people who arrived before January 1973 were entitled to residency and to apply for the legal status of being British but they were never sufficiently encouraged to do so and to regularise their position. The Home Office itself, over decades, was not aware that this particular cohort needed different treatment. That is what I am trying to change.

註八

Q85 Chair: Targets for removals. When were they set? Amber Rudd: We do not have targets for removals.
Q86 Chair: But you did? Amber Rudd: What are you referring to?
Q87 Chair: We have just heard in the previous evidence that in the Home Office there are regional targets for net removals. Amber Rudd: I did not hear the testimony. I am not sure what shape that might be in. If you are asking me if there are numbers of people we expect to be removed, that is not how we operate. I know we are talking about Windrush here, who are legal migrants, but where there are people who are here illegally it is right that we do try to remove them.
Q88 Chair: We have just had testimony in our evidence session that has been very clear that there are removals targets in place. Perhaps Mr Williams could clarify. Are there removals targets for different regions of the enforcement team? Glyn Williams: I am not in charge of enforcement but not as far as I know, no.
 Q89 Chair: Okay. We have just had very clear evidence. We are going to need to clear this up very quickly because if there are removals targets in the Home Office and the two people who are supposedly in charge do not know about them, that feels pretty serious. It feels like a lack of grip anywhere in the system. If there are not, obviously I do not want to be putting unfair questions to you. Amber Rudd: Perhaps you could clarify what was said to us. Was it a target based on a number or a percentage? It is correct that I have asked for more removals to place because I would like to see people who are here illegally removed.
Q90 Stephen Doughty: It was a very clear point from the Immigration Services Union who said there were net removal targets by region across the UK. We need to know if that is true or not. Amber Rudd: By number?
Q91 Stephen Doughty: A net removals target you would assume is a number of people that you are trying to remove from a region. We were told about the wider impact of the net migration policy and how that filters down to KPIs and targets for individual decision-makers, both in terms of removals, processing times and so on. It is very clear this is having an impact on day-to-day decision-making. Amber Rudd: I will certainly take a look at the testimony that you have been given.
Q92 Chair: I have also heard from somebody who works in Immigration Enforcement who said that they have had for some years internal enforcement targets, that these were regional targets, that the targets had been increasing every year, including for removals, and the Director General would report back to the Permanent Secretary regularly. They were set by a local command group. However, there has been an issue recently that some of the targets have been dropped because so few were being met as of this month, but up until this month these targets were all in place. I also was told that local managers, under pressure to meet those targets, would instruct staff to go looking for the easiest targets, the “low-hanging fruit”. What do you say to that? Amber Rudd: I think that is extraordinary language to use. Who would refer to anybody as low-hanging fruit? 

註九

Amber Rudd has resigned as home secretary after a period of political pressure stemming from her handling of the Windrush scandal. Here is the resignation letter she sent to Prime Minister Theresa May. Mrs May's response is also published in full below.

Dear Prime Minister,

It is with great regret that I am resigning as home secretary. I feel it is necessary to do so because I inadvertently misled the Home Affairs Select Committee over targets for removal of illegal immigrants during their questions on Windrush.

Since appearing before the select committee, I have reviewed the advice I was given on this issue and become aware of information provided to my office which makes mention of targets. I should have been aware of this, and I take full responsibility for the fact that I was not.

The Windrush scandal has rightly shone a light on an important issue for our country. As so often, the instincts of the British people are right. They want people who have a right to live here to be treated fairly and humanely, which has sometimes not been the case. But they also want the government to remove those who don't have the right to be here. I had hoped in coming months to devise a policy that would allow the government to meet both these vital objectives - including bringing forward urgent legislation to ensure the rights of the Windrush generation are protected. The task force is working well, the residence cards are being issued well within the two weeks promised, and the design of the compensation scheme is making good progress.

The Home Office is one of the great offices of state and its job is to keep people safe. It comes with the responsibility to fight terrorism, support and challenge the police and protect people against the abuse, as well as manage migration.

It has been a great privilege to serve as your home secretary. I have seen first-hand the second to none commitment and bravery of our police, fire and intelligence services, they truly are the best in the world and we should rightly be extremely proud of them.

I have been particularly pleased that we were able to set up the first Global Internet Forum for Counter Terrorism which has led the way with encouraging social media sites to go further and faster in taking down radicalising and terrorist material, which plays such a dangerous part in increasing extremism.

Setting out new laws to tackle the scourge of knife crime and acid attacks and helping to steer our young people away from a life of crime and violence by providing them with credible alternatives have been particularly important to me.

Opportunities to work on issues that safeguard the vulnerable, champions women and make a lasting impact on people's lives particularly stand out for me. New policies to fight domestic violence and abuse against women are out to consultation, and will lead this country to taking a new approach. Helping to bring thousands of refugees, including child refugees from both Calais and the Middle East region, and meeting some of the families who fled the terrible situation in Syria and have now been given a chance to rebuild their lives here in the UK in safety and security is something we can be proud of.

It has been an honour to work on a new security treaty with the EU as part of our new partnership going forward and to participate in your Brexit sub-committee helping to ensure that we have the best possible EU deal for our economy, businesses, jobs and people across the UK.

The new Economic Crime Centre that i launched with the first use of unexplained wealth orders will be important to the confidence of London as a financial centre.

I will continue to support the Home Office ministerial team whenever possible on all these important subjects, supporting the government from the back benches and continuing to work hard for my constituents of Hastings and Rye.

Best wishes,

Amber Rudd

註十

Here is the prime minister's response:

Dear Amber,

Thank you for your letter of this evening tendering your resignation as home secretary. I was very sorry to receive it, but understand your reasons for doing so.

When you addressed the House of Commons and the Home Affairs Select Committee last week on the issue of illegal immigration, you answered the questions put to you in good faith. People who have entered the United Kingdom illegally or overstayed here should expect to face the full force of the law and know that they will be removed if they will not leave this country voluntarily. Just as importantly, people who have come here legally and enriched the life of our country should not expect the state unreasonably to challenge their presence here; rather, it should help them prove their right to continue living here and contributing to the life of our nation.

Under your tenure, the Home Office has been working to enforce a firm but fair immigration policy - working to increase the number of illegal migrants we remove, while ensuring that we continue to recognise the huge contribution of everyone who has come to the UK legally, and remain open to the brightest and best from across the globe.

When you spoke in the House of Commons, you said that you had not agreed specific removal targets, but that the Home Office's Immigration Enforcement command had been using local targets for internal performance management. You also said that you were not aware that those operational targets had been set.

I understand why, now that you have had chance to review the advice that you have received on this issue, you have made the decision you have made and taken responsibility for inadvertently misleading the Home Affairs Select Committee.

I am very sorry to see you leaving the Home Office, but you should take great pride in what you have achieved there - working with internet service providers to set up the first Global Internet Forum to Counter Terrorism and take extremist and terrorist content offline; countering the cyber threat to British families and businesses; standing up for the victims of crime, abuse and domestic violence; offering shelter to refugees from Syria and elsewhere; and advancing the cause of equality as minister for women and equalities.

This comes on top of the considerable contribution you have made to Government since 2012 - first as a whip, then as minister and subsequently secretary of state at the department for energy and climate change - as well as the devoted service you have always given, and will continue to give, to your constituents in Hastings and Rye.

As a former home secretary myself, I appreciate the particular demands of that great office of state. You should take great pride in the way you have led the Home Office and its dedicated public servants through a number of serious challenges, including five terrorist incidents and other complex national events. You have done so with great integrity, compassion, and selflessness - notwithstanding the personal and political challenges you have faced during this period.

I know that you have a great contribution still to make to national life, and look forward to seeing you do so.

Yours,

Theresa

 

註十一

Thursday 26 April 2018
House of Commons
10.30 am
Urgent question
Removal targets in the Home Office - Ms Diane Abbott
To ask the Home Secretary if she will make a statement about the use of removal targets in the Home Office.

Ms Abbott
Another day, another revelation about the Windrush scandal. Yesterday, giving evidence to the Home Affairs Committee, the Home Secretary said in terms:

We don’t have targets for removals.”

But the general secretary of the Immigration Service Union told the Committee earlier that there is a net removals target that enforcement teams have to meet and that they are aiming to remove a certain number of individuals in any given month. The general secretary later confirmed that the target this month was 8,337, with targets on posters in regional centres. When Lord Carrington resigned over the Falklands, he said that it was a matter of honour. Is it not time that the Home Secretary considered her honour and resigned?

Amber Rudd
I would like to make the very clear distinction between legal and illegal migrants. The right hon. Lady talks about the Windrush cohort. We have already established that the Windrush cohort is here legally. This Government are determined to put this right, which is why I put in the new measures to ensure that that happens.

I believe that I have addressed the issue of targets, referring to the fact that some offices are working with them. Unfortunately, I was not aware of them, and I ​want to be aware of them, which is why I am now putting in place different measures to ensure that that happens.


The document stated that his agency had “set a target of achieving 12,800 enforced returns in 2017/18 … this will move us along the path towards the 10% increased performance on enforced returns which we promised the Home Secretary earlier this year”.


註十二


Kirsty Blackman (Aberdeen North) (SNP)
  The Home Office decides who is legal and who is illegal in these cases. I have seen deported—or threatened with deportation—a man with scars on his back from whipping; somebody who was terminally ill and later died; and somebody whose dead children are buried in my constituency. All those people have been classed as illegal by the Home Office. Surely they should not be removed.

Ruth George (High Peak) (Lab)
Will the Home Secretary please commit to Home Office officials playing by the rules as well, and look into the case of the partner of my constituent Kelly, who was deported back to Jamaica last week with no notice, when his appeal had still not been decided? His partner is due to give birth in four weeks’ time.

13


Mr Speaker
Brevity personified, Anna Soubry.
Anna Soubry (Broxtowe) (Con)
It is not fair, Mr Speaker. You set me up to fail and I always do. This is a serious issue. Does my right hon. Friend agree that part of Labour’s dreadful legacy was an obsession with targets? As an excellent new broom, will she assure us that she will search in every nook and cranny, and ensure that immigrants, migrants, are seen as people and not numbers?

Amber Rudd
I completely agree with my right hon. Friend’s approach, and I do not want us to be run by a target culture. I want to ensure that the individual is put at the heart of every decision.


2018年4月29日 星期日

內地的網上醫療服務




平安好醫生(1833)是一隻網上醫療股,它20148月成立,其業務主要通過手機App平臺提供在線諮詢、預約掛號、在線購藥等服務,以及體檢、齒科以及醫護上門等服務,其覆蓋的醫療網絡,包括3,100間醫院、1,100間體檢中心、500間形科診所及7,500間藥店,其自建醫學團隊達1,000個,日諮詢量45萬次,而2017年截至20171231日,旗下的「在線健康商城」已提供高達178,800SKU。其公司在2015年純利蝕人民幣3.23億。
由於超額認購達數百倍,它在短期內凍資約3,800元。港元弱勢即是市場不需要這麼多的港元,平安好醫生幫助了這一需要。金管局的貨幣基礎約為17千億港元,平安好醫生首次招股無可避免地擾亂了銀行的隔晚息。由於這凍資(應叫凍結流通)3,800億港元不是真正的流通,因此,目前的貨幣基礎設計有一定矛盾。

股仔沒有興趣了解什麼是互聯網醫療行業,本文的主旨是討論中國的“互聯網+醫療健康”。港人只會關注公共醫療不足,但什麼才叫足夠呢?我們站在一個十字路口──要優質的醫療服務還是要廉價的醫療服務?
醫學霸權和政客大叫“人命攸關的”,“唔通見死不救?”,反對引入網絡醫療。問題是,冇錢始於冇得救的,救番只是好彩。小市民以實際行動解答了上述兩難。他們在社交媒體亂傳“各天生吃一斤大蒜可預防癌”等廢話,和自行到藥房配藥。我領教過了,我的寶貝姨甥女在幾歲大時,當著我的面,在地上抓把草,勸我,“食啦,化啖止咳的,我食過啦!” 互聯網醫療包括網上問診,網上購藥。看來,幫襯它們好過上述的民間智慧。

中國的網絡醫療規模

2018-2023年中國互聯網醫療行業盈利模式與投資前景研究報告”表示,“在中國,老齡化、90後、病患群體基數龐大。
國內外的互聯網醫療公司主要有兩類:第一類是從醫療穿戴研發入手發展客戶繼而形成平臺的公司;第二類是搭建平臺集成醫生資源、社群溝通等資源,通過平臺吸引使用者成為醫療服務互動平臺。
過去三年,國互聯網醫療市場約為28%的增長,2013市場規模為85.9億元,同比增長28.02%2014年為114億元,同比增長32.71%
醫療資源的緊缺使得患者、醫院、醫生等產業參與者痛點眾多,而互聯網正是解決這些痛點的契機。
未來預計到2016年,國互聯網醫療市場規模257.9億元,預計到2020年,則有可能超過800億元。(筆者按,單從數字,其規模不算很大。)
根據《2016中國處方藥院外市場研究報告》預測,國處方外流市場潛在規模為4000-5000億。但受制於零售藥店自身藥品供應能力、醫院系統對接能力,以及醫保支付端等問題,它尚需要解決不少關鍵問題

政策文件主導

中國的互聯網+醫療由三份文件主導,分別是201571日的《國務院關於積極推進“互聯網+”行動的指導意見》、  20161025日的《“健康中國2030”規劃綱要》和20180429日的《促進“互聯網+醫療健康”發展的意見》。 

《國務院關於積極推進“互聯網+”行動的指導意見》

這份文件涉及多個行業,與網上醫療相關的為:
在線醫療衛生新模式 
 3.互聯網的醫療衛生服務包括:支持廠商機構構建醫學影像、健康檔案、檢驗報告、電子病歷等醫療資訊共用服務平臺,建立跨醫院的醫療數據共用交換標準體系、在線預約診療、候診提醒、劃價繳費、診療報告查詢、藥品配送等便捷服務;醫療服務機構聯合互聯網企業,發展基因檢測、疾病預防等健康服務模式。
  4.促進智慧健康養老産業發展、健康服務機構利用雲計算、大數據等技術搭建公共資訊平臺,提供長期跟蹤、預測預警的個性化健康管理服務;在線健康市場調查、諮詢評價、預防管理等應用服務,提升規範化和專業化運營水準;提供護理看護、健康管理、康復照料等居家養老服務、便攜式體檢、緊急呼叫監控等設備等。
  5.推動在線課程資源共用,推廣在線開放課程等網絡學習模式,探索建立網絡學習學分認定與學分轉換等制度。
《“健康中國2030”規劃綱要》 
它是一份八篇,二十九章的深度文件,這裡只談其社區醫療。其第六篇,“發展健康產業”的第十七章,“優化多元辦醫格局”,談到:“支持社會力量舉辦非營利性醫療機構,推進非營利性民營醫院與公立醫院同等待遇。鼓勵醫師利用業餘時間、退休醫師到基層醫療衛生機構執業或開設工作室。擴大外資興辦醫療機構的範圍。加大政府購買服務的力度,支援保險業投資、設立醫療機構,推動非公立醫療機構發展,鼓勵發展專業性醫院管理集團。”

其第十八章“發展健康服務新業態”表示:“促進健康與養老、旅遊、互聯網、健身休閒、食品融合,催生健康新產業;發展基於互聯網的健康體檢、諮詢等健康服務,促進個性化健康管理服務發展;探索可穿戴設備、智慧健康電子產品和健康醫療移動應用服務;規範母嬰照料服務。培育健康文化產業和體育醫療康復產業。”

“引導發展專業的醫學檢驗中心、醫療影像中心、病理診斷中心和血液透析中心等。支援發展協力廠商醫療服務評價、健康管理服務評價,以及健康市場調查和諮詢服務。鼓勵社會力量提供食品藥品檢測服務。完善科技仲介體系。”

《促進“互聯網+醫療健康”發展的意見

這是最新的文件,作出了一些具體規範。文件:
1.      允許依託醫療機構發展互聯網醫院。醫療機構可以使用互聯網醫院作為第二名稱,在實體醫院基礎上,運用互聯網技術提供安全適宜的醫療服務,
2.      允許線上開展部分常見病、慢性病複診。醫師掌握患者病歷資料後,
3.      允許線上開具部分常見病、慢性病處方。
這裡只討論社區醫療和藥品供應服務。

社區醫療

(二)推動居民電子健康檔案線上查詢和規範使用。以高血壓、糖尿病等為重點,加強老年慢性病線上服務管理;納入國家免疫規劃的兒童服務,整合現有預防接種資訊平臺。鼓勵利用可穿戴設備獲取生命體征資料,為孕產婦提供健康監測與管理。加強對嚴重精神障礙患者的資訊管理、隨訪評估和分類幹預。
2.探索運用人群流動、氣候變化等大資料技術分析手段,預測疾病流行趨勢,加強對傳染病等疾病的智慧監測,提高重大疾病防控和突發公共衛生事件應對能力。

(三)優化“互聯網+”家庭醫生簽約服務。

1. 加快家庭醫生簽約服務智慧化資訊平臺建設與應用,加強上級醫院對基層的技術支持,探索線上考核評價和激勵機制。

2.為簽約居民線上提供健康諮詢、預約轉診、慢性病隨訪、健康管理、延伸處方等服務。

 “互聯網+”藥品供應保障服務


1.對線上開具的常見病、慢性病處方,經藥師審核後,醫療機構、藥品經營企業可委託協力廠商機構配送。促進藥品網路銷售和醫療物流配送等規範發展。
2.依託全民健康資訊平臺,加強短缺藥品多源資訊採集和供應業務協同應用,提升基本藥物目錄、鼓勵仿製的藥品目錄的遴選等能力。

後記

中國的“互聯網+醫療”在本質上是文革期的赤腳醫生的新版。但它結合了大數據和人工智能,有很強的生命力,也符合中國實際,不能泛政治地討論。
但它過度依賴金融經濟,容易被泡沫化和不務正業。它與全民醫療保障、保險業等有緊密關係,假若它因金融經濟而泡沫化,將觸及中國的社會保障制度,可能引發社會不安。
中國模式的社會主義不能離開其宿命──官僚的無能和貪婪。“互聯網+醫療”是十分集中的經濟。如何避免太子黨插手,是中共無法見對的難題,三文件對此視而不見。

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