How can a ＂network appointment nurse＂ with chaotic fees and unqualified platform be employed according to law？

　　Service price and service standard are not uniform; The quality of medication is difficult to guarantee; Some apps don’t have practice licenses for medical institutions, and many nurses take orders privately on the platform — —

　　How do "network nurses" take up their posts according to law?

　　When you place an order with your mobile phone, you can make an appointment for nurses to come to your home for injections, infusions and dressing changes. With the development of mobile Internet, "online nurses" have come into people’s lives. A few days ago, National Health Commission officially issued the Notice on Launching the Pilot Work of Nursing Service in internet plus and the Pilot Work Plan of Nursing Service in internet plus (hereinafter referred to as the "Plan"), and decided to carry out the pilot project of internet plus Nursing Service in six provinces and cities of Beijing, Tianjin, Shanghai, Jiangsu, Zhejiang and Guangdong, with the pilot time from February to December 2019. This means that "online nurses" are officially recognized. In fact, before this, many "online nurses" apps have already emerged, and they have reflected many problems.

　　According to media reports, many "online nurses" apps have problems such as inconsistent service prices and service standards, and it is difficult to guarantee the quality of medication. However, some apps have not obtained the practice license of medical institutions, and many nurses register their accounts on the platform to take orders privately … … In the investigation, the reporter found that whether these problems can be solved is related to the survival and sustainable development of the emerging format of "network nurses".

　　understaffed

　　Charge confusion

　　Many users have expressed their views on the new service mode of "network appointment nurse".

　　The reporter collected some users’ comments on the use of the "online nurse" App. Users who gave favorable comments said, "Nurses can come to see a doctor at home, which is very convenient", "It is convenient to register, and one-click appointment registration saves queuing time", "It is very convenient for elderly people with mobility difficulties at home" and "Nurses are dedicated and careful, and they will also teach people health knowledge" … … It can be seen from the comprehensive "praise" that many people think that one of the advantages of the "online nurse" App is convenience, time-saving and trouble-saving, which coincides with the formulation concept of "nursing services for discharged patients or special people suffering from diseases and mobility difficulties" in the "Program".

　　However, the bad reviews received by the "Online Nurse" App also reflect some problems to some extent. The user "Tang Yan" commented on an "online Appointment nurse" app, "The after-sales service is particularly poor, and the nurses charge fees indiscriminately". She commented: "The nurse called and said that in addition to the fees paid on the platform, there would be additional money. I want to cancel the order, but the platform still needs to deduct 30% service fee. " The user "Gu Yue Dream" said, "No one has answered the next order, but the related expenses have been paid in advance. No one took the order, indicating that the staff is still insufficient. " As for the difficulty of taking orders, the user "sunray982" also said, "Nurses are either too far away or have no time, so it is too difficult to make a successful appointment." The user "lttxc" reflects another problem. "Three nurses were changed in one order, and personal information was collected offline many times. The nurse who finally took over did not arrive at the appointed time."

　　How does the related "network nurse" App respond to the situation reflected by users? In response to the problem of charging the handling fee, the reporter saw in the "Notice of Appointment" in the relevant App that if the service staff wants to cancel the order after receiving the order, they need to contact the customer service at least 4 hours in advance. If the order is returned within 1 hour before the service starts, the platform will charge 60% of the service fee; If the order is returned within 2 hours before the start of service, the platform will charge 30% service fee. This is similar to the situation that passengers have to refund their tickets after buying train tickets. It is the same as charging 10% handling fee for those who have been driving for more than 24 hours and less than 48 hours, and charging 20% handling fee for those who have been driving for less than 24 hours. The "online Appointment nurse" app charges a handling fee, probably considering 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 set off.

　　Relatively speaking, there are fewer cases of taking orders without nurses in big cities, and some platforms are also improving for the problem of taking orders in small and medium-sized cities that are still developing. In response to the problem that nurses are slow to take orders and charge fees, customer service said that if nurses charge fees privately, users can report to the platform.

　　The platform is unqualified.

　　Suspected of illegal practice

　　Some netizens have also thrown such a question: Before the release of the "Proposal", were those third-party platforms that did not have medical qualifications but provided "online nurses" services legal? Is it illegal to register nurses taking orders as individuals on these platforms?

　　Third-party platforms without medical qualifications allow nurses to register to provide services, which may lead to ambiguous responsibilities, rights and obligations between third-party platforms and medical institutions and nurses in medical services, information security, privacy protection, nurse-patient safety and dispute resolution, and may also cause major hidden dangers to patients.

　　What kind of platform has medical qualifications is clearly defined by 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 examined and approved by the health administrative department of the local people’s government at or above the county level, and an approval letter for the establishment of a medical institution must be obtained; Article 24 stipulates that no unit or individual may carry out medical treatment activities without obtaining the Practice License of Medical Institution.

　　Under what circumstances can nurses carry out medical activities, our laws also have traces to follow. Article 9 of the Nurses’ Regulations stipulates that if a nurse changes her practice place within the validity period of her practice registration, she shall report to the competent health department of the people’s government of the province, autonomous region or municipality directly under the Central Government where she intends to practice; Article 21 stipulates that medical and health institutions shall not allow nurses and other personnel who have not gone through the procedures for changing their practice places in accordance with Article 9 of these regulations to engage in nursing activities stipulated in the technical specifications for diagnosis and treatment.

　　According to the "Program", it can be known that "network nurses" is a way for regular hospitals with qualified qualifications to provide high-quality medical services for patients, and third-party platforms can only cooperate with medical institutions such as hospitals with medical qualifications. Zhou Hao, a lawyer of Beijing Weiheng Law Firm, believes that this kind of "taking private jobs" by nurses is not allowed by the Scheme. Neither the Law on Medical Practitioners nor the Nurses’ Regulations allow nurses to take orders in their own names. 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 the practice license of medical institutions, which violates the provisions of the Regulations on the Administration of Medical Institutions and provides the service of "online nurses" without authorization, which is suspected of illegal practice. According to Article 9 of the Nurses’ Regulations, nurses who register to take orders on third-party platforms without authorization should consider that they have increased or changed their practice places without authorization, which violates the provisions of the Nurses’ Regulations.

　　Nurses take private jobs.

　　The platform is jointly and severally liable.

　　Then, if the "online nurse" privately picks up private work through an unqualified App and causes disputes, who should be responsible for it?

　　Many people have misunderstandings, thinking that nurses should be solely responsible for disputes caused by taking orders privately. When the reporter mentioned that the third-party platform might be responsible for the nurses’ mistakes, Mr. Wang of Beijing expressed doubts: The platform provides convenience for everyone to "match the bridge", why should it be responsible?

　　Article 12 of the E-commerce Law, which was formally implemented in January this year, stipulates that if an e-commerce operator needs to obtain the relevant administrative license according to law when engaging in business activities, it shall obtain the administrative license according to law. Article 38 stipulates that for goods or services related to consumers’ life and health, e-commerce platform operators fail to fulfill the obligation of reviewing the qualifications of operators in the platform, or fail to fulfill the obligation of safety protection for consumers, thus causing damage to consumers, they shall bear corresponding responsibilities according to law.

　　Qiu Baochang, president of the E-commerce Rule of Law Research Association of Beijing Law Society, said that medical institutions, auction companies and other industries need to obtain administrative licenses. Without permission, third-party platforms are obliged to abide by the law and prevent e-commerce from selling goods and providing services. In addition, the third-party platform needs to review the nurses registered on the platform. If the nurses registered on the platform hurt patients because the platform has not been reviewed, the third-party platform needs to bear joint liability.

　　"For medical disputes caused by nurses taking orders privately, the platform party should share the joint tort liability with nurses," Zhou Hao pointed out. "The Plan also makes it clear that the platform party cannot directly cooperate with nurses."

　　Qiu Baochang believes that if there is a dispute over the registration of nurses on a third-party platform in the name of a hospital, it is a duty behavior for doctors to serve patients with the approval of the hospital, and the hospital should be responsible for the patients. In this case, whether the platform needs to pay in advance depends on the contract between the platform and the hospital, the platform and consumers, and the nurses and patients who provide services in the hospital. Several parties agreed in the contract that they should abide by the Regulations on Handling Medical Accidents and other relevant laws and regulations to solve the problem fairly and reasonably.

　　Qiu Baochang said that the platform should take responsibility and abide by laws and regulations. We can’t ignore the relevant regulations because of innovation. Design the rules of service, connect demand and supply, and connect the service of "network nurses" with the needs of patients in an orderly manner.

　　"network appointment nurse"

　　How to set the service price?

　　Regarding the service price of "online nurses", the person in charge of the National Health and Wellness Committee once said that the service price is determined by the market, and nurses mainly provide services in their spare time. The "Program" also retains the mechanism of "market-regulated prices".

　　According to the reporter’s observation, the service prices of multiple "network nurses" apps are quite different. As far as the service of "infusion" is concerned, some apps are priced at 189 times, while others are priced at 289 times. The price of "online nurses" on-site service is also much higher than going to the hospital for medical treatment by themselves.

　　Qiu Baochang said that the "internet plus Nursing Service" should be regulated by the market at the beginning of the pilot, and should not be priced by the government.

　　"Online appointment nurse" is a personalized demand. People can choose to go to the hospital for treatment, or they can choose nurses to provide services at home. Some people think that the comfort and convenience of treatment at home are higher than that of going to the hospital on their own, and the time of seeing a doctor is less than that of going to the hospital, so it is reasonable to have a slightly higher service fee. Qiu Baochang believes that as long as the service pricing 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 recognized by everyone. As long as it does not violate the law, the relevant departments should not interfere too much.

　　Xia Xuemin, a visiting researcher in institute for public policy, Zhejiang Province, said that during the pilot period, "online nurses" can adopt government-guided prices; After the pilot is successfully promoted throughout the country, the market-adjusted price can be adopted.

　　"In the pilot provinces, the health department should take the lead in establishing the online nurse service catalogue and price, and the market supervision department should take the lead in market supervision and inspection, and severely investigate and deal with unqualified, unreasonable charges and unsafe ‘ Network appointment nurse ’ It is forbidden for unqualified medical institutions to provide services. " Xia Xuemin specifically introduced.

　　In addition to clearly marking the price of the "online nurse" service, Xia Xuemin also believes that no individual or organization can delete the bad reviews given by users. Medical institutions and health care groups that provide online nurses should have legal subject qualifications and medical and health practice qualifications, and take the initiative to "highlight" in prominent places on Internet pages. Relevant departments should make an objective and fair third-party evaluation of the service quality of "network nurses".

　　Xia Xuemin further added: "You can put ‘ Network appointment nurse ’ Incorporate into the credit management system of medical and health services, deal with and punish offenders in a timely manner, record bad information in credit files, blacklist those with serious circumstances, and implement joint punishment in the whole society. "

　　For the "network appointment nurse"

　　Provide policy guarantee

　　In recent years, the new service modes of "internet plus", such as "online car ride", "online housekeeping" and "online nurse", have gradually emerged. While "internet plus" facilitates people’s lives, it also makes people worried about whether it can ensure the personal safety of both parties and protect private information. After the release of the "Program", can it provide a security guarantee for people who use "network nurses"?

　　At present, "online appointment nurses" are in the pilot stage. Zhou Hao believes that users should pay attention to medical safety during the online appointment process. In the process of "online appointment", it should be noted that whether the online appointment nurse is a qualified nurse sent by a regular hospital should pay attention to leaving marks in the whole medical process.

　　According to the "Program", only entity medical institutions that have obtained the "Practice License for Medical Institutions" and have provided services such as family beds and rounds of clinics are qualified to provide "network appointment nurses" services based on the Internet information technology platform. Li Hongzhao said that during the online appointment process, users should review whether the relevant platforms have corresponding medical qualifications, and also review the qualifications of nurses. "In the national electronic registration system for nurses, you can check the qualifications of nurses."

　　Xia Xuemin said that "network nurses" is the latest achievement of China’s medical and health system reform, the latest measure to further sink medical resources to patients at the grassroots level, the latest response measure for health and health departments to assume the function of old-age medical services after institutional reform, and the specific application of Internet economy in the medical and health field. The release of "Program" has pointed out the direction, defined the boundary and provided policy guarantee for the development of "network nurses".

　　The National Health and Wellness Committee took 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", which is expected to solve the previous problem of users’ confusion about the identity of "online nurses" and reassure users. Xia Xuemin believes that the "Program" encourages strengthening security control through real-name registration of mobile App, medical institutions or health information platform enterprises, and using mature human feature recognition technologies such as face recognition to ensure the true and effective identities of both nurses and patients on the Internet. If necessary, it can be compared with the public security system in real time, eliminating potential dangers to the greatest extent, and avoiding repeating the crime of rape and murder by drivers on the Internet to a certain extent.

　　"Online nurses" is an inevitable product of the Internet economy. In order to avoid "a flash in the pan", we should treat it with caution and gradually open it up. Zhou Hao suggested that the relevant departments can issue detailed rules to improve the practice rules of "network nurses" and bring them into the supervision of relevant health departments.

　　It should be noted that the "Program" clarifies that the key groups of "network nurses" on-site service are the elderly, disabled elderly, convalescent and terminal patients. At present, there are more than 40 million people in China who are semi-disabled, and the nurse team of more than 3.8 million people is far from enough. Researcher Xia Xuemin suggested that the competent departments of health and education should make a talent training plan as soon as possible, expand the training scale of all kinds of nursing professionals as soon as possible, smooth the promotion channels of nursing talents’ professional titles, and make the "online nurses" get better development, just like actively training obstetrics and gynecology talents to meet the needs of the second child.

　　Su Guangtian Yang Lingling