Medical reform is a very tangled thing, media attention, government troubles, doctors, patients and enterprises are worried. Over the years, I have visited many hospitals and health centers in Beijing, Shanghai, Xi’an, Hunan, and Hebei, visited dozens of pharmaceutical companies, and heard the opinions of many experts on medical reform. My friends include both doctors and nurses, as well as the owner of a pharmaceutical factory and the medical representative "Medicinal Bug".
As a medical school graduate, a three-year-old researcher in the pharmaceutical industry, and an ordinary person who thinks about the world independently, I want to share my understanding of medical reform from another perspective. ——The reason why medical reform is difficult to change is because it is not just medicine or medicine that needs to be changed. Maybe it really needs to be reformed by society and government.
Yesterday, I accompanied my parents to the ophthalmology department in the hospital. The registration fee is 5 yuan, the tear duct irrigation treatment fee is 2.75 yuan, a certain equipment inspection fee is 200 yuan, and a bottle of medicine and 3 eye drops total 300 yuan. ——This is a very typical visit.
1. "Doctors are really cheap" is not normal-please change the ubiquitous and outdated government regulation in society.
Beijing, a tertiary hospital, the outpatient registration fee is 5 yuan. Suppose a doctor goes out for 8 hours a day in an outpatient clinic without drinking or peeing. Assume that each patient takes 5 minutes and the total diagnosis income of 96 patients is 480 yuan. The deduction of rent for water and electricity properties may be Not enough operating costs, the remaining labor income for doctors is only worth 50-80 yuan a day?
The hourly salary for tutoring of college students in Beijing is 50 yuan. The labor value of a doctor who does not drink water or pee all day, and sits full of hemorrhoids, is not as good as the one-hour tutoring of college students? A big mistake.
In Beijing, the monthly rent for a one-bedroom old house near Tongren Hospital is 3,000 yuan. The doctor's contribution to society for a month is not as good as the value created by lying in an old house for a month?
May I ask everyone, is this the hospital doctor "sick" or our society "sick"? Or maybe they are all sick!
The price of medical staff is so low, is it because medical staff have high morals? Don’t they need to eat and sleep without spending money? Is it the result of more than 20 years of open competition in the market economy? No, no, no. The excessively low prices of medical services are not because of market competition, but because of the government's administrative price control.
There is no free lunch in the world. It should be understood that perpetual motion machines do not exist, so things that are too cheap and below the cost will not exist. Unless you pay for meals from elsewhere. These other places are medicine expenses, high-value consumables, and instrument inspection fees. What if these "other places" do not exist, or are blocked by the government's new policies? The income of the doctor will not be able to pay the monthly rent, the doctor will switch careers, and the doctor will disappear as a profession. From now on, "there is no disease", and those who are sick should die by themselves.
From a certain point of view, the public as a whole of our society should even be grateful to these "other places" for compensating for the low prices of medical services and making the profession of doctors exist.
But "by the side" is not right after all. Since hospitals use medicines to supplement their doctors, and medicines make medical losses, everyone naturally tends to pay more attention to medicines than medicines, and more medicines but less medicines. Therefore, the more expensive the medicines, the more expensive the medicines, and the less expensive the medicines. So sometimes "practice medicine" becomes "Selling drugs"; so sometimes we have to "buy drugs" in order to "see a doctor."
Another hazard of "by the way" is that it tends to never-end applications. If you go to check a doctor, you have a higher probability that he can be "sentenced". The Chinese Criminal Law stipulates that commercial bribery worth more than 5,000 yuan can be investigated for criminal responsibility. Anyway, they are all criminals, and they are dead-this is a natural state of mind. In 2006, the national medical and health system launched an "anti-commercial bribery" campaign. For a while, hospitals were raging, and the government suddenly discovered how "all the world is sinful"? So after catching a few hapless guys as a model, the drums died down.
After the government improperly managed "medicine", it had to start to control "medicine", control equipment and consumables, and control production and circulation. The government has to manage more and more, and the medical system becomes more and more chaotic.
Everyone must have read "The Story of Planting Tree Guo Liao Tuo". The author Liu Zongyuan, wrote during the "Yongzhen Innovation" period. At that time, the society of the Tang Dynasty was also ill, and the government harassed the people seriously. The author used tree planting as an example.
"The camel can not make the tree live and grow, and it can follow the sky of the tree, so that its sex is awkward. The nature of planting wood is originally intended to be comfortable, its cultivation desires to be flat, its soil desires to cause it, its building desires to be dense. , Don’t move, don’t worry, go and don’t worry about it. If it is planted as a child, if it is put away, then its heaven is complete and its nature is full. Therefore, I will not harm its growth, it must be a powerful person; In fact, it’s just a waste, it’s not if you can grow it early. It’s not the case that other people plant it, and it’s the root fist but the earth is easy to cultivate, if it is not enough, it will not be enough. If you have the ability, you will love too much. Worry is too diligent, once you look at it and caress it, you have gone and revisited, and even claw its skin to test its growth, shake its root to observe its density, and the nature of wood is separated from day to day. Although it is called love. , In fact, it hurts; although it is said to be worried, in fact it is hated, so it is not if I am. How can I be!"
The government replaces supervision with regulation. Although it is called love, it is actually harmful; although it is called worry, it is actually hated. And the victims are not only medical institutions? Isn’t it the same for securities, funds, and banks?
The government believes that its omnipotent, shaped hand can control everything. But the reality is that China is too big and the situation varies from place to place. At the beginning of the reform and opening up, it was fine, and there were not big differences between different regions; as the society progressed, diversification and differentiation developed day by day, and even the Thousand Eyes and Thousand Hands Guanyin could not manage so many things. The government's "one size fits all" policy and decrees on the left and the right have already appeared to be inadequate. When the child grows up, why not let go of control and replace it with supervision; why not return the power of handling cumbersome internal affairs to the people everywhere for consultation and self-discipline. The central government focuses on national defense, diplomacy, and coordination and supervision with local governments? At that time, the medical treatment may not need to be changed, and the problem will be straightened out.
2. "Pharmaceuticals are really expensive" is not normal-what is expensive is not in corporate profits, not in circulation and distribution, but in the cost of corruption in society.
The ex-factory price of asparagus slices was 15.5 yuan and it was sold to the hospital for 213 yuan. Medicine is not in the profits of the company. Sometimes the pharmaceutical factory will set the ex-factory price at 200 yuan, and then return the 180 yuan. After layers of exploitation and cleaning, the money is eventually used to feed back the cost of medical services that are too cheap. ——The salary of the doctor.
In fact, the medicine is no longer in circulation and distribution. Whether it is Sinopharm, Shanghai Pharmaceuticals, and Nanjing Pharmaceuticals, we can clearly see that the price increase rate for drug distribution and distribution is only 6-8%, and Jointown is even lower, basically like a courier company.
The cost of medicine is the "corruption cost" or "public relations cost" of our society. In order to "let the profession of doctors continue to exist" and in order to send money to the hospital, the pharmaceutical factory must first go to the "public relations" price department to set the retail price high enough, and then go to the "public relations" bidding in various provinces and cities, and then Go to the "PR" hospital. The more "levels" the government controls, the more "public relations" are needed. Only a small part of the price difference between 15.5 yuan and 213 yuan for asparagus slices was delivered to the doctors, and most of them were paid for in various public relations links.
The price of medicines has been falling year after year, and soon the price of medicines has fallen to the point that they cannot afford the "public relations expenses". As a result, the medicine disappeared and was never delivered to the doctor. Pharmaceutical companies are a highly diligent group on the whole, so they go one after another to prevent the latest and most expensive drugs, sometimes not the best drugs, but as long as the exclusive price is high enough to cover the cost of public relations, it is good (sell ) Medicine. In order to apply for new drugs, we will “public relations” with the Food and Drug Administration, prices, bidding, and hospitals.
In a sense, we even have to thank these pharmaceutical companies for their perseverance and supply to hospital doctors so that they can survive and continue to treat everyone.
Among the expensive ingredients, one part is the compensation for the medical service expenses we underpaid, and the other part is the payment of the "uncle" in each "public relations" link. I said there is no free lunch in the world, right? In fact, I also gave everything that was supposed to be given. In addition, I also raised a group of "uncles" who ate institutional meals. The more government supervision and the more links there are, the more "uncles" the people have to raise. This forms the "cost of corruption" in our society. This need to be corrected is not actually a medical issue, but a social issue.
China has the largest civil service system in the world. Not only is the absolute number the largest, but the proportion of civil servants in the population is also very high. Nevertheless, our civil servants are still very hard, because there are so many things to manage. The National Development and Reform Commission is about to conduct another survey on "drug production costs." ——So many products, so many companies, so complicated production process links, what a complicated task is this? By the way: these civil servants are still excellent university graduates, their labor costs are not low, and ultimately they need to be supported by the people.
The government started with a regulation, and the regulation caused an imbalance. The society repaired the imbalance through gray channels. The government cracked down on the gray channels and started more regulation. The regulation caused new imbalances. The society looked for new gray channels and then repaired the imbalances... We are round after round. The change is so repeated. As a result, there are more and more regulations, more and more complicated problems, higher and higher public relations costs, and more and more difficult government control.
Suppose that our government, with the greatest determination and wisdom, successfully eliminated all gray channels for compensation for medical services, and prevented the people from finding new gray channels to eliminate imbalances (though I very much doubt whether the government can do this. ), then the hospital will be closed and all doctors will be diverted. The day when the medical reform is triumphant is the day when the medical treatment is dead.
The direction of medical reform has been reversed. The government should systematically eliminate control and eliminate price distortions caused by control-including inflated prices and inflated prices. Replaced by supervision. Let patients and medical insurance pay reasonable medical expenses instead of paying for the inexplicable and huge cost of social corruption.
Finally, come back to the medical treatment, let me roughly restore the reasonable charges for these items:
The registration fee is 5 yuan-100 yuan. (Doctor's professional skills)
Lacrimal duct irrigation treatment costs 2.75 yuan-50 yuan. (Nurse's skilled technique)
A certain equipment inspection charges 200 yuan-100 yuan. (Such equipment usually fully recovers the cost in 2 years, and the operating cost is mainly labor and electricity, which is very low.)
A bottle of medicine and 3 eye drops totaling 300 yuan. --50 RMB. (Estimated production cost is less than 30 yuan)
Patients and medical insurance:
A total of 300 yuan should be paid.
Now you need to pay 507.75 yuan, you can pay 207.75 yuan less.
Assume that the outpatient clinic sees 4 patients per hour, and the 8-hour consultation fee earns 3,200 yuan. The current 8-hour consultation fee income is 480 yuan. After deducting operating costs, the doctor’s daily salary for visits should be more than 2,000 yuan, and the monthly salary should be more than 40,000 yuan.
At present, the monthly income brought by the doctor’s consultation fee is only 1,000 yuan, and the hospital pays the doctor through the drug addition. According to the payroll posted by Xiehe Zhang Rongya, the total is several thousand yuan. Other income is invisible. .
Profits of pharmaceutical companies:
The production cost is 30 yuan, the factory is 45 yuan, there is no public relations cost, and the profit is 15 yuan.
Now the cost is 30 yuan, the public relations cost is 150 yuan, the hospital's medicines are added 15%, and the secret deduction is 15%. The profit is still about 15 yuan.
Drug sales are not profitable. From the management activities of equipment inspection, doctors, and nurses' labor income, each earns a portion of reasonable profits. For example, roughly accounting for 10% of each medical staff's labor salary, totaling 25 yuan.
At present, the hospital's medical service charges are at a loss, which is not enough to pay the salaries of medical staff. It depends on drug additions and equipment inspection items to make money. In addition, the hospital's internal logistics administration was chaotic and wasted. The government subsidizes a little. The hospital is safe.