Who should be hit by the drug rebate board

Source: Science and technology daily / Li Ying 2017-1-4 the role of doctors' high salary in keeping clean has been fulfilled in some countries and regions with high doctor's integrity index, but it also needs preconditions: first, system loopholes can be blocked, second, the constraint mechanism for job convenience is effective Otherwise, no matter how high the salary is, it's hard to resist the desires of ordinary people It is also difficult to work with high salary without effective industry and job restriction mechanism CCTV recently broadcast a 16 minute special report "drug kickbacks flood" secret visit program, once again caused a stir It is pointed out in the program that the medical representative Commission is 10% of the drug price, and the rebate received by doctors is 30% to 40% of the drug price After CCTV reporters secretly visited and broadcast the report for 8 months, the national health and Family Planning Commission quickly asked the administrative departments of the two health and family planning commissions to investigate the kickback incident and suspend the doctors involved After the drug kickback event, many medical staff expressed their opinions in the circle of friends: the existence of drug kickback is the original sin that Chinese doctors bear for a long time, which has resulted in the stigmatization of Chinese doctors and intensified the distrust and confrontation between doctors and patients At the same time, a large number of clean and self disciplined doctors have to bear the same stigma The key of drug rebate is not in the hands of doctors How is the drug price determined? Zhuang Yiqiang, Deputy Secretary General of the China Hospital Association, said that pharmaceutical companies first calculated two types of costs in drug prices On the one hand, production costs, such as raw materials, employee wages and other manufacturing costs, and on the other hand, period costs, including management costs, financial costs, sales costs, advertising costs and so on "In the process of drug pricing, the hospital is not involved, and the hospital has only the executive power but not the pricing power." Zhuang said Liu Guoen, a member of the Advisory Committee of medical reform experts under the State Council, thinks that when drugs enter the circulation from pharmaceutical factories and then enter the medical service institutions, the prices of drugs may be inflated in all links, so it is not appropriate to emphasize the responsibility of one aspect We can't solve problems in one aspect by ourselves Han Qide, former vice chairman of the Standing Committee of the National People's Congress, once said that in China, the intermediate price of many drugs has increased tenfold from leaving the factory to selling to patients To this end, Zhan Jifu, director of Fujian medical insurance office, said: before the reform, we made a thorough investigation of the drug circulation field, and found that the price of provincial procurement was several times or even dozens of times of the ex factory price when the drug enterprises were counting back through enterprises outside the province For the difference between the sales price and the ex factory price, the medical institution will get 15% of the drug markup, the distribution enterprise will get about 6% of the distribution fee, the medical representative will get about 20% of the marketing fee, the doctor will get about 30% of the prescription rebate fee, and the non provincial ticketing company will get about 10% of the ticketing fee Zhuang Yiqiang believes that the key to solving the rebate problem is not in the hands of doctors, but we should and must take the initiative to promote the government to solve the problem This industry should live a decent life with its own technology and diligence Drug rebate should not rely on "morality" to restrict the statistical bulletin on the development of China's health and family planning in 2015 issued by the national health and Family Planning Commission, which shows that: in the total national medical expenses, the outpatient drug cost accounts for 48.3%, the inpatient drug cost accounts for 36.9%, while the drug cost in developed countries such as the United States and the United States only accounts for about 10%, and there is still much room for drug price reduction in China "There are difficulties behind the public hospital's" medicine for medical treatment " Zhan Jifu said frankly that the government has little investment and doctors' treatment is low If the hospital wants to generate income, it can only implement drug mark up and acquiesce in doctors' prescription If we want to return to the nature of public welfare, we must change the operation mechanism and make clear the government's investment and supervision mechanism In view of "doctor drug rebate", the German government prescribes for medical reform: first, to increase medical insurance costs; second, to reform the medical system structure, introduce market competition mechanism, enhance transparency, and improve the efficiency and quality of medical services The transparency of doctors' prescriptions is the result of a "competition" In Zhuang Yiqiang's view, we should not only rely on "moral" constraints and accusations to solve the problem, but also deeply analyze the causes of the system, especially the source of sunshine income for the system students How high is the cost for Hong Kong doctors to get kickbacks? For example, a doctor should have a reasonable and legitimate high income If a business school student and a medical school student graduate at the same time in Hong Kong, the former has a monthly income of HK $10000, the latter at least HK $30000, and some famous doctors have a monthly salary of HK $200000 or HK $300000 With such a salary, no doctor will care about the red envelopes handed by the patients If the patients want to "show kindness" to the doctors by giving money, they can't afford it at all Zhuang said that if doctors in Hong Kong receive red envelopes or take kickbacks on drugs, the HA and the ICAC will intervene in the investigation Once the problem is confirmed, doctors will be revoked and the whole industry will be informed This means that a doctor who has studied hard for many years, has a good social status and high income will lose the qualification to practice medicine "If Hong Kong Doctors dare to act with conscience, the cost of breaking the law is too high." In most countries, such as the United States and Germany, how to deal with the relationship between doctors and enterprises and prevent doctors from using prescription rights to obtain improper benefits are all issues that managers in these countries have to consider Taking the United States as an example, since 1972, the United States has promulgated and implemented the anti kickback law, which stipulates that no matter doctors, medical institutions or referral institutions, if they collect or pay kickbacks in violation of the law, or have any other form of interest transmission, they will be punished according to the circumstances Among them, those who break the law once and are found guilty by the court will be fined up to $25000 and imprisoned for less than five years, and the government will no longer provide any subsidy or financial support to illegal doctors and medical institutions, and prohibit them from participating in all federal level health projects Even if not finally convicted by the court, doctors or medical institutions that violate the law may still be removed by the relevant health authorities It is one of the important reasons for the high cost of seeing a doctor that the mechanism of "nourishing a doctor with medicine" is not a one-day achievement How to solve the problem of "supporting doctors with medicine" has been proposed by Zhuang Yiqiang: first of all, we should "raise" doctors with high salaries, and then let them "dare not break the law" Doctors in most countries in the world are highly paid jobs Why can't doctors be given high salaries in China? Wang Dingding, an economist, wrote in Caijing that "in order for doctors to abide by their Hippocratic vows, they should get legal income corresponding to value creation." As we all know, the reason why airlines pay high salaries to pilots is mainly for the safety of passengers, so that pilots only think about flying In the same way, the reason why we subsidize hospitals and let doctors get high salaries is that we want them to think only about seeing doctors instead of how to make money to support their families In this way, Chinese doctors are no exception Without high salaries, the long-term development of good doctors and even medical treatment is unimaginable What's more, Chinese doctors are still holding fast to and supporting the largest patient group in the world even under the base salary system of decades, facing the threat of more and more complex doctor-patient relationship The role of doctors' high salary in keeping clean has been fulfilled in some countries and regions with high doctor's integrity index, but it also needs preconditions: first, system loopholes can be blocked; second, the constraint mechanism for post convenience is effective Otherwise, no matter how high the salary is, it's hard to resist the desires of ordinary people It is also difficult to work with high salary without effective industry and job restriction mechanism The medical reform has entered the deep water area We must take measures to overcome the difficulties and take "drug price" as a breakthrough Behind the small pills are all aspects of the medical system In a sense, how to reduce the drug price scientifically and reasonably is an important issue in the current medical reform Liang Wannian, the full-time deputy director of the medical reform office of the State Council and director of the Department of system reform of the national health and Family Planning Commission, pointed out that it is not a one-day success to bite the "hard bone" of "supporting medicine with medicine", and the reform "takes one hair and moves the whole body" Only by taking the "bull nose" of establishing and improving the relevant system and mechanism can we promote the in-depth development of medical reform Gu Xin, a professor at the school of government management of Peking University, said that all kinds of phenomena of Chinese style excessive medical treatment, especially the trend of drug support, false high drug prices and kickbacks, are in the final analysis the result of the government's comprehensive price control over medical services, including drugs Professor Gu Xin pointed out that China's pharmaceutical industry has three major institutional factors, which are crucial First, according to the regulations of the administrative department of health, all medical institutions charge patients according to the items; second, the government implements the administrative pricing for the medical service items; third, the government implements three controls on the purchase and sale of drugs, namely, the maximum retail price limit, the purchase price control of public hospitals and private non-profit hospitals (i.e., the bidding price must be implemented), and the drug markup rate control (from 15% to 0%) According to Professor Gu Xin, the feasible way to curb excessive medical treatment lies in promoting the reform of medical insurance payment system, replacing project-based payment with package payment, and replacing "number details" with "buy it now price" Many countries in the world, including both developed and developing countries, have basically curbed the phenomenon of excessive medical care after arduously pushing forward the reform of medical insurance payment system.