Zero price difference "distortion" of drugs

Recently, the case of corruption in the field of medical purchase and sale in Zhangzhou, Fujian Province, has attracted national attention According to the relevant media, the cost of the injection is less than yuan, the price is more than 10 times; the purchase has to go through many passes, and 50% of the drug price is "public relations expenses" In order to put an end to the high price sale of drugs in the medical system, the zero price difference policy of drugs has been carried out in many places in China At the fourth meeting of the Standing Committee of the 12th National People's Congress of Fujian Province, Li Hong, vice governor of the province, said that in the second half of the year, more than 50% of the county-level public hospitals in Fujian Province will implement the zero drug difference rate reform, while the provincial public hospitals will start to implement the zero drug difference rate reform from the first quarter of next year, and the drug price is expected to fall by 10% to 15%, in order to solve the problem of "supporting doctors with drugs" The reporter learned that the drug zero margin reform has been implemented in 42 public hospitals in 26 counties (cities and districts) of Fujian Province Since March 1 this year, Xiamen has implemented the zero margin rate for drugs, which is expected to reduce drug expenses by more than 144 million yuan in the whole year However, in fact, in view of the zero price difference policy, some hospitals secretly prescribe "indicators" for doctors In addition, it is recommended that doctors prescribe more examination fees to complete the task of drug proportion On the other hand, the patient also has many inconveniences To prescribe more drugs, more cards must be issued at one time (equivalent to registration) As early as in 2011, the "target" of the hospital's Secret controlled drug prescribing was reduced from 15% to 10% From March 1 this year, 11 municipal and district public hospitals and 6 district MCH hospitals in Xiamen began to completely cancel the 10% mark up of drugs, and it is estimated that the annual drug cost can be reduced by more than 144 million yuan 10% of the revenue reduced due to the cancellation of drug mark up and the implementation of zero margin sales in hospitals will be compensated by finance; 8% will be digested by public hospitals through strengthening management and controlling costs; 82% will be compensated by adjusting the prices of outpatient and emergency consultation fees, inpatient consultation fees or TCM syndrome differentiation and treatment fees that reflect the value of medical personnel's technical services However, the policy has been questioned by many in the industry The head of a department of a hospital in Xiamen told reporters that since the implementation of zero difference rate in Xiamen, the drug price of the hospital is much lower than the retail price in the market, resulting in many patients to come to the hospital to prescribe drugs and save the difference However, due to the cancellation of drug mark up by the hospital, all expenditures of outpatient pharmacy, including logistics and personnel, must be subsidized by other aspects Although the government promised 10% of the financial subsidies, the amount of financial subsidies was allocated to each hospital to a limited extent There was a limit to the subsidies, and the hospital's expenditure on prescription increased greatly "In order to control the cost, the hospital has made clear the proportion of drugs prescribed to each patient (commonly known as" the proportion of drugs ") Our department is 42%, that is to say, a patient can only give him drugs that cost yuan." The person in charge said In addition, it is understood that although the current hospital's examination fee is increased by yuan on the basis of the original registration fee, the increased yuan is far from enough compared with the increased expenditure caused by the cancellation of drug price difference by the hospital In this regard, the hospital gives the doctor the control "index" to prescribe medicine secretly In addition, it also suggests that the doctor should prescribe more examination fees to complete 42% of the tasks The person in charge further said that due to the consideration of patients, some doctors did not control the proportion of drugs, and the consequence was that the doctors themselves paid for the extra drugs "Some departments see chronic diseases, so they can't prescribe so many examination items, and some patients come from other places, so it's impossible not to prescribe drugs to each other Some doctors will be deducted more than 1000 yuan in a month." According to the industry, the average proportion of hospital drugs is about 35% The reporter then called the hospital office to confirm The staff said that doctors treat patients according to their condition The hospital has been unable to implement the relevant regulations of "big prescription" and "three urgent and seven slow", and did not positively respond to the problem of drug proportion control But industry insiders told reporters that the proportion of drugs has always been the industry's "hidden rules" Chen Qiu (pseudonym), the head of another department of the hospital, said that although there was no clear document, the hospital always had such requirements when it deployed at the meeting Before that, it had not been controlled so strictly Because of the implementation of zero difference rate of drugs, due to the consideration of cost control, the hospital had to focus on the proportion of strictly controlled drugs as an important work, not only to each department Room, but also to specific individuals, and also launched punishment measures Compared with other hospitals in Xiamen, the practice of the above hospitals is "normal" Chen Qiu told reporters that the average proportion of drugs in the hospital is about 35%, and the highest control is about 37% In addition, although the hospital requires to control the proportion of drugs, it is suggested that doctors should open more inspection items, but for the inspection items, the higher authorities have the positive rate control, that is to say, in the inspection items opened by doctors, the probability of the positive rate (the problem) must reach a standard Therefore, although the inspection items can bring more profits to the hospital than drugs, they can not be opened randomly The reporter then interviewed a number of industry insiders in Xiamen, who also confirmed the above statement "It's not how much hospitals spend, but how much they can be subsidized." A person in the industry told reporters that in general, hospitals need to advance medical insurance and drug expenses for patients, and then apply for subsidies to higher authorities In fact, the financial subsidy is evaluated according to the level of hospitals and other reference indicators, and then the amount of subsidy is determined So once the hospital spends too much on unprofitable drugs, the hospital needs to bear the loss "The reality is that doctors don't want to see a doctor and be controlled." Industry insiders say that hospitals and doctors are in an awkward position between patients and policies Why don't we cancel the outpatient pharmacy? The implementation of zero price difference also causes great inconvenience to patients Ms Chen, a citizen of Xiamen, said that she had recently seen a doctor in a hospital of traditional Chinese medicine Although the registration fee had been cancelled, the examination fee had been increased, and the examination fee would be yuan for one time However, when she prescribed the medicine, the doctor made it clear that she could only prescribe the medicine less than yuan at a time, and if she wanted to prescribe more medicine, she had to register again "Yuan is only enough for two days, but before that, she could prescribe the medicine for ten days, which would not save money Money, on the contrary, has increased the expenditure for medical treatment It will be more troublesome for patients from other places " So said Miss Chen According to the person in charge of a hospital in Xiamen, doctors will ask patients from other places to open several more cards (equivalent to registration) at a time If they want to open drugs for two to three months, they have to open more than a dozen cards, but this is only limited to the specialty with high enough consultation fee The person in charge said that the implementation of zero price difference has aroused a hot debate in the industry The implementation of zero price difference is better than the cancellation of outpatient pharmacy, which has been widely implemented in foreign countries If we want to completely eliminate the "drug based care", it is better to remove the root In fact, there are some problems in the implementation of zero difference rate of drugs When analyzing the pilot reform of zero price difference of drugs in Beijing Friendship Hospital, some insiders said that doctors' kickbacks still exist, and the sales volume of high-priced drugs is still large under the stimulation of kickbacks; the overall medical expenses do not fall but rise, the proportion of patients' self payment decreases, the absolute value of self payment has a growing trend, and the number of patients' registration is increasing Zhou Jianqing, deputy to the people's Congress of Zhejiang Province and President of Lihuili Hospital of Ningbo City, said that the zero price difference measure of drugs has compressed the profit space of the hospital, but not the profit space of drug dealers and intermediaries The price of drugs bidding is higher than the retail price of drugstores, which leads to a situation of "three losses" faced by the government, hospitals and ordinary people Zhu hengpeng, director of the microeconomic Research Office of the Institute of economics, Academy of Social Sciences, has previously written a special article saying that the zero price difference system for drugs will have adverse consequences and should not be implemented He believes that the zero price difference system of basic drugs is not only difficult to achieve the policy intention of reducing drug prices, but also distorts the drug purchase and sale behavior of primary medical institutions, so that the commercial bribery prevalent in secondary and tertiary hospitals spreads to primary medical institutions For example, he said that the purchase price of 1.6 million units of penicillin sodium produced by a pharmaceutical wholesale company in a developed province sold to a health center in 2009 was yuan, plus the distribution fee of yuan, the actual purchase price paid by the health center was yuan, and then it was retailed according to the price of yuan, with the price increase rate of 105% and gross profit rate of 51% In 2010, the bidding price of the drug in the province was yuan, and the pharmaceutical enterprises won the bid at a price more than twice the original wholesale price It can be expected that the actual purchase price of the drug hospital is still around yuan, and the difference between yuan will be kept in the hands of the hospital and its doctors in the form of rebate and rebate And they implement the so-called "zero price difference" retail according to the bidding price of yuan, which not only does not reduce the drug purchase expenditure of patients, but also increases yuan At the same time, Zhu hengpeng said that the zero price difference system does not change the situation of making money by selling drugs in health centers, but only changes the original public and legal profits into a secret operation, making profits through rebates and kickbacks Zheng Zhenquan, an expert in public health management and professor of Fujian Medical University, believes that the most direct purpose of establishing zero margin rate is to reduce the price of drugs, but to truly implement it, the government needs to clear up the account of the hospital first, otherwise it will become a mere formality To promote zero difference rate of drugs in provincial hospitals, the cost of hospitals should be calculated in detail Before the zero difference rate of drugs is implemented in the hospital, what is the profit of drugs and what is reasonable should be compensated in place; what is unreasonable should be eliminated.