Excessive medical care has increased the economic burden on medical care providers, and the high price of medical equipment behind it has also cultivated a breeding ground for corruption. The impact on over-medical treatment has become imminent.

In June last year, Sun Yang, head of the reform department of the Medical Reform Office of the former Ministry of Health, once stated that he hopes that in 2013 all counties across the country will fully implement measures to eliminate public hospital reforms that are key to "remedy for medicine." . At present, all provinces and cities have issued relevant rules to further combat excessive medical treatment. However, at the same time as the reform, some derivative problems have gradually surfaced. Fighting over-medical care is destined not to be a blitzkrieg.

In addition to drugs plus deterrence over medical treatment

Recently, the General Office of the State Council issued the “Main Working Arrangement for Deepening the Reform of the Medical and Health System in 2013” ​​and proposed to initiate the pilot work for the reform of the second batch of county-level public hospitals.

As we all know, county-level public hospitals are breakthroughs in the reform of public hospitals in China, and the drug addition policy is the entry point for the reform of county-level public hospitals in China, and it can be said that it is a “key move” to curb excessive medical care. With the continuous deepening of medical reform, this kind of drug addition policy that has been in existence for a long time gradually began to withdraw from the historical stage of the Chinese medical system.

According to public information, at present, there are 431 counties in 22 provinces nationwide that have eliminated the addition of public hospital medicines, 17 provinces have made comprehensive adjustments to the prices of medical services in the pilot areas, and 27 provinces have begun to reform payment methods.

Before the medical reform, because of the marketization of the hospital and other reasons, the income of medicines constituted the main economic source of public hospitals, accounting for 43.7% of the total hospital revenue. It is understood that the general implementation of public hospitals in China is to purchase drugs at wholesale prices, Western medicine by 15%, Chinese medicine by 25% to 30% mark-up sale.

Sun Yang pointed out that the elimination of "the use of drugs to support medical care" is the key to the comprehensive reform of county-level public hospitals.

Abolishing the drug addition policy, changing the compensation of county-level hospitals from the three channels of past service charges, drug addition revenue, and government subsidies into two channels of post-reform service charges and government subsidies. The compensation will be compensated by adjusting the prices of medical technology services and increasing government investment. This is the current compensation system for public hospital reforms.

In the process of canceling drug additions, some pilot provinces have already gone ahead. Sichuan, Jiangsu, and other provinces have all explicitly required all county-level public hospitals in the province to implement comprehensive reforms throughout the year.

Jiangsu Province has introduced a series of measures to curb the expansion of excessive medical treatment. Measures include the abolition of the drug addition policy. In addition to the important decoction pieces and hospital preparations, all medicines are sold on a zero margin; drugs, high-value medical consumables and large-scale medical equipment are reduced. Inspection and treatment prices; reasonable increase in the price of medical and technical staff, including diagnosis, treatment, surgery, nursing, and traditional Chinese medicine programs; adjusted medical service fees are included in the scope of medical insurance payment.

At the same time, Jiangsu stressed that the reasonable amount of medical service price adjustment should be a part of the reasonable price difference of medical and health institutions that meets the policy requirements and deducts 10% of the self-digestion of medical and health care institutions and the government's special subsidy, and must not increase the actual medical expenses of patients. burden. In addition, medical insurance purchase service is also required as one of the compensation channels for public hospitals to cancel the drug addition policy, and further improve the medical insurance payment method, so that the health insurance payment policy is linked with the price adjustment of medical services.

"This year our hospital's drug use situation has strict electronic systems for monitoring. The hospital will also use each month's drugs, such as antibiotics and infusion drugs, etc., to determine the proportion of use." A hospital doctor in a county-level city in Sichuan told reporters , "If there are any special reasons for the relevant drugs prescribed by doctors in one month, there are no special reasons for them to be punished according to relevant regulations."

The above-mentioned doctors also revealed that: “The individual doctors who rely mainly on medicines to obtain a large amount of gray income have recently left the company quietly because there is no oil and water to be earned under strict supervision.”

New issues surface: quietly increased costs

Excessive medical treatment is being effectively contained, but it cannot be completely eradicated in a short period of time.

In early 2013, the Henan Provincial Department of Health disclosed that, in the past five years, the proportion of drug sales in second- and third-tier hospitals in the province has dropped by 20%. However, Liu Xuezhou, director of the Health Department of the province, said that the mechanism of “taking medicine to support the doctor” has not been completely broken. Overtreatment, excessive use of drugs, and excessive inspections have occurred from time to time. The medical burden of the people is still heavy.

With the further advancement of medical reform, the proportion of medicines in medical expenses has indeed declined, and the living space for “taking medicine to provide medicine” has become increasingly narrow. Another problem that should not be overlooked is that the service fees for doctors in some hospitals have been increasing quietly, while the increase in the cost of inspections and medical equipment costs is difficult to define.

How to increase the doctor's income is also a problem that needs to be solved at the same time as curbing excessive medical treatment.

"According to the current situation of China's medical system, Chinese doctors and doctors in developed countries have the same income from surgery or clinics," said a doctor from a Chinese medicine hospital in Jiangsu province.

Prior to this, Wang Tianyou, deputy doctor of the National People's Congress and director of the Department of Thoracic and Cardiovascular Surgery at Beijing Friendship Hospital, had disclosed his income and compared it with the income of American surgeons.

The surgeons in the United States can be roughly divided into three categories. Among them, 10% are the doctors with the lowest income. For example, young doctors who have just graduated have an average annual income of 200,000 to 250,000 U.S. dollars. The middle 80% of doctors have an annual salary of 500,000 to 700,000. The dollar; the other 10% higher level, such as the director or professor, at least $ 2 million in annual salary.

In contrast, Wang Tianyou stated that his monthly wage was only 5,000 yuan. If he did not give lectures or other income, his annual income was less than 100,000 yuan.

"If the doctor's income does not match his long-term labor, similar to 'over-treatment' will reappear," said a doctor at a Chinese medicine hospital in Jiangsu.

In March of this year, Sun Zhigang, deputy director of the National Development and Reform Commission and director of the State Council Deepening Medical and Health System Reform Leading Group Office, once said in an interview with the media about the “Medicine and Health System Reform”: “At present, medical reforms have entered deep-water areas, and on the one hand, they must be consolidated. The achievements that have been achieved are very arduous tasks, and slight slackening may occur repeatedly; on the one hand, the deep-seated contradictions accumulated in the long-term accumulation of institutional mechanisms have been exposed, and the difficulty and complexity of the reforms have become larger and larger. It is necessary for the entire community to work together to overcome difficulties and jointly promote this reform."