More than 90% of the medical disputes I have come into contact with are caused by patients who have no money or have high expectations for medical results because they have no money.
The following is an article reprinted by Southern Weekend. The Ministry of Health should strictly investigate the problem of red envelopes, and the society should care about the situation of doctors.
The medical industry is located in the downstream of the whole pharmaceutical industry, with drug distribution in the middle reaches and drug production or introduction in the upstream; On top of the whole pharmaceutical industry, there are more supervisors in the pharmaceutical industry. This is actually a food chain. The higher the food chain, the more profitable it is; The lower the end, the less profit. The pharmaceutical industry is a recognized profiteering industry. Because the medical industry is at the end of this food chain, the income is very small, and the huge profits flow to other links outside the medical industry.
The war of encirclement and suppression of red envelopes is starting. Not long ago, a province promulgated the Interim Measures for Investigating the Responsibility of Medical Institutions and Doctors for Asking for and Accepting "Red Envelopes" and Rebates. According to this method, anyone who asks for accepting a "red envelope" and the rebate amount exceeds 6,543,800 yuan will face administrative demotion or dismissal. At the national health work conference not long ago, the head of the Ministry of Health also announced that the Ministry of Health is about to comprehensively rectify the unhealthy trend in the industry, and the first thing to do is to receive red envelopes from doctors. The person in charge said that the health department should set up a patient complaint telephone number, and all doctors who receive red envelopes and kickbacks will be disqualified from practicing medicine.
Frankly speaking, I don't think so. There are indeed many problems in the medical industry, and social satisfaction is indeed unsatisfactory. It can even be said that the medical industry is one of the industries with the lowest social satisfaction. There is no doubt that it is necessary to rectify the unhealthy trend in the medical industry. But because there are many problems, we should not act rashly. Just because people are angry, don't ask why, wait for diagnosis, and the result is often to pass on contradictions and cover up deep-seated problems.
So, what are the deep-seated problems? Using the method of interest analysis, the answer is obvious. The medical industry is not the most profitable part of the entire pharmaceutical industry. The medical industry is located in the downstream of the whole pharmaceutical industry, with drug distribution in the middle reaches and drug production or introduction in the upstream; On top of the whole pharmaceutical industry, there are more supervisors in the pharmaceutical industry. This is actually a food chain. The higher the food chain, the more profitable it is; The lower the end, the less profit. As an expert said, at present, among the total medical expenses of patients in China, the medical staff's labor fees charged by hospitals are actually very small, accounting for a very small proportion of the total expenses-about 5%- 10%, and these fees are not all paid to medical staff. Even the former Minister of Health admitted that most medical technical services are charged at low prices. "The cost of medical services cannot be compensated, and medical institutions can only get compensation from drug sales, large-scale medical equipment inspection and new special projects, which leads to distorted medical behavior."
The pharmaceutical industry is a recognized profiteering industry. Because the medical industry is at the end of this food chain, the income is very small, and the huge profits flow to other links outside the medical industry. For example, a vascular stent costs only 8,000 yuan in the United States, but it costs18,000 yuan in China. Of the extra 10000 yuan, the state collects 2 1%-30% of the total sales, and conservatively estimates that at least 3780 yuan will be taken away; Another 4000-5000 yuan is earned by distributors; Hospital income is only 5% of management fees, which is 900 yuan. To some extent, the medical industry is similar to the courier of the city express company, only running errands to transfer consumables such as drugs from dealers to patients to earn a little money. Originally, it was intellectual labor, but it was almost rewarded by manual labor.
Pay. This special form of "brain upside down" is widespread in the pharmaceutical industry. In almost every region, there are only two or three super-large hospitals and well-known hospitals in good operation, and doctors earn a lot of money. The vast majority of small and medium-sized hospitals are poor in soup and water, and the income of doctors is not above the average level of society, and most of them are facing heavy survival pressure.
The medical industry with the least profit is the most direct link in the whole medical industry, just like the "Mr. Image" of the whole medical industry. As a result, people often simply blame the medical industry for the problems existing in the whole medical industry, and the voices of slander have mushroomed.
In other words, the reason is clear. It's not that doctors are eating people, but that a food chain is eating people. Doctors are only forced to act as the last organ in this food chain.
The next question is, why? Or in other words, what caused this food chain structure? An expert once disclosed: "The high medical expenses are mainly caused by the price inflation of drugs, consumables and equipment. The dealers in the intermediate links earn too much. " It is not difficult to deduce part of the answer, that is, the connivance of regulators. Without the connivance of the regulatory authorities, the dealers in the intermediate link could not earn so much, and the pharmaceutical industry could not be so dark. Another fact disclosed by experts also proves this point: "The price department is very strict with the hospital, but it is all small money, but it does not care about high-quality consumables such as medicines and equipment. For this kind of products, dealers should report to the price department as much as possible, and the price department does not limit the price of this kind of goods. However, patients often spend the most on this kind of high-quality consumables. Some antibiotics cost more than 1 1,000 yuan, and one needle 10 is 1 10,000 yuan; Some drugs, 20 yuan 1 tablet, cost several thousand yuan for a course of treatment. This part accounts for a large proportion of the total medical expenses. " Liu Feiyue, a young teacher who wrote a letter to the national ministries calling for curbing drug prices, provided specific information about the connivance of the regulatory authorities and the inflated drug prices:
"The cost of metformin hydrochloride tablets produced by Guizhou Shengjitang Pharmaceutical Factory is less than that of 5 yuan, and the government's highest price limit is 46.80 yuan.
The actual supply price of Luoxuebao injection produced by Shanxi Evergrande Pharmaceutical Co., Ltd. to the distributor is 2. 10 yuan, but the retail price set by the price department is 14.50 yuan. "
Obviously, the sharp rise in medical expenses, even beyond the actual affordability of the vast majority of citizens, is mainly the result of collusion between the middle and upper reaches of the pharmaceutical industry and regulators.
The last question is, why is there such a conspiracy? The answer is four words: profit-driven. As far as medical practitioners are concerned, they are just businessmen who come for profit. Is there any other way? Without substantial supervision, they certainly hope that everything will be forgiven. As far as regulators are concerned, all functional institutions are actually independent economic entities, and they have strong interest impulses that are no different from ordinary economic entities; Deregulation can provide them with a broad rent-seeking space, so why not?
The continuous expansion of the pharmaceutical market and the continuous growth of the pharmaceutical industry can bring two direct benefits to some local governments: one is to stimulate the growth of GDP and bring political achievements; The second is to increase fiscal revenue, so why not! Taking the pharmaceutical industry as the pillar industry and cultivating the pharmaceutical market with strength has become a * * * knowledge. In this case, it is required to strengthen the supervision of the middle and upper reaches of the pharmaceutical industry and reduce its profits to a reasonable range, that is, the average social profit. Isn't it just a tiger's mouth pulling a tooth? There is such a subtle contrast: on the one hand, the pharmaceutical industry has developed rapidly-since 1990, the output value of China's pharmaceutical industry has increased by more than 20% annually, which is much higher than the growth of the national economy and the average growth rate of the global pharmaceutical industry in the same period. On the other hand, China is listed as one of the countries with the most unfair "health financial burden" in the world-in the fairness ranking of doctors' burden by the World Health Organization in 2000, China ranked 188, which is the fourth from the bottom. It is really interesting whether there is a causal relationship between these two landscapes.
It can be seen that the medical industry certainly needs to be rectified, but the problems of the medical industry are mainly not the problems of the medical industry, but the problems of the whole medical industry, especially the problems of regulators, which are the problems of the whole food chain, and we cannot just push doctors to the forefront. Doctors not only suffer from exploitation within the food chain, but also bear strong public opinion and administrative pressure. In the long run, it is inevitable that you will be exhausted. Doctors are the guardians of our lives. If doctors are exhausted, can we expect them to protect our lives? In this sense, being kind to doctors is actually being kind to yourself.