The More Expensive The Medical Fees Are, The More Expensive The &Nbsp Is; The Experts Say That The 14 Price Controls Are Being Built Up.

There is a Western proverb: "the road to hell is often paved with goodwill bricks and stones". Government regulation is often the best commentary on this proverb.

In order to control medical expenses and reduce the medical burden of patients, the government introduced a series of control measures to control the behavior of doctors in hospitals and control the prices of medical services and drugs.

As long as the monopoly position of public hospitals in medical services and drug retail markets has not been eliminated, all existing price control measures will not help to reduce the burden of medical expenses on patients, but will also bring serious drawbacks.

(see the twenty-second issue of this issue, "why is a public hospital so cattle?")

1, control the price of medical services.

The government first controls the price of medical services, but does not regulate the price of drugs.

The government stipulates that the cost of diagnosis and treatment (registration fee) can only be 5 yuan, which is not higher than this standard.

In order to achieve monopoly income, in order to achieve differential pricing, hospitals will prescribe a box of drugs priced at 995 yuan (hospital purchase price of 50 yuan) for the 5 yuan registration fee. This is the so-called "drug dependent medicine" system (that is, when customers buy a tight commodity, they must buy some unsalable goods at the same time. The essence is that shops are overpriced.

There was no drop in the medical cost of the patients, or 1000 yuan, but the price of the drugs changed from the price of medical services to the price of drugs. The cost of the drugs reduced the actual income of the hospital by 50 yuan, which was totally a waste of social resources, because the patients did not need to eat these drugs, and naturally they did not need to produce and distribute these drugs, either.

2. Maximum retail price of controlled drugs

Later, the government not only controlled the price of medical services by 5 yuan, but began to control the maximum retail price of drugs.

For example, the above hospitals independently priced drugs at 995 yuan, and the government stipulated that the maximum retail price should not exceed 200 yuan.

If there are no new high priced drugs, doctors will prescribe 5 boxes of the above drugs to the rich patients and make the drug priced at 199 yuan / box, not exceeding the maximum retail price stipulated by the government.

Naturally, the medical cost of patients has not declined, or 1000 yuan.

The income of the hospital decreased by 50 yuan to 5=250 yuan, and the social resources waste increased to 250 yuan.

After controlling the maximum retail price of drugs, excessive drug use and drug abuse began to appear and spread.

Moreover, once the maximum retail price of some drugs is reduced by the government, pharmaceutical companies can always use new drug approval and separate pricing policies to provide new medical institutions and doctors.

3, control the purchase and sale rate of medical institutions.

Now, the government not only controls the price of medical services and the highest retail price of drugs, but also further controls the purchase and sale rate of drugs in hospitals, which stipulates that it can not exceed 15%.

This means that the purchase price of 50 yuan of drugs in the past can sell to 199 yuan, now can not, the highest can only sell to 57.5 yuan.

If the retail price of the drug reaches 199 yuan, the purchase price will reach 173 yuan.

Taking advantage of the monopolistic position in drug procurement, hospitals and drug suppliers conspire to raise the purchase price of drugs, raise the purchase price of the past 50 yuan to 173 yuan, and then increase the hospital price by 15% at the retail price of 199 yuan, and still prescribe and sell 5 boxes of medicine to the rich person.

The virtual 123 yuan purchase price will not be owned by drug suppliers, most of which will be returned to hospitals and doctors in the form of rebates and rebates, for example, 100 yuan.

Patients' medical expenses have not declined, while the income of hospitals (doctors) has declined, and social resources have been wasted more.

4, implementation of differential markup rate

Under the above control measures, the original unified fare increase rate is changed to the differential markup rate: low price drug high price increase rate, high price drug low price increase rate.

The government expects that such a differential pricing policy can induce hospital doctors to buy and sell low priced drugs.

The way for hospitals (doctors) and pharmaceutical enterprises to circumvent is that the pharmaceutical enterprises provide the so-called low price drugs for hospitals: the original 20 boxes per box.

5. No discount.

A few years ago, it was legal for a drug company to pay a rebate to the hospital.

Now the government stipulates that discount rebates are illegal.

This regulatory policy sounds very reasonable: since the 100 yuan purchasing pharmaceutical and pharmaceutical companies are willing to return to 20%, that is, to return the hospital cash to 20 yuan, why not directly purchase the price to be 80 yuan, even more sharp.

However, this seemingly clean method is not in line with the interests of the hospital, because under the control of the purchase and sale rate of 15%, the drug hospital with a purchasing price of 100 yuan can be sold for 115 yuan, and then get the drug company to return 20 yuan, and the drug sales in the hospital is 35 yuan.

If the wholesale price is reduced to 80 yuan directly, the retail price of the hospital can only be sold to 92 yuan. The profit from drug sales in the hospital is only 12 yuan, which is reduced by 23 yuan.

How can the hospital be willing?

Now the open discount button is not allowed, the dark fold (back point) is illegal, and the pharmaceutical company turns to recessive return.

The medicine company is in debt to reduce the drug money of the hospital, the hospital is in arrears with the medicine company 10 million yuan of medicine, the medicine company remissions for it 10%, only 9 million yuan.

In addition, subsidized hospitals cover the building to buy equipment and banquet to give gifts.

The cost of implicit rebate is higher than that of direct discount. If a pharmaceutical company wants to survive, the higher cost can only be added to the wholesale price of drugs.

6. Control prescriptions prescription and average cost.

In order to reduce the economic burden of patients, the government has further increased control and started to limit the prescribed prescriptions. The hospital (Doctor)'s response is to increase the number of prescriptions. 6 prescriptions were prescribed in one prescription, and now only 2 prescriptions are prescribed, but 3 prescriptions are given to you.

Therefore, the government further restricted the average outpatient expenses. The hospital (Doctor)'s response measure was that once there was no average cost limit, once a week to the patient's dosage (chronic disease patients even once a month's dosage), now only give you two days of dosage.

Therefore, before the outpatient expenditure control, the patients can go to the hospital once a week. After the control of the outpatient expenses, the patients need to go to the hospital 3 times a week.

The actual medical expenses paid by patients have not been reduced at all, but the trouble and hardship have increased.

7. Control drug ratio

In order to curb the excessive use of drugs in hospitals and reduce the medical expenses of patients, the government began to control the proportion of drug costs in medical expenses.

However, the total medical cost of an appendicitis surgery patient in the past was 8000 yuan, of which the drug cost was 6000 yuan, and the drug accounted for 75%.

Now the government stipulates that the proportion of drugs can not exceed 50%. Hospitals (doctors) can not meet this requirement by reducing the cost of drugs to 2000 yuan, but they still maintain 6000 yuan of drugs. However, an increase of 4000 yuan of medical examination, such as doing MRI, CT and so on, increases the total medical cost to 12000 yuan, thus making the proportion of drugs lower to 50%.

"Drug proportion control" not only can not reduce, but also improve the medical expenses of patients.

The medical expenses of affluent patients are further increased, while those who are at the edge of the disease can be excluded from medical treatment because of the increase of medical expenses.

In other words, this regulation increases the medical burden of the rich, and the poorer people begin to see nothing.

8, the government centralized bidding procurement

Due to the high level of drug fees and the unhealthy trend in the field of drug purchase and sale, the government decided to deprive hospitals of the right to purchase drugs independently and implement centralized bidding and procurement of drugs.

The implicit logic of this is that the president of the hospital is unreliable, and the director of the pharmacy department of the hospital is unreliable. The government tendering is reliable.

However, the municipal government centralized bidding has been implemented for six or seven years. The price of drugs has not dropped substantially. The cost of drugs has increased rapidly year by year. The unhealthy tendency of rebate and rebate has not been reduced, but has become more and more popular.

In addition to the hospital management and doctors, the public relations companies of pharmaceutical companies have increased the number of public bidding offices and government officials holding the tender offices.

The patient's medical burden has not declined, but continues to rise rapidly year by year.

The behavior of hospitals (doctors) has been greatly restricted, but the high fee behavior has not changed at all.

9, drug centralized government procurement at provincial level

I do not know what the reason is. The government decided to increase the centralized procurement of pharmaceuticals from the municipal level to the provincial level. Since 2009, the provincial government centralized procurement system has been implemented.

However, from the 2009 to 2010, the price of winning drugs has not been substantially reduced, especially in the provincial level centralized bidding of the basic medicines. The price is much higher than the previous purchase price of primary medical institutions, or even a significant portion of the retail price of the basic medical institutions.

The degree of specialization of domestic funded enterprises, especially small and medium-sized enterprises, is often only increased by the staff and capital involved in government public relations, and its institutional setup has not increased significantly.

In addition, due to the huge scale and the high level of specialization, foreign pharmaceutical companies have increased the Ministry of Commerce in recent years besides the traditional government affairs department. Its main task is to publicizes public bidding offices and health administrative departments in various regions.

For more and more public relations investment, pharmaceutical companies are very annoyed and complain.

10, zero price difference

In order to cut the interest chain between selling drugs and prescription, the government adopted a more stringent control policy: zero margin policy.

In this regard, the first measure of the hospital is to raise the price of drugs, buy and sell at this price, and then get the proceeds of drug sales in the form of rebate and kickbacks, which is called "zero price difference". There is also a medical staff opening a drugstore at the door of the health center to induce patients to buy medicine at their own drugstore.

The other way is to reduce the dosage of oral medication, and to induce patients to fight the bottle as far as possible. Although the price difference is zero, the price of the bottle, the observation and the material of the bottle are profitable. The thirty or forty yuan oral medicine can cure the disease. Now the patient will spend one hundred or two hundred yuan to fight the bottle.

All these are different.

11, prohibition of "two bargaining".

In order to maintain the seriousness of centralized procurement by the government, the relevant government departments clearly stipulate that after the government has centralized bidding, the public medical institutions must purchase drugs according to the marked price, and prohibit the "two bargaining" between the local administrative departments and the public hospitals.

One fact that has to be pointed out is that provincial centralized bidding improves the price maintenance ability of pharmaceutical enterprises, that is, the ability of individual drug suppliers to maintain high prices of drugs, and also improves the ability of pharmaceutical enterprises to form "price alliance", that is, the ability of multiple drug suppliers to maintain the high price of pharmaceuticals.

The prohibition of "two bargaining" has further enhanced the capability of pharmaceutical enterprises.

Such a policy is actually the government's use of its monopolistic administrative coercive power to pfer part of the monopoly position of public hospitals in the pharmaceutical retail market to drug suppliers, which will form a monopoly rent.

The example of real estate Tendering can directly illustrate this point. The government auctions a piece of prime lot land by way of public bidding, and the highest bidder obtains the land, thus obtaining the monopoly supply right of the commercial housing. However, the monopoly rent brought by the monopoly right does not belong to the developer, but most of them come to the government in the form of land auction.

12, single source commitment

Ten years of drug centralized government bidding is not a real tender.

Because it only determines the purchase price and the number of purchases, the successful bidder only obtains the qualification to enter the public hospitals in the bidding area, whether the public hospitals will purchase or purchase, and also needs the pharmaceutical enterprises to do marketing and public relations.

It has been suggested that the single source commitment system should be introduced, that is, one product, one plant, one drug product regulation, which only wins a pharmaceutical production enterprise, and the enterprise exclusively provides all public medical institutions in the province or a designated area to ensure that the successful bidder obtains all the market share in the designated area, ensuring that every public medical institution uses only one enterprise.

However, is such a tender becoming a real tendering? First, the government deprives the hospital purchasing agent and the buyer of the bidding decision making power, but expects the hospital to implement the tender result, which is purely wishful thinking.

Secondly, what drugs can be used and how much quantity can only be calculated by the doctors, and the Dean can not interfere with them, let alone government officials?

If the median price of drugs makes medical institutions no longer have room for profit, the purchase volume of medical institutions will be greatly reduced or even not purchased. After all, most medicines are substitutes.

Damage to the interests of patients can bring economic benefits, doctors may do harm to the interests of patients can not get any benefits, how can doctors do?

Therefore, the implementation of a single source commitment system will not substantially reduce the price of drugs, and it will further eliminate a group of cheap drugs.

13, crack down on kickbacks and other commercial bribery.

In addition to adhering to the above control measures, the government began to crack down on commercial bribery such as kickbacks.

If we really dare not get the kickbacks again, will hospitals and doctors reduce the medical expenses of patients? Of course not.

Since the patient is willing to pay 1000 yuan, why only let him pay 500 yuan? Since we can not get the kickbacks, then we should open up high priced drugs as far as possible, and we can increase the price by 15%. The higher the price of drugs, the greater the legal increase, the greater the proceeds of drug sales.

Another way to avoid this is to reduce the amount of prescribing, but increase the amount of medical examination, the patient's medical expenses have not declined, and the hospital (Doctor) income has not declined.

In public hospitals, they are in the "oligarchy" status, or the existing medical service market is imperfect competition market, but in the case of monopolistic monopolization market, though limited, there is still a little competition that makes public hospitals unable to charge their fees to the highest payment ability of patients.

However, under the rigid constraint of the existing income, the way of "Combating Commercial Bribery" eliminates the limited competitive ability of public hospitals, so that they can only meet the regulatory requirements by raising the medical expenses of patients.

It has facilitated "

14, two lines of revenue and expenditure

All the above control measures are null and void. The government has adopted the most stringent control measures. The two line of revenue and expenditure is that all the business income of the hospital is turned over to the special financial account, and all expenditures of the hospital are approved by the competent authorities of the government.

Popularly speaking, every penny of the hospital's income is handed over to the finance, and every cent of its expenditure, including the purchase of drugs and the wages of medical personnel, is uniformly paid by the finance.

However, the income level of medical personnel will inevitably become the wage level of egalitarianism.

This is actually a reward for laziness and punishment, to crack down on the excellent doctors and backbone doctors in primary medical institutions, and to shield and conniving those quack doctors who have mixed up their lives and have entered the public medical institutions by virtue of their relationship.

After implementing the two line of revenue and expenditure and the zero difference policy, all the doctors in all primary medical institutions have basically paid the same wages in the form of financial support, and some doctors who have been eliminated by the market have returned to work.

This is not a "strong grassroots" but a weakening of the grass-roots level.

Under the two line system of revenue and expenditure, medical personnel fall into the situation of "doing more, doing less and doing the same, doing well and doing worse." seven or eight days a day, we can simply look at the problem and suggest that it should go to a county hospital.

Patients are more crowded into the county hospitals. Seeing a doctor is harder and more expensive.

Some doctors engage in private medical practice to make up for the economic losses brought by the reform and increase the risk of medical treatment for the common people.

In short, as long as a public medical institution has a monopoly, he will charge according to this monopoly position, and the medical expenses of patients will be monopolized.

Not to eliminate monopoly, all control measures are to allow medical institutions and stakeholders to adopt a variety of ways to avoid regulation and maximize the access to monopoly rent.

In this process, the rent will be dispersed among all the participants, which will be wasted on various evasion measures, but the final result will not change.

Patients' medical expenses will not drop, and social resources will be wasted.