Chapter 1273 Medical Separatment
For the problem that it is difficult and expensive to see a doctor, many people put the blame on hospitals and doctors, but Peng Jianming believes that this should actually be a system problem. And because doctors are too professional, it is difficult for general government departments to deal with these problems to the point.
Now many people complain that there are more and more costs for various examinations and tests in hospitals. It turns out that when you go to the hospital to see a doctor, as long as you see a doctor, you can go directly to get the medicine. But now, register to the doctor, no matter how it is, the first thing to do is to give you a few check-ups or test sheets, and wait until the results come out before prescribe the medicine.
Many people think that such a test or test is actually unnecessary, because with the doctor's experience, he should have been diagnosed at that time. But why do doctors insist on laboratory tests or examinations? The main reason is that once there is a doctor-patient dispute, there is no neutral structure recognized by both sides to deal with it. The evidence of both sides is more risky for doctors.
For example, for a common cold, you only need to prescribe some medicine and go back to take it. But now if the patient does not drink more water according to the doctor's instructions after returning home, especially for older patients, once they have a fever and sweat, the blood will thicken. Once a myocardial infarction occurs, the doctor must show evidence to prove that there was no myocardial infarction at that time, so an electrocardiogram should be done.
Can it not be expensive like this? If there is any infection, use some antibiotics first, or there will be a secondary infection in the future, and then ask the doctor to prove that there was no infection at that time. Isn't it troublesome? In order to avoid trouble, it is natural to consider all kinds of possibilities in advance. Only the tests and tests that need to be done, one cannot be missing, and one cannot be missing.
Besides, the salary of doctors, it should be said that the vast majority of doctors are still conscientious, which Peng Jianming has a deep understanding. But it is also unrealistic to make everyone selfless. No matter who is, there will be a profit. For the same two kinds of drugs, he can get a bonus to prescribe low-priced drugs every month. Not only is there no bonus, but he is also criticized by the leader. It may not matter once or twice, but if it goes on in the long run, I'm afraid it's not a matter of bonuses, but whether you can keep your job.
Careful patients will find that the chloramphenicol eye drops that used to cost 1 yuan are now difficult to find. Erythromycin for injection is out of stock across the country, and it is difficult to find one. The lack of some cheap first-aid drugs makes patients more worried and doctors have headaches. Relevant departments once made a statistic that the shortage of cheap drugs in hospitals reached 342. Why did cheap drugs disappear? The pharmaceutical factory said that doctors don't like to use the market, while doctors said that the pharmaceutical factory has no profit and is unwilling to produce. Who is to blame for the shortage of cheap drugs in hospitals?
Peng Jianming believes that if the hospital becomes a for-profit structure, if the doctor's salary is linked to his performance, such a problem will always arise. Even if the heart booster is more than one yuan, even if all the hospital makes money, it is only more than one yuan. However, the heart-strengthening needle of more than 200 yuan, in any case, is also fifty or sixty times the profit of the heart-strengthening agent.
Peng Jianming slowly made his point of view clear to Zhu Daidong. He analyzed such things from the perspective of a doctor, the hospital, and the cadre of the health department. He increased the doctor's salary and reduced the profit-profit of the hospital. The municipal government came forward to purchase the national basic drugs separately. For low-income households, the national basic drugs are also mainly used. As long as these points can be achieved, he believes The financial expenditure on free medical care will drop rapidly.
"Comrade Jianming, your point of view has inspired me a lot. Do you think you can combine your point of view to form a written thing? In addition, is there really such a big difference in the price of drugs with the same curative effect? Zhu Daidong still doesn't believe it. You get what you pay for. If the price is too expensive, how can it be accepted by the market? This is obviously not in line with economic laws. Although Zhu Daidong doesn't know much about the health system, as long as it is related to the economy, he still knows it.
"I will write everything down as soon as possible and report to you then. As for the price difference of drugs with similar curative effects, I would like to give an example. Westland is a kind of heart-strengthening agent. Lin** is very commonly used. Although there are drugs such as 'poisonous hair K' and 'Milinon' in the treatment of heart failure, the side effects of 'poisonous hair K' are relatively large, and the price of 'milicon' is as high as one or two hundred yuan. In addition, Westland can also treat other diseases such as tremor, which is irreplaceable. If there is a shortage of this medicine, the consequences for patients in the intensive care ward will be very scary. But now in many hospitals, there are very few Westland. If there are really patients who need first aid, they can only use Milinong, which is more than 100 yuan, which is more than 100 times the difference.
In addition, Bicketone for the treatment of asthma, sulfadiazine injection for meningitis caused by Neisse fungus, and cyclophosphamide injection for cancer treatment are all difficult to find in hospitals. There are also 1 yuan for chloramphenicol eye drops, a box of fluperic acid for a few yuan, eight yuan for 100 yuan for periodontal tablets, etc. Some commonly used drugs that were very familiar have almost disappeared from the doctor's prescription.
These drugs are like this, and other drugs are similar. Many drugs with a few cents and a few yuan are becoming more and more difficult to find. The original intention of China's medical treatment was to benefit patients, but because of the loopholes in the policy, now it mainly benefits hospitals and pharmaceutical factories. Even for patients with medical insurance, the price is also very high. Peng Jianming sighed and said.
"In fact, I also understand what you mean. Medicine is not divided into different families, and it is difficult to reduce the price of medicine." Zhu Daidong said helplessly that in fact, it is impossible to have cheap drugs in China now. Under the premise that public hospitals are not compensated, the drug price has actually included the labor costs of some medical staff, and if public hospitals want to be subsidized, it requires a lot of financial investment, but according to the current situation, Zhu Daidong felt that it would be better to subsidize the hospital than to let them earn the price difference from the drug price. If all the medical workers in all public hospitals in the city are included in the financial budget, how much burden will it add to the city's finances? If Kikawa wants to provide free medical care for all, it is imperative to put medical workers in public hospitals in the budget.
As for the construction of the hospital, if it is infrastructure, it is easy to do. There is a city investment company. If equipment is needed, the hospital's equipment, especially some large-scale equipment, still needs to be imported. This requires a good channel in foreign trade. Zhu Daidong suddenly thought that if Zhang Tianrui's Hengtian Foreign Trade Company introduces the medical equipment of all public hospitals in Muchuan and gives it to Hengtian Foreign Trade Company, will it let the hospital purchase by itself, or will it be much stronger for government departments to purchase?
Now a hospital wants to import a set of equipment. In addition to the very expensive price of the equipment itself, it will also incur a lot of additional costs. For example, in some places, an inspection team will even be sent to visit abroad first. After returning, if the proposed plan is not approved, it is necessary to send someone to inspect again. After repeated inspections, the final cost will naturally be calculated on the medical equipment. And these costs ultimately need to be borne by patients.
In addition to letting Hengtian Foreign Trade Company be responsible for imports, in fact, a supervision agency should be added, otherwise, it will always be exploited.
Some people in government departments have nothing to do every day. What they think about all day is how to find loopholes from existing policies to make themselves more convenient.
"In the words of Mayor Zhu. In fact, a doctor's labor has to bear the labor costs of two or three hospital employees. In other words, in the prescription given by the doctor to the patient, in addition to the price of the medicine itself, there are also the operating costs of the hospital, the compensation for the doctor's low treatment, the salary of nurses, etc. Peng Jianming said that the mechanism of public hospitals with drugs remains unchanged, and high-priced drugs are always more popular than cheap drugs. At this point, I don't think that people's will is transferred. Even if Zhu Daidong is so strong, he can't change it if he wants to rely on a few documents.
But if we start from the system, things will be much simpler. Otherwise, according to the normal market rules, low prices often sell quickly, but the higher the price of drugs in China, the better they sell. Hospital drug addition mechanism is an important factor in the formation of this abnormal phenomenon. According to the regulations, the hospital can increase the price of 1% on the basis of the drug purchase price and sell it to patients. If the hospital buys KC yuan of medicine, it can earn 5 yuan. If you buy 0 yuan of medicine, it can only earn 15 yuan. Therefore, hospitals are willing to choose expensive drugs in drug procurement, so that they can make more profits.
In recent years, the National Development and Reform Commission has reduced drug prices many times, and cheap drugs have often become the target of price reduction, and after each price reduction, a batch of cheap drugs will always disappear. Because the highest retail price is set low, the operating space in the middle is reduced, and the rebate that doctors want to get is naturally smaller.
It is precisely because of the above reasons that in the drug bidding, if the same variety of drug has foreign capital and multiple domestic enterprises win the bid, the hospital often purchases a foreign drug because it is restricted by the "first-class double regulation" (the first-class double regulation: that is, only two specifications of the same drug of the same dosage form can be purchased Choose an enterprise to purchase, or even do not purchase domestic products. The drugs of foreign-funded pharmaceutical factories have the same specifications and dosage forms, which are often more expensive than those made in China.
"Comrade Jianming, you have been working in the health system for a long time, and now you are responsible for the work of the Civil Affairs Bureau. This low-income free medical care is a preview of the city's free hospitals. I hope that the Civil Affairs Bureau can actively cooperate with the Health Bureau and the Finance Bureau to practice this work for a long Zhu Daidong said solemnly.
"Mayor Zhu, please rest assured that our Civil Affairs Bureau will definitely cooperate with the Health Bureau and the Finance Bureau, and under the correct leadership of the municipal government, we will unswervingly implement the issue of free medical care and free education for subsistence allowance." Peng Jianming said.
"If you have such an attitude, I believe that the low-income free medical system will be well implemented." Zhu Daidong said firmly.
"It's mainly because we have Mayor Zhu in Kikawa, otherwise I don't think this system will ever be implemented." When Qin Xiaojuan added water to Zhu Daidong, she heard their conversation and said something.
"Of course, Mayor Zhu is not only the youngest mayor in the province, but also the most courageous mayor. I am really lucky to be able to work under the leadership of cadres like Mayor Zhu in my life. Peng Jianming looked at Qin Xiaojuan angrily. He was talking to Zhu Daidong. What right did Qin Xiaojuan have to interrupt? Although Qin Xiaojuan can be the master at home, now Zhu Daidong is here, which is the working time.
"Premier Hong often said that Gong Shengming, Lian Shengwei, as long as we are not selfish at work, in terms of style, honest and self-disciplined, I believe that you will become better leading cadres in the future." Zhu Daidong said righteously, Gong Shengming, Lian Shengwei, and the six short words are easy to say, but it is so difficult to do. Some cadres have practiced all their lives, but they have not been able to control themselves in the last step.
Qin Xiaojuan looked happy. She wanted to say something else, but Peng Jianming gently pinched it in her hand. On such an occasion, she made a speech, which was against common sense. If she spoke again, I'm afraid that no matter how good Zhu Daidong's skill was, she would be dissatisfied.
"Comrade Jianming, Director Qin wants to speak. You can't deprive others of their right to speak. Our party has always advocated democracy and freedom. Today is not a formal meeting. You can speak freely. Zhu Daidong said with a smile.
"Mayor Zhu, I promise you that I will think that you will follow an example in the future, and you will be my goal and motivation to move forward." Qin Xiaojuan said firmly that she now has a punishment on her back and has been demoted by half a level at the same time. Although her current working environment is better than when she was the former director, after all, she is only a deputy section-level cadre now. Now Zhu Daidong visits in person. How many cadres in Muchuan City can enjoy such an opportunity?
"Comrade Qin Xiaojuan, your essence is actually good. In fact, there is no need to pay attention to the punishment received before. If you make a mistake, you can correct it. If you know it, you can correct it. As long as you remember what I just said and take it as your motto for the rest of your life, I believe that you will definitely make progress. Zhu Daidong said righteously that he was actually very clear about Qin Xiaojuan's mood when facing himself.
When I was in Yuhua County, I was also very excited to see the leaders of the city. A word of encouragement from the leader and an encouraging look can make his whole body full of strength. Now because of Peng Jianming, Zhu Daidong can be said to be a good encouragement to Qin Xiaojuan. He believes that as long as Qin Xiaojuan is self-motivated, there is still a lot of room for progress.
"Thank you, Mayor Zhu. Please watch my performance in the future. I will not let you down!" Zhu Daidong said with a smile.
"Oke, Comrade Jianming, remember to inform me of Comrade Xiaojuan's personnel transfer in the future, and I will come back to congratulate you and your husband. Goodbye." Zhu Daidong said.