December 27, 2014, in the seventh Health China Forum, the former Minister of Health Gao Qiang could not help but spit out a lot of spit, a lot of spitting points to surprise people.
The theme of this year's Health Forum is "Integration and Renewal of the Pharmaceutical and Health Industry", and Gao Qiang understands that the so-called integration and renewal is to try to integrate the relevant sectors, industries, people, interests, contradictions, views and so on, in the field of health. Together, a variety of different interests together, the difficulty is indeed great.
Spouting medical investment:
The state invested so much money, how the people did not feel
Not long ago the media published a medical reform blue paper called "China's medical system reform report", which pointed out that the 2009-2013 national financial health care expenditure accumulated 3068.2 billion, the budget for the 2014 financial 10071 billion arranged health expenditure. In 2003, when I first arrived at the Ministry of Health, the nation's fiscal expenditure on health was only 77.8 billion yuan, and in 11 years it has grown to more than 10,000 billion yuan.
But there is a sense that the government's investment has not effectively reduced the burden on individual residents. Where does the government's investment money go? Some say it is wasted, flowing into the hands of hospitals, pharmacies, pharmaceutical companies and doctors, with no direct benefit to the people.
The problem is that very little of the government's input is used to reform the unreasonable revenue-generating mechanisms of public hospitals. In recent years, although some hospitals have reformed the mechanism of medicines to compensate for medical care, hospital income has decreased, but this part of the need to make up for, the government has not correspondingly increased the subsidy, but through the adjustment of medical service charges to increase revenue and make up for it, how can such a mechanism effectively reduce the burden of the masses of the cost of medicines?
It can be imagined that in the case of public hospitals still practicing the self-supporting revenue-generating mechanism, if the government allocates funds only for the improvement of the hospital's infrastructural conditions and the purchase of large-scale equipment, the result can only be a further enhancement of the hospital's revenue-generating capacity and level, which is likely to further aggravate the burden of the masses' medical expenses.
Spitting hospitals to generate revenue:
Only buy you equipment, do not pay your salary
For how many years we have been talking about the integration of the interests of the medical staff and the public, we have been emphasizing that public hospitals should maintain public welfare, do not compete with the masses for profits, but little effect, the key is that our hospitals are still a kilometer of the mechanism of generating revenue. The government's salary for medical staff is basically not a penny, relying entirely on medical services to sell drugs to earn money in a way that earns more hair more, earn less hair less, this mechanism is to encourage medical staff to increase income, but also led to the increase in the burden of medical costs, this mechanism is always difficult to solve.
Some of our departments adhere to the principle of not supporting people, I can give you money to buy equipment, build houses, but we can not guarantee your salary, you go to the service to generate income to pay wages, this mechanism is to push our medical staff to the mass interests of the opposition, which is to lead to conflict between doctors and patients is a very important reason. Both hurt the interests of the masses, but also hurt the dignity of our medical staff and the image of the white warrior.
Spitting on the prevention and control of chronic diseases:
There are more and more patients, only waiting for the patients to come to the door
The 2003 SARS epidemic has made us realize the importance of public **** health, so the country invested a huge amount of money to strengthen the basic preventive and control system construction, so now to deal with a variety of infectious diseases and emergencies of the ability to public **** health significantly enhanced, but we are in the prevention of a variety of common diseases, multiple diseases, geriatrics, and the prevention of a number of diseases. common and frequent diseases, geriatric diseases, chronic diseases, etc., the ability is still quite weak.
Cardiovascular and cerebrovascular diseases, cancer, diabetes, kidney disease, liver disease and other serious diseases are still threatening the health of the people. 2006 I have a survey in the Ministry of Health, the number of people who went to various types of medical institutions was 2.8 billion, and last year more than 6 billion, which shows that there are still many problems in the control of some of the serious diseases we have. In the past, it was called "the upper work to cure the disease, the lower work to cure the disease", indicating the importance of preventive disease control, but the real implementation of this correct concept of health into the work of the work there is still a very long way to go.
We now have a health control system in which prevention and control and treatment of disease are separated, and most of our disease control personnel are dealing with the spread of infectious diseases, and whether or not there are not many effective means of spreading chronic and common diseases. Most of our doctors sit and see patients and wait for them to come to their homes, and they seldom go into the communities and families to investigate and understand the epidemiological trends of diseases. We have a lot of work to do in this regard. How to realize the combination of prevention and treatment requires not only the efforts of the health system itself, but also the active participation of academic institutions, the media and hundreds of millions of people in the community to form a social synergy *** with the control of the occurrence and prevalence of diseases.
Spitting health insurance reimbursement:
The more imported efficacious drugs, the more not reimbursed
Our health insurance agencies for medical services behavior supervision is very weak, but also on the residents of the rights and interests of health but set up all kinds of limitations, let's say that we are participating in the health insurance, we are in the medical reimbursement of medical expenses have a directory, the directory of this is reimbursable! However, there are quite a number of medicines and services that are not included in the list and are not reimbursed at all. The more expensive the drug, the more imported the drug, the more effective the drug, it is not reimbursed.
The problem now is that our health insurance departments only regulate the reimbursement of expenses, and no one is in charge of the people's out-of-pocket expenses. If our public hospitals steer the people to take more out-of-pocket medicines and services just to generate revenue, how can the burden of the masses be eased?
I don't agree that our expense reimbursement system is a two-track system of partly reimbursed and partly not reimbursed, and that all expenses and services related to treating and saving people's lives should be included in the scope of reimbursement.
Spouting about drug approval:
A few people approving drugs behind closed doors can't be corrupt!
The order of medicine is now very chaotic, not only because everyone is fighting for financial benefits and profits, but also because our government departments have had serious problems in approving medicines and drug prices in the past few years.
We have only 7,000 or 8,000 kinds of medicines in the country, but the number of approved medicines is about 180,000 or 190,000 almost, and there are dozens of numbers of a variety of medicines, and the approved prices are different, and the same medicines are more than ten times different, which leads to the same medicine with many names, the same medicine with many prices, and inevitably does not produce corruption.
Pharmaceuticals are a special commodity, different from other commodities. First, the health and safety of people's lives, lives are at stake; second, the use of medicines in patients is under the guidance of the doctor's passive consumption, it is difficult to take the initiative to choose; third, the price of medicines is not directly proportional to the efficacy of the more money spent may not be a good result. And other consumption is not the same, to the restaurant to eat, spend a thousand dollars certainly eat better than spending one hundred dollars, but take medicine to spend a lot of money, but the efficacy is not necessarily good. So this particularity requires our government and society to give a high degree of protection to the rational use of drugs by the public, it is necessary for our government to implement special policies and regulatory measures for drugs, rather than letting go.
There are some problems in the approval of the regulatory offer, this problem is not in the approval system itself, but in the lack of openness and transparency of the approval process, only a few people secretly approved, this is not a problem of the system, this is the operation of the problem.
The world's major developed countries medicines are basically government-regulated and not liberalized. A few days ago, a French friend came to introduce to me, all of their French medicines are government regulation, government approval, but not a department, there are health, Ministry of Finance, Ministry of Economy, Ministry of Security, several departments jointly organized a drug price committee, joint approval, regular publication, which can be out of what corruption?