At present, the tendency of many doctors' self-media is to highlight the main reasons for doctor-patient conflicts and medical disputes in patients, in the media that push the envelope, and in the government and hospital policies, and the more such emotional articles the more they can get the brainless support of the doctors' community, and wherever there is the slightest opposition, they will be scolded for their opinions, and attacked, except for selectively ignoring the unregulated use of medication and diagnosis and treatment due to the profit-driven. Aggravating the burden on patients is also an important reason for the number of doctor-patient disputes. In fact, most of the patients are vulnerable, but also more kind, even if the aggrieved will choose to bear the main, which is completely different from the medical trouble.
So doctors receive kickbacks is a common phenomenon rather than an individual case, this is an indisputable fact, but this industry subterfuge is how to make it?
Causes 1: work income from a very low starting point
Doctor's training time is long, the work pressure is great, but the starting income is very low, this is an objective phenomenon, the general doctor five years after graduation from undergraduate school can not work independently, after the examination of the license and after participating in two years of training is only the lowest level of doctors, the level of the level of the level of the need for superior doctors to pass on the help of the continuous learning and further training. Therefore, the beginning of medicine is indeed somewhat similar to apprenticeship, with craftsmen, chefs and comedians have a spell, Yue Yunpeng flirted with "three years to learn the art, two years of effectiveness", probably this is the meaning. Simply put, it is "eating less than a bird, do more than a cow", contracting a variety of miscellaneous work, write more medical records, more duty, sleepless nights were called up by the patient is the norm, so this group is also known as the "resident". And basically, there is no way to get a job in a large hospital without getting a master's degree or a doctorate.
There are no exceptions, and no need to complain, all doctors, including academicians, have come this way!
So doctors are again a profession that needs to stay up for years of seniority, and the thousandth of a percent that breaks the mold won't be there, and most will need to go through the motions. With slow promotion, income will gradually increase, but at this point the doctor is about thirty years old, often face the pressure of marriage, childbirth, children's education, buy a car, buy a house, support the elderly and other pressures, the desire to seek additional income will be very strong, so this is one of the biggest reasons for doctors to receive kickbacks - profit-driven!
The health care reform in many places mentions that a good doctor will be given an annual salary of 200,000 yuan, but in fact 50,000 or 60,000 yuan will have to be removed from the payment of taxes and social security, and in the end only 100,000 yuan or so of money will be left. But kickbacks have another advantage, because it is gray income, is cash, no way to regulate also do not pay taxes, all the other nominal high income is likely to bring a huge amount of taxes, the actual hand is not so much. That would make a direct cash kickback very attractive by comparison.
Doctors as a group are the same as the general population in other professions, and the overall morality is not much higher, and they know in their own minds that it is indeed non-compliant and unethical to do so. Of course, when you talk to a doctor, he will tell you that his income is low, and that he is tired and under pressure, etc. In fact, these two things are not related. Is it true that a cab driver who complains about being tired and earning a low income can take his customers on a long detour? Teachers complaining about low income can deliberately not teach some content in class, and let students attend his private tuition? What about the civil servant who feels that because his job is stressful and his income is low, he can feel free to be corrupt and accept bribes?
These things are not fundamentally different, relatively speaking, the income of the doctor group in the entire social population or belong to the middle, part or even on the upper side, we do a lot of other industries, including clerks, staff or even read a doctor's degree as a laboratory technician, do a dozen or so 20 years of income of only a few thousand dollars to go.
At the same time how much they contribute, the level of good or bad, high or low income is a very subjective thing, doctors do generally overestimate themselves. Not only that, but they want more, they want to take more, they want to take more, and human desire is endless, and even doctors earning over a million dollars a year will take a thousand or eight hundred dollars in kickbacks!
Cause 2: This is a problem of the "name and shame"
As mentioned above, the doctor's acceptance of kickbacks is not an individual phenomenon but a common phenomenon. The information of the medical representatives are all through each other, when the whole hospital, the whole department are receiving, people are doing you do not do, what do you want to do in the end? Do you want to report it? Or do you want to do something else? In the long run, the same department with the hospital people still can not play happily? The guys will have to get along with each other and work together in the future.
Including a part of the interests of the department down if you do not want, then in the future in the department you with the director and how to get along with the people? In the future, the job search, promotion, further training, including the improvement of technology still want to get support? So this is a question of "name and reputation". The first thing you need to know is that you have been in the same class together, you have carried a gun together, you have shared the spoils together, and that is the four most ironic relationships in life!
Most people who are deliberately out of touch are either marginalized or have left the industry.
And many doctors need a certain financial base in order to move up the ladder, whether it's from the academic dimension, rising status in the hospital department, or for other reasons such as wanting to be known among peers and the patient end of the spectrum. A lot of things can't be done when it's entirely about making ends meet.
Cause #3: Being chased backwards by pharmaceutical device companies!
In fact, in essence, the first two points is the root cause, but we can not ignore the reality of the huge "operational push"!
China's one trillion two hundred billion prescription drugs, more than four hundred billion devices and high-value consumables scale, thousands of pharmaceutical industry, tens of thousands of commercial, including pharmacies and genetic testing industry more than 10 million practitioners with a doctor's a pen relationship. Where there is interest, there is a jianghu, and non-compliance marketing, that is, with gold sales to kickbacks is the best results, the highest input-output ratio model, but also in order to survive the brutal competition in the market. Therefore over a million of front-line staff will be deeded to cash or equivalent to pursue doctors, the average general about 20% rebate, some drugs and devices can reach 40%, some genetic diagnostic products even up to 50%.
As the saying goes, when a man pursues a woman, he is separated by a mountain, and when a woman pursues a man, she is separated by a veil. In fact, the principle is the same, after the deed, some doctors gradually began to a small amount of receipt of some benefits, followed by self-congratulation, often walk by the river, how can not wet shoes?
Since the wet shoes, why don't you wash your feet, and since you wash your feet, why don't you take a bath ...... In this way, the two sides constructed harmony, and the disharmony became the interests of the patients.
And in fact the most clinically greeted people are their own. "Dr. X, my relative is hospitalized with you, take care of him more." So they get it, tests that can be done but not done, not done, drugs that can be prescribed but not prescribed, not prescribed, because they are their own people. Many doctors often prescribe different medications to their patients than they do to their own family members.
There are very few black-and-white scenarios in reality. More often than not, we are all at fault, and hospitals and governments need to reflect on this, as do doctors!
All comments can be left below, feel free to discuss.
Appendix:
Kickbacks are a social phenomenon, in fact, Europe, the United States and Japan before the occurrence of such commercial bribery, in the chaos of the world they applied a lot of heavy, such as huge fines, revocation of licenses, etc., after many years of hard work to effectively solve this problem.
Taking Germany as an example:
In the mid-to-late 80s of the last century, the problem of medical corruption in Germany was once very serious, with doctors receiving kickbacks on medicines, and accepting all kinds of sponsorships from manufacturers in violation of the law being very common. This situation caused a great deal of concern for the German Bar Association, and lawyers collectively filed lawsuits against the entire medical profession. A large number of media outlets followed up, leading to the integrity of the entire medical profession being widely questioned by society. It was only after a strong push from the legal profession and the public that Germany introduced a relevant bill to inventory the illegal gains of doctors and revoke the licenses of corrupt doctors that the problem of corruption in the German medical community was significantly improved.
Currently, the main laws governing commercial bribery in Germany are the Unfair Competition Act, the German Penal Code and the Anti-Corruption Act. These laws define various forms of bribery and provide for corresponding punitive measures. In Germany, the suppression of bribery is mainly by judicial rather than administrative means, in order to exclude undue interference by the executive.
The pharmaceutical industry is a special field. In order to avoid pharmaceutical companies to bribe doctors, the German Medical Science Professional Association, the Federal Association of Pharmaceutical Manufacturers, the Federal Hospital Pharmacy Federation, the Federation of German Universities and other 12 related associations in 2001 developed the "criminal assessment of the points of cooperation between the enterprise and the medical institutions and their responsibilities", the first part of the first part of the list of the pharmaceutical industry practitioners must know the legal knowledge; the second part of the standardization of the pharmaceutical companies and the The second part regulates the forms of cooperation between pharmaceutical enterprises and medical institutions, and sets out the principles of cooperation and the issues to which attention should be paid in cooperation.
The third part is devoted to banquets and gifts. It is not permitted for employees of pharmaceutical enterprises to invite doctors to banquets in their private capacity, but doctors can be invited to attend when organizing certain activities or holding working meals. Each invitation should be recorded for the record. It is also legal for a doctor to receive small gifts, but over a certain amount or under certain conditions can be regarded as bribery. Doctors caught accepting bribes can be fired.
Because of Germany's "separation of medicine," it is virtually impossible for pharmacies and doctors to bribe each other. The Essentials, however, provide detailed regulations on the behavior of pharmaceutical companies and doctors, minimizing the possibility of bribery.
In addition, Germany has a universal health insurance system, where patients' medical and pharmaceutical bills are ultimately paid by insurance companies. If pharmaceutical companies pay bribes to hospital pharmacies and market pharmacies, it will inevitably increase the cost of medicines, which means it will increase the amount paid by the insurance company, which therefore also has a strong supervisory role over doctors and pharmacies.