The other is that there is some connection between doctors and pharmacies. For example, I am a pharmacist selling gynecological lotion, and then I found a pharmacy outside the hospital to put a batch of my medicine. The purchase price is five yuan, the selling price is fifty-five, and the intermediate profit is fifty-five. I want 25, the doctor gets 15, and the drugstore gets 10.
How should I calculate the doctor's fifteen dollars? Naturally, it is a medicine list. Some pharmacies will take inventory every day, put the list of medicines prescribed by doctors together when checking out, pay the bills to the doctors on a monthly basis, or return the money directly to the doctors after taking the medicines.
There are also agreements between pharmacies and doctors. Generally, this medicine is not available in other pharmacies, or it is not common. As long as it is prescribed by a doctor, how much will the doctor pay for a bottle of commission? Or simply, how much does it cost for the doctor to put this medicine here and sell it to the pharmacy?
If this medicine is really effective and there is no medicine in the hospital, let the patient buy it himself, write down the name of the medicine casually, and the pharmacy will not leave your list, so this is usually the first case.
If you really write down the name of the drug in detail, bring your signature, or some special symbols, or the pharmacy must take away your drug list, then it should be the second case.
On the surface, the difference in drug prices seems to be zero, but this is not the case:
The so-called zero price difference of drugs only blocks the original 15% retail price difference after hospital procurement.
The actual black-box operation, the bidding price has been reserved in the factory or pharmaceutical factory, which is called about 25% in the industry and is guaranteed.
On the one hand, when there is a shortage of drugs in public medical institutions, they buy drugs in designated pharmacies with external names to make up for the shortage, increase income and make profits.
On the other hand, some doctors can't get kickbacks for their work, so they seek other channels to prescribe drugs outside.
There are also some manufacturers, the bidding price is too low, and there is no room for operation, so they abandon the bid and choose the nearest pharmacy to operate behind the scenes.
In short, there are policies at the top and countermeasures at the bottom. The Tao is one foot high and the devil is ten feet high.
Bidding breeds corruption, and zero price difference seems to be close to the people. In fact, only the registration fee, examination fee, hospitalization fee and treatment fee have been increased, and the problem of over-medical treatment has not been solved.
It is not surprising that there is no medicine available in famous hospitals when medicines are prescribed outside hospitals!
I have been working in medical and health posts since I graduated from medical college. As a member of the medical industry, I can tell you that the rules and direction of this industry are adjusted with the changes of national policies. In recent years, with the reform of national medical and health undertakings, the medical industry is related to the people's livelihood of thousands of households, so the reform is also constant.
First, we are striving to achieve the goal of "linking the three hospitals and breaking the government slogan", so the pharmaceutical industry is the forerunner of reform. Take Xi 'an, the city where I live, for example. From April 17, all government-sponsored public hospitals must implement zero price difference sales of drugs. What do you mean, when you enter the hospital, you have to sell more money to patients, for example, a box of medicine 2 1 yuan must be sold to patients.
Second, the result of this policy has really dealt a heavy blow to supporting doctors with medicine. Hospitals, including doctors themselves, will not prescribe large quantities or excessive drugs to patients as before (in the past, the purchase volume and profit of drugs were linked to the interests of doctors and hospitals, and they could all benefit), but now there is a zero price difference, and hospitals cannot profit from drugs. The more drugs sold at the same time, the more drugs are in stock, the maintenance of drugs (such as expired drugs and damaged drugs) and the related labor costs of pharmacies ().
Third, hospitals are reluctant to sell drugs at so much cost, but patients need treatment drugs, so many tertiary hospitals have set up their own companies. For example, the pharmacy at the entrance of the hospital is their company's industry, allowing patients to take medicine at pharmacies outside the hospital, or cooperate with pharmacies outside the hospital, because pharmacies can sell at higher prices, who doesn't make money? Other industrial chains in hospitals have also brought profits, so getting up early is not enough!
In a word, this is why people like patients to take medicine in pharmacies outside hospitals! However, we can pay attention to the recent 4+7 drug procurement policy pilot work, and the drug price has been greatly reduced, but at present only some pilot cities have implemented it.
Interest contributes to success. After seeing the patient in the hospital, the doctor asked him to go to the designated pharmacy outside to get the medicine, and the pharmacy gave the doctor a certain percentage of kickbacks. The more drugs sold, the more kickbacks doctors get. Another is that medicine in hospitals is much more expensive than that in pharmacies. Moreover, hospitals no longer pay doctors according to prescriptions. As a result, the turnover of outside pharmacies has increased, doctors have earned more money, and patients' drug costs have returned to a lower level. Everyone is very happy. But in the final analysis, wool comes from sheep. They also make money from patients. This shows that China's medical system is in urgent need of reform and improvement. A few days ago, I bought cilnidipine tablets in the hospital, which were produced by Shanxi Zhendong Pharmaceutical Co., Ltd., and each box was 23.88 yuan. I bought a box in 8.5 yuan from a drugstore outside, and the specifications and packaging of the place of origin are exactly the same. The price of the hospital is nearly three times. For some unknown reason. Maybe that's the reason.
Because of the policy, 30 years ago, because the doctor's income was too low and the country had no money, the policy of supplementing the doctor with medicine was put forward, which is also called commission. This is officially allowed, and many people often use it as an excuse. In fact, young doctors in China basically don't have this income now, especially after the zero price difference comes out, it is more difficult for hospitals to get medicine. The same drug store is more expensive than the hospital. Many drug dealers prefer not to take medicine to the hospital, and doctors have no medicine to prescribe, so they can only let patients go to the pharmacy to buy it themselves. In short, there are fewer and fewer medicines in hospitals, and many of them are useless at all. Some specific reasons involve Fu Zheng, so I dare not say more here. I just want to say with a smile, now there is zero price difference, and drug rebates are severely cracked down. Has the price of medicine dropped?
Doctors order patients to take medicine from outside pharmacies for many reasons. Among them, the establishment of pilot cities for separating medicines is in line with local policies, and the medicines that are not available in outsourcing hospitals are in line with hospital regulations. There is no separate municipal hospital. It is illegal for some doctors of the same kind in hospitals to let patients outsource drugs, which is also one of the unhealthy trends in the medical industry. It is likely that the doctor Yamatonokusushi and the pharmacy have a direct interest relationship, which is what people often say.
The "kickback" in the medical industry has existed for many years, and the people have great opinions. The government has repeatedly banned it, blocking pharmacies with departments, blocking departments with doctors and blocking hospitals with pharmacies. Rebate is like a mouse crossing the street, but no one can kill the mouse, everyone opposes it, and no department has the ability to completely eliminate it. I think there is a very important reason besides the system and intensity, that is, people's understanding of the value of mental labor.
For example, in daily life, how much does it cost to find someone to move, and how much does it cost to find an hourly worker to do some housework? People think it is a natural and reasonable service and a served labor relationship. But no doctor has ever been used to asking patients to write prescriptions, and how much does it cost for an hour of treatment? The registration fee for experts in super-large hospitals is also one of the hospital management measures. For a long time, the price of drugs has included the doctor's labor value, in fact, it also includes the doctor's labor value, which is nothing but undisclosed or undisclosed.
Therefore, in the future medical system reform and medical circulation system reform, the labor value of doctors must be fully and legally reflected, and the money collected should be aboveboard, fair and reasonable. As for whether the doctor's prescription is taken in the hospital pharmacy or outside pharmacy, as long as the quality and price are guaranteed, it doesn't matter where to get the medicine.
I treated my daughter in the First People's Hospital of the city, and the doctor prescribed medicine for me to buy at the drugstore opposite the hospital. Because my car was parked at the back door, I thought about buying it at any drugstore, but I couldn't find a drugstore, so I had to go to the drugstore designated by the doctor opposite the hospital. There must be a routine.
I prescribe medicine for my family, and I basically buy my own medicine from ordinary people. Nothing is just because of trust and convenience. Now pharmacies are very standardized. I have hardly been exposed to counterfeit drugs, especially large chain stores and listed companies. Another point is convenience. There are too many procedures for buying medicines in hospitals. It takes at least half an hour from prescription to medicine, and it may take an hour on Monday. I can't spare the time, unless those pharmacies don't have medicine, I have to go to the hospital to get it. I, I, for example, have to.
At present, there are three forms of selling drugs in hospitals. I experienced it personally in a 3A hospital in Jiamusi two months ago. Disgusting and dark! 1. Take medicine in the hospital pharmacy normally. 2. The doctor prescribed medical equipment, and after paying the money normally, he took the medicine from the biological laboratory next to the consulting room (after meeting the drug sellers he knew, they said that this is a health care product, which is for individual departments of the hospital, and it can't be bought or seen outside, and the price is not cheap. If something goes wrong, it is difficult to defend rights. 3. Open a convenience pharmacy in the outpatient hall of the hospital and take the doctor's list to buy medicine. The price is more expensive than outside, and there is no general medicine outside. This is the way of selling medicine in a big hospital in Jiamusi city. It's too dark, which is more annoying than receiving red envelopes.
Understand three words. 1. Drug proportion. 2. Average outpatient expenses. 3. Average hospitalization expenses. If one of the three exceeds the standard, the doctor's money will be deducted. If a doctor accepts a serious patient and spends a lot of money on treatment, then other patients with less serious illness should be used to reduce the average cost. So I let you go out to buy medicine, usually because he wants to lower the average. Albumin should be the most commonly needed drug to go to the pharmacy. This medical insurance card is strict and expensive. Even if it fully meets the use standards stipulated by medical insurance, the hospital has no inventory. Doctors usually tell you to buy medicine at any drugstore. No pharmacy will be designated to avoid being accused of insider trading.