Breaking the reform of public hospitals: solid foundation and worrying funds

Source: pharmasia news 2015-06-10 [Abstract] according to the latest guidance issued by the State Council, hospitals should break the mechanism of drug addition and over prescription However, well-known analysts think it's easier said than done Hong Kong - with the goal of building a proud medical system, the State Council's recent guidance stresses the need to break the "profit seeking mechanism of public hospitals" and strive to change the revenue dependent drug sales model of hospitals However, at present, the proportion of drugs is as high as 40% - 80% The guidance requires that in addition to solving the drug distribution system for increasing hospital income rather than patient service, hospitals should also improve personnel compensation policies In addition, the system reform also proposes to reduce the proportion of patients in large hospitals The medical insurance department should not only reduce the public medical expenses, but also achieve the goal of reducing the proportion of individual payment to less than 30% of the total expenses by 2017 As a push forward on the basis of "one goal, four beams and eight pillars" proposed in 2009, analysts believe that the biggest problem of the current health reform plan is how to pay for it Wei Yongqiang, a Shanghai partner of Baker & McKenzie law firm and chief lawyer of Greater China pharmaceutical industry, pointed out that "hospital revenue mainly comes from three aspects: drug markup revenue, consulting, bed fee, operation fee, testing fee and other auxiliary service fees and government subsidies." In an interview with Asia Pharmaceutical News, Wei raised a series of questions: "if the hospital is suddenly asked to cancel the drug mark up fee, then how to keep the hospital balance? If we cancel the drug sales revenue which accounts for more than 50% of the hospital revenue, we will increase the service cost, which is not conducive to the principle of reducing the hospital cost Or the government will have to fill the gap People mistakenly think that health care reform is to reduce all costs of patients, which sounds incredible, there is no magic bullet " "If I were asked about the effect of health care reform in 2009, I would feel optimistic at that time, but now I don't feel so good The starting point of the government is very good, involving two issues: accessibility and affordability, which is what the Chinese call the "difficult and expensive" problem Accessibility should be seen nationally, not just in cities A large number of patients in rural areas travel to large towns for medical treatment He said patients in second tier cities will go to first tier cities for better treatment All this puts pressure on the biggest hospital with the best doctors " Zhou Jun, executive director of China US medical and health cooperation program (HCP) under the "four beams" framework of China's medical reform, explained that "one goal, four beams and eight pillars" refers to "universal coverage and guarantee of accessibility and affordability" Earlier, Zhou called for deeper reform to improve the quality of China's health care "Four beams" refers to strengthening the construction of medical service system, improving the public health service system, accelerating the construction of medical and health insurance system and establishing and improving the drug supply and safety system "Eight pillars" refers to the management system, operation mechanism, investment mechanism, price formation mechanism, regulatory system, scientific and technological innovation and talent security mechanism, information system and legal system Zhou Jun believes that the most difficult goals to achieve are hospital reform and basic medical security Private hospitals will continue to play a more important role "Ideally, public hospitals provide regular services to the public, while private hospitals provide value-added services." "By the end of 2015, private hospitals should provide 20% of the number of beds At present, it seems that this indicator can be achieved, because according to the government statistics, the proportion has reached 16% in 2013, and is growing at 2% per year The question is where does the revenue from public hospitals that rely on drug sales come from? " According to data from different sources of affordability dilemma, the proportion of drug sales expenses to hospital income is 40-80% (the latter is Bain consulting company data) Obviously, the gap is huge On June 22, the Wall Street Journal quoted health and Family Planning Commission officials as saying that by providing graded services for patients, the new hospital revenue source will narrow the gap In addition, private health insurance will be further developed, linked to the basic health insurance system currently covering 96% of the population "As people get richer and richer, they are ready to spend more, so multiple insurance systems complement each other to provide sound solutions," Zhou said Government spending on health care accounts for about 5% of GDP, compared with about 10% in OECD countries In order to stabilize the economic base, it is advisable to increase medical investment no more than the GDP growth level At present, China's GDP growth is 7.7%, although it is expected to slow down "While we are happy to see the best treatment available to the public, we also understand that the government cannot pay for it, which is a dilemma," he said "One of the problems is that the medical staff's income is too low and the expenditure on equipment and medicine is too high At present, the compensation is too low, so we should increase the input of service resources At the same time, investment should focus on innovation, not only products, but also service efficiency The government is fully aware of this and is looking for a solution " According to Wei Yongqiang, "one of the issues discussed is to increase doctors' income by increasing government salaries and allowing doctors to practice more, such as visiting private hospitals or teaching in university hospitals." This has been discussed but no final decision has been made " The lawyer for private insurance added that the fundamental problem remains more effective patient diversion In this way, the patients are transferred to the basic level, second tier cities and even private hospitals, so as to alleviate the burden of the third tier hospitals The problem is that people know that the best doctors are in big hospitals, which have advantages in training, medical conditions and career prospects Lawyer Wei pointed out that a large number of patients poured into high-quality resource hospitals, and doctors simply did not have enough time to take care of every patient Sometimes they are accused of not being attentive, because patients wait for most of the day, and the visit time is only 5 minutes As a result, resentful patients or their families "resort to violence, as a result, we see more and more medical staff being injured or even killed The more complicated situation is that people give doctors red envelopes in exchange for better services Wei is more optimistic about private insurance The government is committed to promoting private health insurance to play a greater role in reducing public medical expenses, and the proportion of personal expenses will be reduced to 30% by 2017 "Insurance companies recognize that this is a huge business opportunity, especially for the middle class," he said Although insurance is a relatively new thing, but now most people have probably understood that many insurance companies intend to provide such services, I am relatively optimistic about it " For private hospitals, he thinks the reputation is poor Because "people think private hospitals are just looking to make money, not provide quality medical services." "There are still huge business opportunities in some areas of the medical market for private enterprises, such as nursing homes and maternity hospitals and other professional areas," he said The pilot work of medical reform has been carried out in 17 cities in 2010, and the new guidance requires to be fully launched in 6800 public hospitals nationwide by 2017.