Inspection after strict control of drug costs is a big deal

01 Medicare has a hole in overdose

01 Medicare has a hole in overdose

One of the problems that the medical insurance department should focus on solving now is the imbalance between the overall planning of medical insurance funds and the expenditure of medical expenses
.

The two seem to be a pair of intractable contradictions

In this regard, over the years, the relevant government departments, especially the current medical insurance department, have spent a lot of effort and taken many measures, and they have also received varying degrees of results
.

Generally speaking, medical expenses are mainly composed of three parts: examination expenses, drug expenses, and treatment expenses
.

The "expensive medical treatment" that the society strongly reacts to is mainly composed of these three parts.

The masses vividly summarize it as over-examination, over-medication, and over-treatment
.

The three major excesses are wasting medical insurance (including personal) funds, wasting medical resources, harming patients' bodies, delaying medical treatment, and damaging the government's image, which has been criticized by society for a long time
.

However, this matter involves the reform of the entire medical and health system, and it is a huge issue.

Not enough attention has been paid to excessive inspection.
In recent years, the biggest effort has been to change excessive drug use - including formulating a list of essential medicines, formulating a list of medical insurance drugs, centralized procurement, sharing part of the expenditure by individuals, and the "proportion of drugs" adopted in recent years.
"Control, these are all to curb overdose and reduce spending on medicines
.

Through the control of "drug ratio", large prescriptions are curbed, the use of available and dispensable drugs is curbed (the so-called harmless and ineffective), and the cost-effectiveness of drugs is emphasized
.

At the same time, through the centralized procurement of drugs, the nominal purchase price of drugs has been greatly reduced; by preventing secondary bargaining, the actual purchase price of drugs has been greatly reduced; through consistency evaluation, many generic drugs with similar quality It has replaced high-priced imported drugs and pushed the price of imported brand-name drugs down
.

After the hospital implemented the "drug ratio", the effect was obvious
.

The proportion of "drugs" in many hospitals has dropped by nearly half from 50-60% to 30% or even lower

02 After the drug, over-checking is the problem

02 After the drug, over-checking is the problem

Is it possible to set an "inspection ratio" to control the inspection cost in the same way as setting the "drug ratio" to control drug expenditure?

The most obvious and superficial problem right now is over-checking
.

Regarding excessive censorship, there are many jokes and videos on the Internet, revealing a corner of the dark side, which is extremely ironic, and some are also extremely vivid

Excessive examination is very harmful to the patient
.

In addition to increasing unnecessary expenses, it also delays treatment opportunities and increases patient suffering

Why do you need to check the patient's body before diagnosis? One of the most used words is "to exclude ** (a disease)", which is the purpose of the examination
.

There are many kinds of diseases that the human body may suffer from.
Now, when you enter the hospital, the first thing you need to do is a stack of checklists to do an instrument check
.

Through inspection, of course, the purpose of ruling out a certain disease can be achieved
.

But are many checks necessary? Do many tests have proper symptom support? Can some examinations be achieved with the medical analysis of a doctor?

Although it is no longer possible to ask doctors to diagnose diseases by seeing, hearing, asking, and cutting, can doctors improve their medical level to diagnose them by themselves? If all inspections are handed over to the instrument, can we use the robot to analyze the instrument data instead of the doctor for the first consultation of the patient? Simply analyzing instrument data, robots are more precise and comprehensive than humans
.

It is recognized by society that the labor of doctors is both complicated and heavy
.

This not only refers to the treatment and operation of the surgeon, but also refers to the examination, diagnosis and treatment of various doctors

The progress of contemporary medicine is mainly the innovation of various inspection and treatment equipment and medicines
.

But we must not deny and abandon the doctor's thousands of years of medical ethics and medical technology to make inspection and diagnosis skills
.
At least at this stage, human wisdom is still far superior to instruments, and instrument inspection can only be an aid to doctors in diagnosing diseases, not a doctor's reliance
.

Of course, setting the "inspection ratio" does not completely exclude the inspection of the device, just as setting the "drug ratio" does not mean canceling the treatment of drugs
.

Thousands of years ago, Chinese medicine paid great attention to the six methods of "Bianstone, acupuncture, moxibustion, medicine, Daoyin, and diet therapy", and did not rely solely on medication
.
Therefore, reducing the "proportion of drugs" and "proportion of inspections" now is only to solve the problem of excessive, not to avoid drugs and inspections
.

Just as reducing the "medicine ratio" requires the labor (intelligence, physical strength) of doctors, reducing the "examination ratio" also requires the labor of doctors
.
Moreover, this payment may be even more than reducing the "medicine ratio"
.
Therefore, efforts should be made to increase the open and legal remuneration of doctors
.
Of course, that's another topic
.

Abuse of inspections increases the time to see a doctor, exacerbates the overcrowding of hospitals, and prompts hospitals to purchase expensive inspection equipment; at the same time, in order to increase the utilization rate of equipment, it in turn intensifies the abuse of inspections
.
In the United States, there are only one or two MRI diagnostic machines in a city, but now in our country, almost every hospital has them
.

03 Is it feasible to reduce the "proportion of inspections"?

03 Is it feasible to reduce the "proportion of inspections"?

Some people may ask, if reducing the "proportion of screening", wouldn't it be impossible to rule out many diseases? So, reducing the proportion of "drugs" will not be able to treat many diseases? The two reductions are very similar:

Reducing the "proportion of drugs" is to change the variety, quantity and price of drugs used; reducing the "proportion of inspection" is to change the variety, quantity and price of instrument inspection
.

The reduction of the "medicine ratio" is mostly through centralized procurement and procurement bidding to reduce the price; to reduce the "inspection ratio", the variety of instruments used (what symptoms can be used) and the quantity (how many days can not be re-inspected) can be reduced by national regulations.
, price
.

Reducing the "medicine ratio" is to use the doctor's treatment method to replace the drug, which is relatively difficult; to reduce the "examination ratio" is to use the doctor's inspection method instead of the machine, which is relatively easy
.

For doctors, the importance, complexity, risk and technical difficulty of examination and diagnosis are no less than prescription and surgical treatment
.
Therefore, it is no less difficult to implement a reduction in the "proportion of inspections" than to implement a "proportion of drugs"
.
However, in order to cost-effective, in order to achieve "good health, do not waste", it must be so
.

The disease-specific payment that is being trialled and gradually rolled out, of course, controls the three major excesses of over-examination, over-medication, and over-treatment
.
However, the scope of application is limited, and it is difficult to be as comprehensive and extensive as the implementation of "drug ratio"
.
The implementation of "proportion of inspections" can work on a large scale like the implementation of "proportion of drugs"
.

The direction of the reform of the medical security system is, of course, the implementation of free medical care for all on the premise that individuals and enterprises pay social security, and hospital doctors are supported by the state
.
For various reasons, this step is still difficult to achieve
.
However, some local reforms can be carried out first, such as implementing payment by disease type, controlling and reducing the "proportion of drugs" and "proportion of inspections" according to actual possibilities
.

According to a Zhejiang news report from Chinanews.
com, Zhejiang Province has established a general platform for "Zhejiang Medical Mutual Recognition", which connects the platforms of various cities in the province.
All hospitals share data and the results are recognized
.

At present, Jiaxing (pilot) and Shaoxing have implemented this innovative measure
.
In the next step, it will be promoted across the province and extended to townships and communities, and finally achieve interconnection and mutual recognition between provincial-city-county-township medical institutions
.

I remember that in the past few years, in order to reduce the expenditure of medicines, some hospitals set up a link of "prescription review", allowing the reviewing doctors to reduce or change the medicines of outpatient doctors
.
However, because it is impossible and necessary for the trial doctor to arrange the outpatient process like the outpatient doctor, the effect is not good
.

First, they clearly do not trust outpatient doctors; second, the trial doctors cannot bear the responsibility of changing the medication; third, some trial doctors may not necessarily come up with better medication plans
.
Therefore, it will soon exist in name only and die without a problem
.
It was finally replaced by a reduction in the proportion of "drugs"
.
Reducing the "drug ratio" is much more effective than "prescription review"
.

Setting the "proportion of inspection" will be more effective than implementing "proportion of medicine"
.