Why can't education and medical care be marketized?

Your health and mine: the consequences of medical marketization and the horror of privatization

Meritorious bacteria (Global Meritorious Network) found a recent news, which is very helpful to analyze why the contradiction between doctors and patients is getting more and more serious.

CCTV reporters spent eight months investigating six major hospitals in Shanghai and Hunan, and uncovered the secrets. According to CCTV's investigation, the rebate accounts for 40% of the drug price, and the commission of medical representatives accounts for 10%. The rebate of general drugs must reach at least 20% of the bid price to ensure a certain sales volume. Doctors generally only prescribe drugs with a high rebate ratio and a large amount. Moreover, they found that the bid price of some commonly used drugs in Shanghai is generally about 5 times the wholesale price of the market, and the highest is more than 10 times.

Expensive medical treatment has been criticized by the society, and expensive drugs are an important reason. Although the drug rebate is not the only reason for the high drug price, it is definitely one of the important reasons. Although it cannot be said that every doctor in every hospital has the behavior of taking kickbacks, it is no exaggeration to say that drug kickbacks are a very common phenomenon in the medical system. What CCTV reporters found was just the tip of the iceberg.

Nowadays, there are many contradictions between doctors and patients, and the relationship between doctors and patients is becoming more and more tense, and distrust between doctors and patients is very common. Sometimes conflicts will develop to the level of violence, and vicious incidents will be seen in the media from time to time.

There are frequent contradictions between doctors and patients, and the right and wrong of each case may have its particularity. However, the emergence of a large number of incidents at least illustrates one fact. Patients' trust in doctors declines, and the decline in trust will be transformed into patients' opposition to doctors because of some factors. Coupled with the patient's own factors, it is easy to lead to violent conflicts.

When did this distrust become a phenomenon? In the era of free medical care, the relationship between doctors and patients is still harmonious as a whole. It cannot be said that there is absolutely no contradiction between doctors and patients, but on the whole, it is rare. At that time, "saving the wounded and dying" was not just a slogan on the hospital wall, but most doctors consciously did it.

At that time, the medical system was purely public welfare, and the cost of prescription and examination was not linked to the personal interests of doctors. The professional orientation of doctors is to provide medical services for the people, and the doctor-patient relationship is to serve and be served. Because the doctor's professional behavior is not directly related to the doctor's personal economic interests, the doctor-patient relationship becomes very simple.

Although public hospitals in China are still the main providers of medical services, it is undeniable that marketization has been injected into all aspects of medical services. The individual salary incentive of doctors is directly linked to the treatment cost of patients. In some public hospitals, doctors can get commissions by prescribing drugs and performing operations. This kind of incentive mechanism in hospitals certainly improves the enthusiasm of doctors, but this alone may lead to overtreatment problems. Doctors may choose expensive drugs with similar efficacy. Some can be operated but not operated, and doctors will recommend surgery.

This patient's distrust of doctors will continue to accumulate, and it will rapidly evolve into a universal social psychology through the transmission of interpersonal relationships and media reports. When the treatment results are not satisfactory, distrust will develop into suspicion of hospitals and doctors. The patient thinks that there is a medical accident in the hospital, but the hospital strongly argues and denies it, and no one can convince anyone. When the patient's family members are sad, their emotions will be more easily out of control, and the suspicion of the doctor will further evolve into personal hatred for the doctor. Coupled with the patient's own personality factors, it is easy to lead to violent conflicts.

Theoretically, the status of doctors is angels in white, but the introduction of market-oriented factors has caused multiple changes in the realistic status of doctors. However, the pursuit of economic interests has made some doctors play the role of businessmen and become * * * relations with medical representatives. I believe that not all doctors are like this, but some doctors have these phenomena, but it is easy to lower the overall evaluation of doctors in society and make the whole society distrust doctors. Let those doctors who lead an honest and clean life also be shrouded in the atmosphere of distrust between doctors and patients.

Now there are thousands of pharmaceutical companies in China, and the competition at home is fierce. Similar drugs produced by different pharmaceutical factories have similar efficacy, but hospitals have a great say in whose drugs to use. The conclusion of CCTV survey is that the kickback taken by doctors accounts for 30% to 40% of the drug price, but the kickback is only a part of the benefit transfer, and it is not the part that can be put on the table. There is also an open way to transfer benefits-"academic promotion" activities.

Judging from the published data, the sales expenses of pharmaceutical companies are on the high side. Huiheng Pharmaceutical Co., Ltd., which mainly produces anti-tumor drugs, accounts for 38.5 1% of its sales, and its sales expenses mainly include market expenses, travel expenses and vehicle use fees. Because of the huge sales expenses, the gross profit margin of pharmaceutical companies must be maintained at an alarming level. After circulation, the price of drugs that patients get has become several times or even dozens of times the price of pharmaceutical products. The wool is on the sheep, and these expenses are finally borne by the patients.

The most thorough marketization is private hospitals, and Putian Department is the representative in this respect. Different from public hospitals, private hospitals are tied to the market-oriented interest chain as a whole. The hospital has become a pure enterprise. Since it is an enterprise, profit comes first. Other considerations, including treating patients, are subordinate to the pursuit of profits by capital, and even unscrupulous for economic benefits.

Reduce the contradiction between doctors and patients, or let medical care return to public welfare. China should not learn from the western medical system design, but should explore the establishment of a socialist medical security system. In this regard, Cuba is an example for China to follow. Cuba has free medical care for all, its medical level is world-famous, and its life expectancy is higher than that of the United States. Now that China's economy is developed, it should be said that it has the strength to provide free medical care for the whole people. Cuba's economy is not as developed as China's, and it can be done. The distrust between doctors and patients caused by market-oriented medical care can only be completely solved under the free medical care system.

The red envelope incident exposed by CCTV, the health department only handled a few doctors, and it didn't have much effect. Once the market-oriented mechanism is introduced, the functional orientation of medical care is bound to be kidnapped by the economic interest chain, and it is easy for doctors to involuntarily and irresistibly do things that violate medical ethics in order to distribute benefits. Medical marketization is a hotbed for drug dealers and doctors to make profits. As long as that interest chain is still in operation, a large number of doctors will find it difficult to live a clean and honest life. The urgent task is to face up to the problem, find out the reasons, and let medical care return to public welfare. Pan-market thinking, thinking that marketization will be zero as soon as it is grasped, is a new dogma, and this incident should also be used for thorough reflection.