"Health points" since the end of December 2016 CCTV news channel exposure of Shanghai, Changsha between six hospitals doctors from a medical representative hands breach charge exorbitant drug kickbacks case, whether national or local health authorities, swift action was taken against the doctors concerned.
And compared to the exposure of such doctors receiving kickbacks in the past events, this way, and storm are also unresolved. But this time, people's attitude towards the events is not consistent. Doctors believe that current drug prices and medical service prices are set by the State, doctors ' income and pay generally disproportionate in this case doctors kickbacks is an act of frustration. There are quite a few people said system is not reasonable is a fact, but doctors kickbacks and conflicts of laws and regulations, as a doctor, should not distort defended the rebates, but to cry for a reasonable salary.
Regardless of whether controversy will subside, drug rebates to doctor-patient trust damage already appeared. The end of 2016, new financial journalist visited Peking University Cancer Hospital, Beijing sixth hospital more than 10 patients found that most patients doctors kickbacks have become common, even said, if the doctor does not take kickbacks, don't accept a red envelope, but not practical, always feel surgery can be a problem.
Recalls in recent years, medical injury, frequently exposed to kill medical event, in part, is why, when when the doctor-patient relationship exists only relies on the money, the trust between doctors and patients vulnerable. Zhai Xiaomei, Director of Bioethics Research Center of China Union Medical University told caixin, reporters, doctors always serve patient interests as the highest ethical standards, even in the absence of legal provisions, the doctor took kickbacks on ethics is also "do not have access to the defence", as this will cause serious conflict between individual interests and interests of patients, further exacerbating conflicts between doctors and patients.
"Now, some doctors do not have this consciousness, continues to believe that receiving kickbacks for granted. "Zhai Xiaomei said. "Not earning enough to solve the problem of insufficient income, kickback Kickback problem to solve, not to confuse two problems", China's medical profession needs to be a discussion, "Kickback is not wrong, went wrong," "If doctors when such problems arise, you should be aware of the seriousness of the problem."
Despite repeated prohibitions rule
Drug rebate not only today's mess, is not unique to Changsha, Shanghai, six hospitals.
The CCTV exposure between Shanghai, Changsha hospital drug rebate chaos, and then immediately since the media issued a reminder in the pharmaceutical industry medical representatives went to the hospital to remain vigilant, not to mention any of your work to strangers, not to carry cash, which meant that for many years, drug rebate medical industry has become an open secret.
According to Shanghai one Qian health sector led to fiscal new reporter revealed, doctor took rebate of phenomenon "very general", "outpatient of many doctor are is such", drug must after doctor sold patients, doctor open have more, drug enterprises on to have more, and due to doctor took rebate "are is secretly to of", hospital and impossible in Department in loaded camera, so only is "was to we reported, only will to investigation", but "General no people reported".
Had in Beijing Concord hospital emergency section served of beauty in the should be and integrated Outpatient Center CEO Yu Ying December 25, 2016 sent micro-Bo blunt, "drug rebate that is facts exists of, people know, doctor are know, hospital led know, Ministry of health door big led also know", "drug rebate of problem sooner or later is to completely rectification of", just if "live ammunition liquidation words, medical on big earthquake has".
Although doctors for Orioles stand are unhappy, but for many doctors, kickbacks are nothing new. A doctor working in the Hospital of shunyi district in Beijing said, "as long as the kick, who's never too much money" and "Kickback is not the moral immoral thing", "what is the moral? Morality is to heal ", as long as doctors cure patients, even took the drug rebate doesn't matter.
Back in 2001, Ningbo doctor with bribery was exposed: pharmaceutical representative Deng inadvertently 42 Pack envelopes of money left in a taxi, after verification, 42 envelope to the infectious diseases hospital in Ningbo city doctor drug rebates, involving a total of at least 32 medical staffs. Since then similar incidents repeated exposure. New financial reporters interviewed many patients think doctors kickbacks and receiving red envelopes is a very common thing.
In the eyes of some patients, although they do not agree with the doctor kickbacks, he could do nothing. Several patients told caixin reporter, long before the CCTV reported, they had heard a doctor taking drug rebates, but also had experience of being prescribed, but the problem has existed for so many years, "already dead".
Prescribe medication, large prescription, as well as unnecessary tests are normal on Chinese patients to go to the hospital. Zhai Xiaomei said doctors as personal income, give patients unnecessary medicine, more expensive drugs will inevitably lead to overtreatment, which waste of medical resources, and also increases the burden on patients, or even cause health damage to the patient.
A father of two children said his children traveled from birth the doctor as much, and now drugs have only twenty thousand or thirty thousand Yuan spent two years all the savings. He told caixin said in that case, if a doctor then rebate some unnecessary drug, "that is a great deal of harm to patients."
On May 21, 2016, the World Health Organization issued a call for global focus on antibiotic resistance problems, which mentioned antibiotics dosage, China accounts for about half of the world, apart from the agro-pastoral farming abuse of antibiotics, 48% antibiotics for people, if no effective measures are taken, by 2050 antibiotic resistance will result in about 1 million people in China die each year. According to analysis of the Peking Union Medical College hospital pharmacy pharmacist Zhang jichun, Director, doctor, hospital, "medicine" and that give patients a "large prescription", is one of the main causes of abuse of antibiotics.
Multiple prescriptions, prescribe expensive medication and a heavy burden on the medical insurance fund. According to the latest data, although 2015 urban workers ' medical insurance fund generally smooth operation, coordinating Fund spending growth is slightly lower than revenue growth 0.5%, but there are still six of funds can be paid less than six months. Risk management and Insurance Department of Nankai University, Professor Zhu Minglai told caixin reporter, if doctors, hospitals continue to tend to give patients a drug, opening your medicine, along with aging, health-care Fund will be "put bottom" risk.
Medical practice guidelines
Seen from the source, the rebate actually comes from the patient's doctor to pay. 2009 new medical reform policy, health system continues to improve, more medical expenses can include health care, and health care funding also comes from every paying people. But, the doctor by way of kickbacks in return, is not a system designed in the first place. Zhai Xiaomei said, probably because the drug rebate has become commonplace, so "we do not think this is a problem," look to the concept and practice of the medical profession in the world, doctor kickbacks are wrong, but China currently lacks the relevant discussion and consensus of the medical profession.
The medical profession from the start accompanied with ethical and philosophical torture. To be a doctor, and the patient is not simply the exchange of benefits, or else, because the doctor's professional threshold, asymmetry of information between doctors and patients, it is difficult to prevent some doctors use their own advantages harm the interests of patients, this is the consensus of thousands of years of human.
In the West, known as the "father of medicine" of ancient Greece the physician Hippocrates, promoting good doctors "compliance for the interests of the patient and family of doctrine", often "show off my body", "no harm and bad behavior." He is the author of the Hippocratic oath is still required content for medical students to join.
Under the influence of Confucianism and Chinese ancient system of medical ethics also sprout, the pursuit of "benevolence" and "medical nairen." In China, every medical student should read "medical student vowed:" health and life entrusted "," I was determined to do everything apart from man's suffering, the perfect health and maintenance skill of a holy and honor, saving lives, regardless of the hardships, persistent pursuit ". These few lines actually contains more than mere moral pursuit, is a necessary requirement for this occupational specialty.
Zhai Xiaomei explained said, for doctor,, is must comply with than General career requirements more high of career ethics, is because medical industry threshold very high, and medical patient relationship has trust of nature, "social to medical some privileges", "through to doctor issued license maintained doctor of monopoly status", patients put life and health entrusted to doctor, so, doctor "must to representative patients of best interests Act".
Peking University School of public health, Department of health policy and management Professor Liu jitong were of the view that "health care is the highest level of human services", "doctor face is a matter of life and death", highly professional, so "should be subject to the highest standards of professional ethics system", have the highest responsibility requirements.
According to Zhang jinzhong, Gong Fuqing, who edited three of the medical ethics described in textbooks, in modern times, medical technology progress and social development of the Western medical profession to further enhance awareness of the importance of professional ethics.
Theory of blood circulation, marked the establishment of theories of Cellular Pathology, gradually from empirical medicine to Western medicine and laboratory medicine system of modern medicine, combined with the continuous development of the market economy, State power is gaining momentum, doctor facing increasingly complex conflicts of interest during the treatment process.
In 1948, the World Medical Association in ancient Greece the Hippocratic oath, formulated on the basis of the Geneva Declaration, which emphasized the interests of patients, which can be seen as the modern reshaping of the doctors ' professional ethics of the medical profession. And patient's interests first as the starting point, Western medicine has gradually established the principle of respect, no harm principle, the principle of fairness as a basic principle of professional ethics.
Since in the 1980 of the 20th century, China began introducing Western medical ethical thought, and inside was a native of doctors ' professional ethics system. Now in medical ethics textbook, editors to respect the principles, the principles of good Western doctors ' professional ethics, such as the core principles were explained in detail.
For example, principle requires that doctors must choose the most beneficial treatment for patients, means of diagnosis and treatment in order to reduce side effects and patients pay the price. Again, the Justice asked the doctor to patients should be treated without discrimination to seek medical attention, so that every patient can be treated fairly.
Starting from the core principle, China's medical sector also formed a clinical, research, care and other specific requirements of professional ethics of medical practice. In drug use, for example, doctors in the prescribing process must follow the principle that "the best, safe and sound, suffering the smallest, least-cost" to avoid prescription and drug abuse.
According to the modern principles of ethical principles of beneficence and justice, physician diagnosis and treatment behavior not only serve interests of patients first, also consider the social welfare. Doctors collect bonus and rebate Act, essentially that is inconsistent with their original vows and professional requirements.
One years had seven ten of lung cancer patients more is on fiscal new reporter said, not took rebate is doctor this career should comply with of bottom line, medical system bad should calls for change medical system, and cannot "to wrong on wrong", if doctor can because medical system not reasonable on took rebate, that any a industry also are can such do, "everyone are can outlaw has".
Why words
Medical ethics requires doctors put the interests of patients in the first place, why do drug rebates have become a common phenomenon?
Analysis of Liu jitong, "said matching the level of ability and ethics should be", "medical services is the precious thing", "matching system, should also be all patient-centered", but now drug rebate issues remained unresolved, indicating it's not just individual doctors did not comply with professional ethics, but a "systemic" problem.
According to Huang shangzhi, Professor of Peking Union Medical College hospital medical genetic memory, more than 40 years ago, when he had just become a doctor, while the wage level is not high, "but they live quite well, that when doctors get respect, don't care about the money with less money, and feel that they are doing something like to do things."
But the planned economy-led health care system, its drawback is obvious, the overall efficiency of the health care system, gradually and not adapted to patient needs. Late since the reform and opening up, the Government will be a large number of public hospitals to market, the implementation of balance mechanisms of financial assistance. Meanwhile, the reform of medical service price, doctors ' compensation system has not kept up, in the view of many people in the industry, it would gradually introduce doctors and patients for profit.
Shanghai first maternity and infant health Institute's Director, said Duan Tao, at present, most public hospitals only 10% source of income on financial aid, hospitals go off and make the rest, and medical service prices were artificially distorted for hospitals to get income, "not from drugs, from inspection."
Public hospital income-generating pressure further transferred to doctor who. In accordance with the wage system of public institutions, doctors in the public sector wages by level of salary, performance pay, allowances, and wage level by the health sector according to the poll, post allocated to public hospitals, but doctors ' salaries constitute only a small part of most wages were performance-related pay, which requires doctors and hospitals to earn for themselves.
One capital Medical University subsidiary Beijing century altar Hospital of doctor told fiscal new reporter, different Department doctor wage level differences is big, its main reasons on is the Department of "profit capacity" not as, like orthopedic will earned have compared more, but if thought orthopedic doctor "daily wearing 30 pounds heavy of lead clothing, every day in x ray Xia stay with, from morning till night", actually orthopedic doctor of income and pay also is serious not match of.
According to network online survey platform dxy in 2015, the per capita disposable income of urban residents was 21,966, surveyed nearly 30,000 doctors per capita income was 77,000 yuan, contrast, physicians per capita income are not too low. But considering the cost of medical education, as well as doctors work, three-fourths doctors in the survey were not satisfied with their income.
Lilac Park survey, 78% of doctors working more than 8 hours a day, 27% of doctors working more than 10 hours a day, but per capita income is less than 80,000 yuan. Even if the doctor workload doubled, and income levels are only slightly, growth in most cases no more than 10,000 yuan.
In addition to performance pay does not reflect the doctor's labor value, doctors wage level has different opinions. In General, under the influence of level of hospital and doctor title, hospital level the higher the higher the doctor title, higher the level of wages, thus different hospitals, doctors wage differences at different levels.
Has 26 years ' experience in the second Hospital of Zhejiang University School of medicine doctor Hu Hua thinks that, with the level of hospital and doctor title for assessing doctors ' salaries, it is unreasonable, the doctor of labor value should be reflected in the quality and quantity of medical services, many community health care institutions work intensity is also great.
Analysis of Huang shangzhi said doctors are faced with life's instruction, often in a State of nervous wreck, may wander surgery goes wrong, so a high risk doctor's job, should receive higher incomes and social status.
Many doctors believe the drug rebate is on the level of remuneration of doctors is artificially correction. 304 hospital anesthesiologists Su Xiaojun told caixin, reporter, "country doctor's price too low, but in fact these people's market price is much higher than.
