Some views about high medical care expenses in China
Shao Jufang, Shen Huiyun
Institution: Editorial Office of Chinese Journal of Emergency Medicine, the Second Affiliated Hospital of Zhejiang University College of Medicine, Hangzhou 310009, Zhejiang Province, P.R. China
Corresponding author: Shen Huiyun, Email: [email protected]
Abstract: Since China\'s Reform and Opening-up to the Outside World, medical technology and medical treatment have been greatly improved, but at present, but the medical care expenses increase, and this increases the burden of people. The authors try to find the reasons for high medical expenses: (1) the price of new drug and high medicine rebate; (2) bonus distribution system in hospitals; (3)over-dose. Finally, the authors provides some countermeasures to control the high expenses, such as controlling the price of new drug, controlling the medical examination fee, and some relevant punishment.
Key words: Medical care expenses; China
Since China\'s Reform and Opening-up to the Outside World, medical technology and medical treatment have been greatly improved, but at present, some unhealthy tendency appears in the medical trade, which hinders the further development of medical trade. According to media reports, about 70% persons are not satisfied with medical status, especially with the increasing medical expenses. The following is to talk about the reasons of high medical expenses in China and also countermeasures to control the medical expenses.
1 Reasons for high medical expenses
1.1 In China, the number of new drugs, which are invented by the enterprises themselves, is limited. Enterprises often develop “Ëœnew drugs’ through changing medicament form, casing, and complex prescription. “ËœNew drugs’ entitle the enterprises to fix prices on their own. The enterprises always fix a high price, so that they can promote “Ëœnew drugs’ through high high medicine rebate to doctors. This is one reason why the medical expenses are always high. At the same time, some doctors are not very familiar with drugs’ components within short time after drugs are renamed, so this may cause some “Ëœrepeated administration’. This not only increases economic burden of patients, but also leads to adverse reaction because of overdose.
1.2 Economic accounting of hospitals stimulates the increase in medical expenses. In China, the government doesn’tput enough capital to the hospitals, so the hospitals have to increase business income for the development, and this causes the allocation mechanism of the hospital always connected with the business income. Under this situation, bonus distribution system is the most effective method. All kinds of economic indicators of the hospitals are associated with business income. Compared with cutting expenditure, the hospital always put increasing income in the first place. Each department has the business income task appointed by the hospital. To complete the task, departments always charge a little higher medical cost or the cost of consumed materials from the patients. That’s say, regardless of patients’ illness state or economic condition, doctors first let patients do a lot of examinations (of course including some unnecessary examinations), and then start to treat.
For some illness, either cheap drug or expensive drug has the same effects on the patients, but some doctors usually choose the expensive one, because the bonus distribution system works. Such phenomenon is caused by the imperfection of the management measures. Even the supervision department of the government regards the business income as an evaluation indicator for the hospitals.
The system of bonus linked to income contributes significantly to increases in hospital revenue. On the one hand, it resolves the capital problem of hospitals, and on the other hand, it increases the utilization of equipments. But for the society, it implies adverse results, because such increase of revenue implies waste. In the recent years, the system of bonus linked to income has been regarded as an effective method in increasing hospitals’ revenue. This is the subconscious guide of the government, and this causes the high medical expenses.
1.3 The phenomenon of ultra-conventional medication exists. As we all know, doctors are regarded as angels, and their job is holy and adoring, but some doctors lose professional ethics because they submit to the “Ëœmoney’. During the treatment, they usually choose the drugs with high medicine rebate, so the phenomenon of large prescription of high-price drugs is very common, and cheap antibiotics don’tsell well. This causes over-dose and high medical expenses.
In the drug market, there’re lots of new drugs, but the pharmacological mechanism of some new drugs is similar. To solve this problem, first the relevant department of the government shouldn’tapprove such kind new drugs with the same pharmacological mechanism. Second, the relevant department of the government should strictly control the price of new drug through checking the real cost of new drug, but not passively assent to the price provided by the enterprises. Third, sales price should be fixed based on ex-factory price plus markup ratio. Of course, the sales price also includes transport cost, drug loss, custody fees, loss cost, and various taxes. Fourth, the government procurement through public tendering can effectively reduce the drug price. If these measures could be carried out, the drug price could be obviously decreased, so that the masses burden of the medical care expenses can be reduced.
The abuse of the medical examination is very common and is difficult to be solved. Patients know nothing about the medicine, so some doctors always let patients do a lot of unnecessary medical examination to gain more bonuses. The business income from the all kinds of medical examination is usually higher than that from drug.
To solve this problem, we can take the following measures. First, Government porocurement of medical equipment can reduce the medical examination fee. Second, with the production levels improved, standardize prices of medical equipment reduce. This on the one hand can reduce the medical care expenses of patients, on the other hand can solve such problems as medical equipments’ waste and unnecessary examination. Third, the relevant department of the government set up medical norms. According to general rules for medical treatment, the government department can formulate the medical norms for different kinds of diseases to control the medical care fee. Fourth, hospitals with the same grade should avoid the repeated medical examination for patients.
Every year, patients will pay a lot of unnecessary money, which inpours into the pockets of some hospital’s administrators and doctors through improper channels. Such unhealthy tendency of medical trade should be punished.
To solve such problem, the government should on the one hand carry out ethics education for the medical personnel, and on the other hand set up related system with force of law to control medical conduct, and strengthen in the supervision of medical corruption. For example, the evaluation index for hospitals should not only include the business income, but also include the medical treatment quality and social effect, and the latter two are more important. Hospital leaders can establish a medical audits team, composing health care workers, pharmacists, finance staff. The task of the team is to audit the rationality of the prescription and the medical examination. The audit results about each medical care personnel can be associated with the promotion.
1. Xiao YQ, Zheng DX. Reasons and counter measures for drugs with high price . Chinese Pharmaceutical Affairs, 2008,22(9): 751.
2. Tang J, Xiong Y. Analysis over the situation inaccessible to the reduction of medicine prices. Prices Monthly, 2002, 4:5-6.
3. Zhu XG,Zheng BZ. The analysis of outpatient irrational drug use in 2007 in our hospital. Chinese Journal of Hospital Pharmacy. 2008, 28 (17):1512-1514.
4. Yao Y, Rui J. The practice of bonus distribution system in hostipals. Chinese Hospitals,2008, 12(8):23-25.
5. Guo D. The study on the value chain of hospitals. Chinese Rural Health Service Administration,2005,25(5):36-37.
6. Ruan YM. The Analysis of drug use in March in our hospital. Chinese Journal of Modern Drug Application,2008, 2 (16):111-113.
7. Tan HY. Th study on the administration of fixed asset in the hosptials. Hospital Admin, 2008, 6(6):49-51.
8. Gao YL. An criminal law perspective on high medicine rebate. Chinese Health Service Management, 2007,23(11):757-758.