Frequent medical treatment calls for banned drugs

Transnational drug companies have been exposed to bribery, and 73 hospitals in Cangzhou, Fujian Province have been involved in drug rebates. The recent medical cases are frequent, causing people to think about the pharmaceutical industry. The Chinese Medical Doctor Association issued three articles from August 6th to September 9th, calling for doctors to strengthen self-discipline in resisting drug kickbacks, and proposed to advocate the establishment of a “blacklist” system for physicians.

Experts believe that the drug-bribery case involves medical ethics, seriously affecting the doctor's image, but to fundamentally govern drug-related bribery, it is even more necessary to improve the medical system.

Drug bribery: industry "group dance"

GlaxoSmithKline (China) took direct bribery or sponsorship projects and paid bribes to a handful of pharmaceutical industry organizations, hospitals, doctors, etc.; Fujian Province's drug rebates case in the city of Luzhou had no more than Class II hospitals; Sanofi was exposed. Research funding, cash reimbursement, gifts, etc., bribed more than 500 doctors in more than 70 hospitals, and the most well-known large-scale top-three hospitals were all on the list.

"These are forms of drug claim rebates." A front-line doctor bluntly stated that these are the common mode of inertial operation and the "group dance" of the industry.

A doctor at a municipal hospital in Shandong revealed that a physician who has prescription rights can get a drug rebate of more than 10,000 yuan a month. And these are only small heads of drug rebates. 60% to 80% of the rebates are used for leadership of public relations agencies, pharmacy directors, director of equipment departments, and pharmacies.

Zhuang Yiqiang, deputy secretary-general of the Chinese Hospital Association, pointed out that although foreign companies have been exposed recently, the situation of domestic pharmaceutical companies is no less than this.

He pointed out that there are few original drug companies in domestic pharmaceutical companies, and it is difficult to compete with product characteristics, and they can only compete in marketing. From this point of view, domestic drug companies may pay bribery even more. The reason why multinational drug companies can be reported and verified is precisely because of strict management and sufficient evidence. Some domestic drug companies are unable to find evidence and are even more chaotic.

Wang Yongguang, a professor at Tongji University, said that the prevalence of phenomena is not necessarily justified, but that it has conditions for existence. If these conditions do not change, the phenomenon will be difficult to eradicate.

System "Internal Injury": Distorted Evaluation System

In recent years, China has made significant progress in deepening medical reforms. With the basic coverage of the basic medical insurance system and the initial establishment of the basic pharmaceutical system, it is difficult for people to see a doctor to get a certain degree of relief. At the same time, the health field has been consistently fighting against and controlling commercial bribery in the field of pharmaceutical purchases and sales, and regulating medical behavior.

But why is it that “cutting” the bribe of bribery? Zhuang Yiqiang bluntly said: "We need to review the relevant system."

The first is that the system does not guarantee the legitimate interests of doctors. Zhuang Yiqiang pointed out that current pharmaceutical and inspection revenues account for more than half of the hospital's total revenue. The “doctor to medical care” mechanism has erased the doctor’s knowledge value, causing people to pay for the medical device but is unwilling to pay for knowledge and technology. From acceptance of red envelopes to drug rebates, from large prescriptions to large inspections, are closely related to this distorted value evaluation system.

Dr. Sun Qifeng, Deputy Chief Physician of People's Hospital of Laiwu City, Shandong Province, practiced for 19 years, earning only a dozen yuan per month from the registration fee; a major surgery with a surgical cost of 2,000 yuan, a doctor can only get 120 yuan. "For doctors, knowledge is not respected."

Second, the unscientific and opaque drug pricing mechanism leaves room for drug rebates. At present, drug pricing is mainly determined by pharmaceutical companies, lacking scientific and solid cost accounting and investigation, and manufacturers often set aside high pricing, on the one hand, reserve kickback space for each link, and on the other hand, under the system of “taking drugs to support medical care”. High-priced doctors prefer to open and raise the bargain.

Many business areas have rebates, but the dangers of drug rebates are more concerned. It led to inflated drug prices and harmed the interests of patients. Drug rebate expenses generally accounted for 20% to 30% of drug prices; at the same time, it also damaged the image of hospitals and doctors, leaving a small number of people unethical, not based on the quality of drugs. The patient is selected for medication but is determined by the number of rebates.

"We quickly removed the grey income and squeezed the 'sore' of the drug rebate as soon as possible. We also wanted to raise our heads and get a fair amount of income," said one doctor.

Complete governance: The knife can only be removed if it is rooted

The GlaxoSmithKline case and the case of Zhangzhou, Fujian Province have all been investigated and dealt with. The parties involved in reporting Sanofi materials have also made it clear that an investigation will be conducted. If it is verified that it will never be tolerated, the offenders will be severely punished.

The Chinese Medical Doctor Association is entrusted by the National Health and Family Planning Commission to undertake the assessment of practicing physicians. In a statement issued on August 9, the association stated that it established a "blacklist of doctors" system and would recommend that all medical institutions no longer use the doctor.

“This system is operative for individual cases, but it will be paralyzed for the common phenomenon of medical bribery.” A senior industry official bluntly said: “The knife is not moving at the root, and the disease is hard to remove. Cut this sore, will A tumor grows in another place."

A multinational pharmaceutical company staff also told reporters that the general punishment is only to extend the chain of interest in drug bribery. If the environment is unchanged and the conditions remain unchanged, the sales methods will not change.

Interviewees suggested that in order to fundamentally eliminate or reduce medical and bribery incidents, it is necessary to reform the income distribution system in the medical field, increase supervision of the pharmaceutical industry, and increase transparency in the medical field.

First of all, it is necessary to cancel the use of drugs to raise medical services and raise the prices of medical services so that they can get a decent income that is directly proportional to their efforts. Yin Aitian, a professor at Shandong University’s School of Public Health, said that doctors are relatively high-income groups in all parts of the world. They are groups of people’s health and destiny. They should receive higher incomes that match their efforts and receive social benefits. Respect, instead of secretly taking "rebates" as it is now, is a shame on the existing medical system.

Second, on the basis of raising income, supervision and penalties should be increased to increase doctors' illegal costs. In Hong Kong, doctors may revoke their license to practice medicine if they break the law, and it is difficult to re-enter the industry; there is no question of kickbacks in private hospitals in China because the doctors are immediately dismissed. Therefore, relevant experts also recommend that domestic regulations on "forbidden medical treatment for life" be added.

Third, it is necessary to standardize pharmaceutical companies and markets, promote openness and transparency in drug R&D, sales, and circulation; strengthen the control of drug companies and scientifically formulate drug prices.

A multinational pharmaceutical company staff member said that experts are invited to attend academic conferences, lectures, and clinical studies. This situation also exists in foreign countries, and some are also normal academic exchanges.

"The clinical research of drug companies subsidizing drugs is justified or even necessary, and pharmaceutical companies must invest in research and development." A senior industry source pointed out that the key is to establish a clear system, which will be implicitly covered and publicly accepted. Supervision by the social and regulatory authorities.