Chapter 8 Chapter 07 Why Our Medical Reform Is So Difficult
The medical reform is going in-depth, facing problems and challenges.
64.3% of ordinary people think that seeing a doctor is expensive, and serious illnesses are looked down upon.
How can Obama solve the problem that stumps Americans?
Let’s talk about China’s medical reform through the American medical reform, and how each of us can get better protection.
What is the secret of global medical insurance with the same purpose?
If you want to succeed in medical reform today, you must first break this vested interest group.
The pharmaceutical industry is the most important interest group, and any reform must first cut the pharmaceutical industry out.
Recently, there was a sensational news that US President Barack Obama passed the US health insurance bill, which not only excited the Americans, but also the whole world, and I was also very excited.But after the excitement, I began to think that our own medical reform is still in mid-air.
On April 6, 2009, the "Opinions of the Central Committee of the Communist Party of China and the State Council on Deepening the Reform of the Medical and Health System" was officially issued. This is a programmatic document aimed at realizing the ambitious goal of providing basic medical and health services for all. The medical reform has turned a new page.The new medical reform plan clearly defines China's basic medical and health system as a public product, and clearly proposes three-year phased goals such as the realization of the basic medical insurance system covering urban and rural residents in 2011 and the obvious alleviation of the problem of "difficult and expensive medical treatment".However, during the implementation of this macro document, it also encountered challenges of various complex practical issues. On March 5, 2010, when Premier Wen Jiabao delivered a government work report in the Great Hall of the People, he talked about medical and health issues in a thousand-character length, and said, "We must overcome all difficulties and solve this worldwide problem."So, why does medical insurance become a worldwide problem, and where is the key to the success of my country's medical reform?
According to the survey report on the urgent need to solve problems in the medical and health field, among the people surveyed, 64.3% of the people think that seeing a doctor is expensive, and serious illnesses are looked down upon. This is the most dissatisfied part of the common people.Secondly, 42% of people said that the process of seeing a doctor in the hospital is very unreasonable and not people-oriented. When they go to the hospital to see a minor illness, they have to run upstairs and downstairs, tossing back and forth several times.Some people joked that we should not blame our hospital, the reason why the hospital let us run around like this is because they love us.Think about it, many of the people we go to the hospital to see a doctor are because of a cold, because the hospital is not people-oriented, we have to run upstairs and downstairs, for example, register to the fifth floor, see a doctor on the second floor, and urinate until seven Lou, let's run back and forth like this, and we will be fine if we don't get sick.Therefore, when we Chinese go to the hospital to see a doctor, many of them are not cured by doctors, but delayed. Therefore, we have to thank our terrible hospitals, precisely because they never put people first, and cured them by accident. A lot of cold diseases, save a lot of medicine.In addition to these two dissatisfaction, there is another dissatisfaction of most ordinary people, that is, the price of medicine is too expensive.In fact, our nightmare is not just a simple problem of expensive medicines. Do readers know how difficult it is for us to buy medicines in pharmacies?Even if we buy cefradine, we have to ask a doctor to prescribe it before we can buy it.In fact, we didn't suffer from any serious illness. If we buy this kind of medicine, it is nothing more than a cold, and it is used to reduce inflammation or something.You know, for the common people, if they have to ask a doctor to prescribe medicine for a little ailment, how much will we have to spend?I spend a lot of time in the Mainland, but I go back to Hong Kong to buy medicine every time, why?It is because you can buy any medicine in Hong Kong.Then many readers will ask, does Hong Kong care about these medicines that cannot be taken casually?Let me tell you, Hong Kong does not ignore it, but lets you make your own judgment.Take the purchase of anti-inflammatory tablets as an example. The anti-inflammatory tablets sold in Hong Kong are usually marked with the word "poison" on the package. If you buy it yourself, just take care of yourself. This is very convenient for me.For example, I was sick before, and the doctor prescribed some medicine for me, and I got better after taking it. Now, I have the same disease again, so I can go to the pharmacy to buy the same medicine. You don't need to go to the doctor for a prescription every time.It's not like in our mainland, I have to go to the hospital in order to make a start, which not only costs more money for the patients, but also increases the "burden" of the hospital for nothing.The purpose of my citing this example is to say that the reason why our medical reform has had little effect is because we simply do not know what the essence of the medical reform is, nor do we know what areas should be reformed in our medical reform.Before talking about our health care reform, I would like to talk to readers about the US health care reform. On March 21, 2010, US Eastern Time, the much-anticipated and controversial US healthcare reform bill passed the House of Representatives at risk. On March 23, President Obama signed the bill into law.According to the more than 2,000-page bill, by 2014, 32 million Americans who currently do not have medical insurance will be included in the medical insurance system, and the medical insurance coverage rate in the United States will also increase from the current 85% to 95%.At the same time, the new health insurance bill will also reduce the government's deficit by more than $1 trillion in the next 10 years.So, why does the United States want to carry out medical reform?What is the reason why Obama, who is in the predicament of the financial crisis, is promoting the health care reform plan with all his strength?
The medical reform in the United States is very complicated. If you only read our media reports, you will basically not understand it. Why?Because our media have never understood it themselves. These media basically write what they see in other people's press releases.In the end, we discovered that we hadn't learned anything real from the US health care reform.Let's first look at why the United States wants to carry out medical reform?Because of the major medical crisis in the United States, a developed country like the United States basically spends 2.4 trillion U.S. dollars a year on public health care, but there are still nearly 80 million people without regular medical insurance, which accounts for almost 100% of the U.S. a quarter of the population.what is the reason?It is because the medical insurance in the United States is too expensive. Why is it so expensive?Because American pharmaceutical companies and insurance companies are linked.If an American doctor wants to prescribe medicine, the insurance company has a catalog in which it will clearly stipulate which two medicines can be prescribed for a cold, which medicines can be prescribed for liver disease, and what other medicines can be prescribed for other diseases. The medicine, and what brand, what ingredients, and the price of the medicine are very clearly stated. What does this mean?In fact, the insurance company supervises the doctors, and the doctors cannot prescribe medicines that exceed the insurance company's catalog.As for patients who seek medical treatment, there are probably two types. One is individuals without insurance. If these people see a doctor, they have to pay for it themselves, but most of them belong to another situation. These people are provided by enterprises. Insurance. However, American pharmaceutical companies have very strong financial resources and great political power. Whenever these pharmaceutical companies launch new drugs or some new medical equipment, they will find ways to pass these drugs and medical equipment through Congress and other legislative departments. included in the coverage of the insurance company.For example, a drug was originally sold for 5 yuan, but now a new drug is invented and sold for 100 yuan. These pharmaceutical companies can use their political lobbying or political power to get the insurance company to put this new drug in the catalogue. As a result, a situation in which pharmaceutical companies and insurance companies are linked.According to this new catalog, doctors can prescribe expensive drugs, and uninsured patients suffer because if the doctor prescribes this drug to them, they have to pay more.For patients with insurance, because their insurance is paid by the company, once the drug price increases, the company must pay a higher premium to the insurance company, otherwise the company's employees will simply look down on the doctor.Let's take General Motors as an example, can you imagine?Every GM-made car basically costs $1,500 in employee insurance.However, Toyota only needs to share $200 per car.Therefore, just from the perspective of insurance premiums, the burden of General Motors is much heavier than that of Toyota, and the competitiveness of General Motors has been stifled.Because of this unreasonable process, in the 10 years from 1993 to 2003, the medical expenditure of the American people increased from 900 billion US dollars to 1.7 trillion US dollars, and the per capita expenditure increased from 3354 US dollars to 5670 US dollars per year.Moreover, according to a study of 1,700 personal bankruptcy cases in the United States released by Harvard University in 2005, among the 1,700 individuals, more than half of them went bankrupt because they could not afford heavy medical expenses.And 75% of these people have medical insurance. Think about it, these people with medical insurance will go bankrupt because they cannot afford medical expenses, which shows how expensive the medical expenses are.Why are medical bills so expensive in the United States?It is because of the existence of this unreasonable system linking pharmaceutical companies with insurance companies. "Obama's health care reform should be recorded in history", this is the Western media's evaluation of Obama's health care reform.Among the major developed countries in the West, the United States is the only non-welfare country, and 46.3 million of its more than 300 million citizens are not covered by any medical security system.In the history of the United States, health care reform is a minefield that cannot be touched lightly.Since the 1930s, successive US presidents, from Roosevelt and Truman to Kennedy and Clinton, have vowed to realize universal medical insurance, but all of them ended in failure.It is estimated that in order to promote medical reform, the United States needs to raise 940 billion US dollars of funds within 10 years, calculated at 94 billion US dollars per year, which is basically equivalent to the annual military expenditure of the US war in Iraq.So, how does the Obamacare solve the funding problem?Where is the key to ensuring the success of the US healthcare reform?
Successive U.S. presidents have reformed health insurance, and Clinton has made the biggest move.In the health care reform during the Clinton era, his wife Hillary served as the chairman of the US Health Insurance Reform Committee, and it took a lot of effort, but it still had to declare failure two years later.As for the US health care reform this time, no matter whether Obama passed his personal charm or lobbying in Congress, the health care reform bill was passed by a very small margin, about 212 votes to 209 votes , but the significance of passing the customs is very important.How did Obama reform?In fact, what Obama really did was to cut off the link between insurance companies and pharmaceutical companies.He didn't come with an executive order or a red-headed document like us to do the cutting.He added a very creative factor called "rich people".Obama proposed a health care reform tax, that is to say, all bonuses, bonuses, options, dividends, etc. other than salary must be taxed. This is the problem. These bonuses, bonuses, options, and dividends that are taxed are generally All are owned by the rich, and in doing so, you essentially subsidize health insurance for the poor by taxing the rich.For example, for the poor with an annual income of less than $88,000, their health insurance is fully subsidized by the US government through the health reform tax. You know, the rich don't want to pay more taxes unless they are full.But according to the bill passed this time, you have to pay, so what should you do?This makes the rich feel uncomfortable, but there is nothing they can do about it.But if these patients see more doctors and use more expensive medicines, they will need more insurance premiums, and the rich will have to pay more taxes for this. Of course, the rich will feel even more uncomfortable. For them, if they have to pay taxes , the less tax paid is naturally the better, so please think about it, what would the rich do in order to pay less tax?They will ask the insurance company to settle accounts and not allow the insurance company to put expensive medicines in the catalogue.We all know that the power of the rich is very powerful. They have very strong bargaining power in Congress, which is no less than that of pharmaceutical companies. Therefore, the rich, like pharmaceutical companies, use Congress and other institutions to force insurance companies not to Expensive drugs are put into the catalogue, so the final result is that the rich will supervise the insurance company, so that the insurance company will re-examine the catalogue, and remove all expensive medicines, so that the insurance company's catalogue will be full of cheap medicines.Therefore, when doctors see patients, they always prescribe convenient medicines, which not only reduces the burden on individuals, but also reduces the burden on enterprises. All of them are cheap instruments, and insurance premiums will naturally be lowered, and the rich will be able to pay less medical reform taxes. After the rich are happy, they will try every means to get pharmaceutical companies to develop cheaper medicines... According to the analysis, over the past 30 years, the policy of the US government and the market trend of Wall Street have made the gap between the rich and the poor more and more serious.The pre-tax income of the rich has skyrocketed, but the tax cuts have been far greater than those of the middle class and the poor.Obamacare offers a reconciliation solution to the polarization.Different from the United States, China's medical reform after the reform and opening up is based on breaking the dominance of state-owned public hospitals and using market-based incentives to improve the level of medical care. With the deepening of the reform, the disadvantages of market-oriented gradually emerged. In 2005, the person in charge of the relevant department of the Ministry of Health stated that "marketization is not the direction of medical reform", while the research institute of the State Council stated that "my country's medical reform is basically unsuccessful."So, what exactly are the problems that marketization has brought to China's healthcare sector?
The problem in China's medical and health field is very strange. Unlike the United States, where pharmaceutical companies are linked to insurance companies, the problem in China is that pharmaceutical companies are linked to doctors.Our pharmaceutical factory recruited a bunch of salesmen to go to the doctor every day.Our insurance company is not popular, and the drugs listed in the insurance company are all cheap drugs, but because pharmaceutical companies are linked to doctors, doctors are reluctant to prescribe drugs listed in the insurance list when they see patients, because they are too cheap Well, our doctors like expensive medicines produced by pharmaceutical factories, so that hospitals can have high profits and doctors can get kickbacks from them.No way, these hospitals and doctors think they also want to generate income.And when we dealt with this problem, we committed the old problem of treating the head for the headache and treating the foot for the foot.Hearing our common people complain about the high price of medicines, our government directly forces the price of medicines to drop. In October 2009, the National Development and Reform Commission imposed a price limit on the retail price of essential drugs. Compared with the retail guide price stipulated by the government at that time, 45% of the drug prices were reduced, 49% of the drug prices were not adjusted, and 6% were in shortage Drug prices have increased, and overall drug prices have dropped by 25%, but what is the use of this?When ordinary people go to the hospital to see a doctor, the doctor originally only prescribed one medicine for you, but now they prescribe ten kinds of medicine. That is to say, although the price of medicine has dropped, our burden has become heavier instead.why?This is because we haven't figured out the essence of the problem at all. In fact, as long as the problem of linkage between pharmaceutical companies and doctors is not solved, the problem of medical reform will never be solved. But if the government wants to solve this problem, it must know how many interests are involved.We all know that the kickbacks of our Chinese doctors come entirely from pharmaceutical companies, so if we want to successfully promote medical reform, we cannot link doctors and pharmaceutical companies. This is different from the situation in the United States, where insurance companies and pharmaceutical companies Hooked.In China, it is precisely because of the link between doctors and pharmaceutical companies that doctors prescribe more expensive medicines to patients, and they can get a proportional commission. It's getting better and better, and pharmaceutical companies won't do business at a loss. In the end, it must be us ordinary people who pay the bill. In fact, this is a vicious circle. Now ordinary people complain that it is difficult and expensive to see a doctor, and they look down on serious illnesses. I saw a piece of news recently that made me feel very sad.A cancer patient goes to the hospital to see a doctor. All the departments in the hospital are busy. What are they busy with?Busy in robbing patients, even pediatrics, urology, obstetrics and gynecology are robbing this liver cancer patient.Are readers wondering?In fact, you don’t have to feel so strange, the reason is very simple, because patients who are seriously ill are willing to spend a lot of money to see a doctor, which is very lucrative for the hospital, so every department should grab this Big fat sheep, which department can create more benefits, and doctors can get more kickbacks.I really don't understand where the medical ethics of these doctors have gone now. Our medical reform is not only inferior to that of the United States, but also far behind that of Hong Kong, China.The medical care in Hong Kong is actually very good. If you travel to Hong Kong, if you get sick unfortunately, you can go to the hospitals in Hong Kong to see a doctor. Their emergency rooms are free. The medical system in Hong Kong has inherited The system during the British rule, some readers may have asked, to maintain such a good system must require a lot of financial support, so much money is invested in this free medical system, how does Hong Kong survive? The UK is the home of public health care and distributed health insurance.According to a survey, 46% of British people believe that the greatest achievement of the British government in the 20th century was the establishment of the British National Health Service.This important social welfare system advocated by the Labor Party in 1948 allows British people to receive free and fair medical services regardless of their social status or income.This medical welfare system, which has been implemented for more than half a century, has also been emulated by many countries and regions around the world.Although the public medical care in the UK still has the problems of low service efficiency and heavy public financial burden, many of its practices are worth learning from.
Hong Kong supervises doctors through the Hospital Authority, and the Hong Kong Hospital Authority plays the same role as the American insurance company, that is, the Hospital Authority issues a drug list, and the medicines prescribed by the doctor to the patient must be based on the list of the Hospital Authority. Yes, the management of the whole process is very strict.It is precisely because of this management method that the Hospital Authority has successfully separated doctors from pharmaceutical companies, and pharmaceutical companies have no political power to force the Hospital Authority to put expensive drugs in the catalogue, so Hong Kong Medicine costs are low.Although many people in Hong Kong receive public medical care, due to the low cost, public medical care can still be maintained until now.For rich people, it’s a different situation. Because they are rich, they don’t want to be like us. For example, for an operation, rich people don’t want to be crowded in a room with other patients. They want to live in a room by themselves, and it must be luxurious. Doctors and nurses must be the best, and they also need the best service.Rich people demand to use the latest drugs in the United States instead of drugs approved by the Medical Administration, so what should we do?Then you can find an insurance company to insure yourself. In this case, this rich person will supervise the insurance company. If your insurance company’s premiums increase, I can switch to another insurance company. Anyway, there are plenty of insurance companies.Therefore, the status of insurance companies in Hong Kong is completely different from that of insurance companies in the United States. Insurance companies in Hong Kong are insured by rich people, and then the rich people supervise the insurance companies. If your premiums are unreasonable, I will replace them with reasonable ones. .Through this system, rich people can find private doctors, and they can also use expensive medicines not approved by the Hospital Authority. Anyway, for these rich people, money is not a problem.Because my brother is rich, I can do whatever I like, so because of the existence of these two different medical systems, a successful Hong Kong medical system has been born. From the above examples of the United States and Hong Kong, China, how to effectively separate doctors from pharmaceutical companies is the first issue we must consider in our medical reform. Only by solving this problem first can our medical reform be successful. In my opinion, at present We simply don't realize it. In fact, China also has a good model, which the media calls the "Gaozhou Model".We are talking about Gaozhou in Guangdong. In the mountainous area of western Guangdong, this is a little-known second-level hospital, but it is very popular now.In fact, I think that Gaozhou is actually just an experience, not a model. First of all, let’s talk about the Pharmaceutical Affairs Committee of Gaozhou. Each of our hospitals has this kind of committee, but sometimes it is called differently. It is to randomly select a few doctors, and everyone will make a list together. However, when these doctors make the list , It is not allowed to contact anyone from any pharmaceutical factory.In fact, this is not the real reason for the success of Gaozhou Hospital. The real reason for success lies in the implementation of the system. The medicines prescribed by the doctors of Gaozhou Hospital must be within the scope of the catalog issued by the Pharmaceutical Affairs Committee. Other hospitals are more thorough, and the expert team has to go to the clinical department for random inspections every morning, so that effective supervision can be achieved.According to what their hospital said, after seven years, they saved 130 million yuan. In fact, I think there is another more important reason for the success of Gaozhou Hospital.The biggest highlight of Gaozhou's experience is that doctors and pharmaceutical companies were accidentally separated.The efficiency of the hospital is not good, so the salaries of the doctors are naturally low. In order to prevent the life of the doctors from being too difficult, the hospital decided to share a part of the profits of the hospital with the doctors, that is, the profits after deducting the costs from the income of the hospital. It can be divided into about thirty or forty percent.In this case, doctors naturally hope that the hospital can have better benefits.So how can we make the benefit of the hospital better?Naturally, more patients can come to the hospital for treatment, so how can we make patients choose to come to this hospital for treatment?The hospital thought of a way, and they put up a signboard at the door saying "Spend less money, cure diseases, and treat serious diseases".Of course, just setting up such a signboard is not enough, the key is still in execution.For the doctors in Gaozhou Hospital, if they follow the signboard, many patients will come to see the doctor, and the hospital's benefits will naturally improve, and the doctors will be able to share more profits.And if the price of medicine goes up, fewer people will come to see the doctor, the profit margin will be smaller, and the doctor's share will also be reduced. Therefore, doctors themselves are not willing to let the price of medicine go up, and they will drive down the cost on their own. , so they generally do not use imported medicines. In 2009, only 4.5% of all Western medicines prescribed by Gaozhou Hospital were imported, and injections below 44 yuan accounted for 83% of the total injection doses. Their purchases are simply more professional than Shenzhen’s foundries.Their control over costs, including inventory capacity, is very strong. The total inventory of Gaozhou Hospital is 0.015% of the total purchases. Maintaining such data is even more powerful than Toyota's zero inventory management. Why is their cost so low?It is because they share profits through doctors, and accidentally cut the collusion between doctors and pharmaceutical companies.In Gaozhou Hospital, if the doctor uses expensive medicines, you are against all other doctors. In other hospitals, the situation is just the opposite. If you, the doctor, use cheap medicines, you are against all other doctors.However, the result of Gaozhou's experience has actually increased the income of doctors.According to our data, the annual income of doctors in Gaozhou Hospital is about 100,000 to 200,000. This kind of small place can have an annual income of 100,000 to 200,000, which is considered very good.In addition, the profit of Gaozhou People's Hospital in 2009 was as high as 6.1%. In the end, it was the doctors who made money, and the hospital also made money.Moreover, financial subsidies only account for 0.11% of their total income, which is far lower than the national figure of 7.4%. In fact, I think Gaozhou’s experience is the result of hard work in the market environment. Think about it, if you want to succeed in running a hospital in a poor area, the first task is to run the hospital diligently and frugally, and to run the hospital diligently and frugally must cut costs. Low cost to win the market.The second is to work hard. Think about it, the medical staff of Gaozhou Hospital have a heavy workload every day.Because they have a lot of patients, from about 580,000 in the past year, it has suddenly increased to 780,000.Moreover, Gaozhou People's Hospital attracts not only some local patients in Gaozhou, but also patients from Inner Mongolia, Beijing, Jiangxi, Chongqing, Hong Kong and Macao Special Administrative Regions, and even the United States and Indonesia.Tourism in Gaozhou did not attract many people, but the hospital attracted many foreigners.In fact, from the experience of Gaozhou Hospital, it can be seen that "small profits but quick turnover" is also a market business model, but is it right to do so?I think we should do some reflection. In fact, there is no way to do this, because the government does not provide enough financial support for hospitals.But it has to survive, so it can only improve efficiency through small profits but quick turnover, so that's how it got its first pot of gold. In addition, I hope that we will not go to Gaozhou to study and inspect as soon as we see the media promoting the Gaozhou model. After learning and learning, we only learn the surface phenomenon in the end.I think the Gaozhou model has one of the most important ideas that we should all learn from, that is how to use a set of creative methods to separate medicine and doctors, so that not only does not cause any loss to both parties, but it can also benefit both parties.Because, you know, as long as any one of the interests is lost, it will be combined again.The Gaozhou model is to separate medicine from doctors carelessly through profit. Of course, this is not only an innovation in the system, but also because they have strictly implemented it and carried out effective supervision. This is the experience of Gaozhou. the essence ofIn fact, in the final analysis, cutting is not our ultimate goal. Our ultimate goal is to benefit patients.Our ancestors said that people should be treated like wounds. He meant that people should be cared for as if they were their own wounds. Therefore, the core of the medical reform is to let the people get benefits. The Financial Times) hosts an annual competition that pits new investors and market analysts against each other. In 2002, a 5-year-old girl in London randomly selected some stocks from the 300-page list of listed companies listed in the Securities Trading Column of the Financial Times. After a year, the little girl won handily.Her stock went up.In stark contrast, professional analysts lost their portfolios. Either the little girl is lucky and the analyst is unlucky; or the much-touted stock-picking skills don't appeal to all smart investors. Of the 100 million individual investors in the U.S. holding $8 trillion in stocks, more than $7.5 trillion of them are misdirected—investments used by some financial planners for what I call "overaggressive investing." Management", they try to outperform the market by selecting stocks and market forecasts. This is the investment of "dumb money". In stark contrast, trillions of dollars in assets such as pension funds, foundations, and college endowments are well-placed—financial managers invest them in stocks and bonds with broad market indices in an effort to capture market returns , This is "smart money" investing. Ironically, it is much easier for "smart money" to invest in market returns than overactive investments. Virtually all brokerage financial advisors and most independent financial advisors manage their money through "dumb money" management techniques.Financial advisors, financial planners, and mutual fund managers all try to outperform the market by engaging in what I call "overactive" management.I call these professionals "overactive brokers and advisors" because that's exactly what they are. The success of overactive brokers and advisors is not investment success but sales success.Their sales success is based on five misconceptions: 1. Overactive brokers and advisors can outperform the market. 2. Overactive brokers and advisors can successfully forecast markets. 3. Market prediction and stock selection are really important. 4. The more expensive the product or the higher the service fee, the higher the value must be. 5. High-end or brand-name items are more valuable. It's a demagogue, where they rely on millions of dollars in advertising to convince you to follow the advice of these "experts."Don't take them at their word, smart investors don't give their money to overly active brokers or advisors because that will only make them do things that are more beneficial to them. This article is excerpted from "The World's Smartest Investing Book" by Daniel R. Solin
According to the survey report on the urgent need to solve problems in the medical and health field, among the people surveyed, 64.3% of the people think that seeing a doctor is expensive, and serious illnesses are looked down upon. This is the most dissatisfied part of the common people.Secondly, 42% of people said that the process of seeing a doctor in the hospital is very unreasonable and not people-oriented. When they go to the hospital to see a minor illness, they have to run upstairs and downstairs, tossing back and forth several times.Some people joked that we should not blame our hospital, the reason why the hospital let us run around like this is because they love us.Think about it, many of the people we go to the hospital to see a doctor are because of a cold, because the hospital is not people-oriented, we have to run upstairs and downstairs, for example, register to the fifth floor, see a doctor on the second floor, and urinate until seven Lou, let's run back and forth like this, and we will be fine if we don't get sick.Therefore, when we Chinese go to the hospital to see a doctor, many of them are not cured by doctors, but delayed. Therefore, we have to thank our terrible hospitals, precisely because they never put people first, and cured them by accident. A lot of cold diseases, save a lot of medicine.In addition to these two dissatisfaction, there is another dissatisfaction of most ordinary people, that is, the price of medicine is too expensive.In fact, our nightmare is not just a simple problem of expensive medicines. Do readers know how difficult it is for us to buy medicines in pharmacies?Even if we buy cefradine, we have to ask a doctor to prescribe it before we can buy it.In fact, we didn't suffer from any serious illness. If we buy this kind of medicine, it is nothing more than a cold, and it is used to reduce inflammation or something.You know, for the common people, if they have to ask a doctor to prescribe medicine for a little ailment, how much will we have to spend?I spend a lot of time in the Mainland, but I go back to Hong Kong to buy medicine every time, why?It is because you can buy any medicine in Hong Kong.Then many readers will ask, does Hong Kong care about these medicines that cannot be taken casually?Let me tell you, Hong Kong does not ignore it, but lets you make your own judgment.Take the purchase of anti-inflammatory tablets as an example. The anti-inflammatory tablets sold in Hong Kong are usually marked with the word "poison" on the package. If you buy it yourself, just take care of yourself. This is very convenient for me.For example, I was sick before, and the doctor prescribed some medicine for me, and I got better after taking it. Now, I have the same disease again, so I can go to the pharmacy to buy the same medicine. You don't need to go to the doctor for a prescription every time.It's not like in our mainland, I have to go to the hospital in order to make a start, which not only costs more money for the patients, but also increases the "burden" of the hospital for nothing.The purpose of my citing this example is to say that the reason why our medical reform has had little effect is because we simply do not know what the essence of the medical reform is, nor do we know what areas should be reformed in our medical reform.Before talking about our health care reform, I would like to talk to readers about the US health care reform. On March 21, 2010, US Eastern Time, the much-anticipated and controversial US healthcare reform bill passed the House of Representatives at risk. On March 23, President Obama signed the bill into law.According to the more than 2,000-page bill, by 2014, 32 million Americans who currently do not have medical insurance will be included in the medical insurance system, and the medical insurance coverage rate in the United States will also increase from the current 85% to 95%.At the same time, the new health insurance bill will also reduce the government's deficit by more than $1 trillion in the next 10 years.So, why does the United States want to carry out medical reform?What is the reason why Obama, who is in the predicament of the financial crisis, is promoting the health care reform plan with all his strength?
The medical reform in the United States is very complicated. If you only read our media reports, you will basically not understand it. Why?Because our media have never understood it themselves. These media basically write what they see in other people's press releases.In the end, we discovered that we hadn't learned anything real from the US health care reform.Let's first look at why the United States wants to carry out medical reform?Because of the major medical crisis in the United States, a developed country like the United States basically spends 2.4 trillion U.S. dollars a year on public health care, but there are still nearly 80 million people without regular medical insurance, which accounts for almost 100% of the U.S. a quarter of the population.what is the reason?It is because the medical insurance in the United States is too expensive. Why is it so expensive?Because American pharmaceutical companies and insurance companies are linked.If an American doctor wants to prescribe medicine, the insurance company has a catalog in which it will clearly stipulate which two medicines can be prescribed for a cold, which medicines can be prescribed for liver disease, and what other medicines can be prescribed for other diseases. The medicine, and what brand, what ingredients, and the price of the medicine are very clearly stated. What does this mean?In fact, the insurance company supervises the doctors, and the doctors cannot prescribe medicines that exceed the insurance company's catalog.As for patients who seek medical treatment, there are probably two types. One is individuals without insurance. If these people see a doctor, they have to pay for it themselves, but most of them belong to another situation. These people are provided by enterprises. Insurance. However, American pharmaceutical companies have very strong financial resources and great political power. Whenever these pharmaceutical companies launch new drugs or some new medical equipment, they will find ways to pass these drugs and medical equipment through Congress and other legislative departments. included in the coverage of the insurance company.For example, a drug was originally sold for 5 yuan, but now a new drug is invented and sold for 100 yuan. These pharmaceutical companies can use their political lobbying or political power to get the insurance company to put this new drug in the catalogue. As a result, a situation in which pharmaceutical companies and insurance companies are linked.According to this new catalog, doctors can prescribe expensive drugs, and uninsured patients suffer because if the doctor prescribes this drug to them, they have to pay more.For patients with insurance, because their insurance is paid by the company, once the drug price increases, the company must pay a higher premium to the insurance company, otherwise the company's employees will simply look down on the doctor.Let's take General Motors as an example, can you imagine?Every GM-made car basically costs $1,500 in employee insurance.However, Toyota only needs to share $200 per car.Therefore, just from the perspective of insurance premiums, the burden of General Motors is much heavier than that of Toyota, and the competitiveness of General Motors has been stifled.Because of this unreasonable process, in the 10 years from 1993 to 2003, the medical expenditure of the American people increased from 900 billion US dollars to 1.7 trillion US dollars, and the per capita expenditure increased from 3354 US dollars to 5670 US dollars per year.Moreover, according to a study of 1,700 personal bankruptcy cases in the United States released by Harvard University in 2005, among the 1,700 individuals, more than half of them went bankrupt because they could not afford heavy medical expenses.And 75% of these people have medical insurance. Think about it, these people with medical insurance will go bankrupt because they cannot afford medical expenses, which shows how expensive the medical expenses are.Why are medical bills so expensive in the United States?It is because of the existence of this unreasonable system linking pharmaceutical companies with insurance companies. "Obama's health care reform should be recorded in history", this is the Western media's evaluation of Obama's health care reform.Among the major developed countries in the West, the United States is the only non-welfare country, and 46.3 million of its more than 300 million citizens are not covered by any medical security system.In the history of the United States, health care reform is a minefield that cannot be touched lightly.Since the 1930s, successive US presidents, from Roosevelt and Truman to Kennedy and Clinton, have vowed to realize universal medical insurance, but all of them ended in failure.It is estimated that in order to promote medical reform, the United States needs to raise 940 billion US dollars of funds within 10 years, calculated at 94 billion US dollars per year, which is basically equivalent to the annual military expenditure of the US war in Iraq.So, how does the Obamacare solve the funding problem?Where is the key to ensuring the success of the US healthcare reform?
Successive U.S. presidents have reformed health insurance, and Clinton has made the biggest move.In the health care reform during the Clinton era, his wife Hillary served as the chairman of the US Health Insurance Reform Committee, and it took a lot of effort, but it still had to declare failure two years later.As for the US health care reform this time, no matter whether Obama passed his personal charm or lobbying in Congress, the health care reform bill was passed by a very small margin, about 212 votes to 209 votes , but the significance of passing the customs is very important.How did Obama reform?In fact, what Obama really did was to cut off the link between insurance companies and pharmaceutical companies.He didn't come with an executive order or a red-headed document like us to do the cutting.He added a very creative factor called "rich people".Obama proposed a health care reform tax, that is to say, all bonuses, bonuses, options, dividends, etc. other than salary must be taxed. This is the problem. These bonuses, bonuses, options, and dividends that are taxed are generally All are owned by the rich, and in doing so, you essentially subsidize health insurance for the poor by taxing the rich.For example, for the poor with an annual income of less than $88,000, their health insurance is fully subsidized by the US government through the health reform tax. You know, the rich don't want to pay more taxes unless they are full.But according to the bill passed this time, you have to pay, so what should you do?This makes the rich feel uncomfortable, but there is nothing they can do about it.But if these patients see more doctors and use more expensive medicines, they will need more insurance premiums, and the rich will have to pay more taxes for this. Of course, the rich will feel even more uncomfortable. For them, if they have to pay taxes , the less tax paid is naturally the better, so please think about it, what would the rich do in order to pay less tax?They will ask the insurance company to settle accounts and not allow the insurance company to put expensive medicines in the catalogue.We all know that the power of the rich is very powerful. They have very strong bargaining power in Congress, which is no less than that of pharmaceutical companies. Therefore, the rich, like pharmaceutical companies, use Congress and other institutions to force insurance companies not to Expensive drugs are put into the catalogue, so the final result is that the rich will supervise the insurance company, so that the insurance company will re-examine the catalogue, and remove all expensive medicines, so that the insurance company's catalogue will be full of cheap medicines.Therefore, when doctors see patients, they always prescribe convenient medicines, which not only reduces the burden on individuals, but also reduces the burden on enterprises. All of them are cheap instruments, and insurance premiums will naturally be lowered, and the rich will be able to pay less medical reform taxes. After the rich are happy, they will try every means to get pharmaceutical companies to develop cheaper medicines... According to the analysis, over the past 30 years, the policy of the US government and the market trend of Wall Street have made the gap between the rich and the poor more and more serious.The pre-tax income of the rich has skyrocketed, but the tax cuts have been far greater than those of the middle class and the poor.Obamacare offers a reconciliation solution to the polarization.Different from the United States, China's medical reform after the reform and opening up is based on breaking the dominance of state-owned public hospitals and using market-based incentives to improve the level of medical care. With the deepening of the reform, the disadvantages of market-oriented gradually emerged. In 2005, the person in charge of the relevant department of the Ministry of Health stated that "marketization is not the direction of medical reform", while the research institute of the State Council stated that "my country's medical reform is basically unsuccessful."So, what exactly are the problems that marketization has brought to China's healthcare sector?
The problem in China's medical and health field is very strange. Unlike the United States, where pharmaceutical companies are linked to insurance companies, the problem in China is that pharmaceutical companies are linked to doctors.Our pharmaceutical factory recruited a bunch of salesmen to go to the doctor every day.Our insurance company is not popular, and the drugs listed in the insurance company are all cheap drugs, but because pharmaceutical companies are linked to doctors, doctors are reluctant to prescribe drugs listed in the insurance list when they see patients, because they are too cheap Well, our doctors like expensive medicines produced by pharmaceutical factories, so that hospitals can have high profits and doctors can get kickbacks from them.No way, these hospitals and doctors think they also want to generate income.And when we dealt with this problem, we committed the old problem of treating the head for the headache and treating the foot for the foot.Hearing our common people complain about the high price of medicines, our government directly forces the price of medicines to drop. In October 2009, the National Development and Reform Commission imposed a price limit on the retail price of essential drugs. Compared with the retail guide price stipulated by the government at that time, 45% of the drug prices were reduced, 49% of the drug prices were not adjusted, and 6% were in shortage Drug prices have increased, and overall drug prices have dropped by 25%, but what is the use of this?When ordinary people go to the hospital to see a doctor, the doctor originally only prescribed one medicine for you, but now they prescribe ten kinds of medicine. That is to say, although the price of medicine has dropped, our burden has become heavier instead.why?This is because we haven't figured out the essence of the problem at all. In fact, as long as the problem of linkage between pharmaceutical companies and doctors is not solved, the problem of medical reform will never be solved. But if the government wants to solve this problem, it must know how many interests are involved.We all know that the kickbacks of our Chinese doctors come entirely from pharmaceutical companies, so if we want to successfully promote medical reform, we cannot link doctors and pharmaceutical companies. This is different from the situation in the United States, where insurance companies and pharmaceutical companies Hooked.In China, it is precisely because of the link between doctors and pharmaceutical companies that doctors prescribe more expensive medicines to patients, and they can get a proportional commission. It's getting better and better, and pharmaceutical companies won't do business at a loss. In the end, it must be us ordinary people who pay the bill. In fact, this is a vicious circle. Now ordinary people complain that it is difficult and expensive to see a doctor, and they look down on serious illnesses. I saw a piece of news recently that made me feel very sad.A cancer patient goes to the hospital to see a doctor. All the departments in the hospital are busy. What are they busy with?Busy in robbing patients, even pediatrics, urology, obstetrics and gynecology are robbing this liver cancer patient.Are readers wondering?In fact, you don’t have to feel so strange, the reason is very simple, because patients who are seriously ill are willing to spend a lot of money to see a doctor, which is very lucrative for the hospital, so every department should grab this Big fat sheep, which department can create more benefits, and doctors can get more kickbacks.I really don't understand where the medical ethics of these doctors have gone now. Our medical reform is not only inferior to that of the United States, but also far behind that of Hong Kong, China.The medical care in Hong Kong is actually very good. If you travel to Hong Kong, if you get sick unfortunately, you can go to the hospitals in Hong Kong to see a doctor. Their emergency rooms are free. The medical system in Hong Kong has inherited The system during the British rule, some readers may have asked, to maintain such a good system must require a lot of financial support, so much money is invested in this free medical system, how does Hong Kong survive? The UK is the home of public health care and distributed health insurance.According to a survey, 46% of British people believe that the greatest achievement of the British government in the 20th century was the establishment of the British National Health Service.This important social welfare system advocated by the Labor Party in 1948 allows British people to receive free and fair medical services regardless of their social status or income.This medical welfare system, which has been implemented for more than half a century, has also been emulated by many countries and regions around the world.Although the public medical care in the UK still has the problems of low service efficiency and heavy public financial burden, many of its practices are worth learning from.
Hong Kong supervises doctors through the Hospital Authority, and the Hong Kong Hospital Authority plays the same role as the American insurance company, that is, the Hospital Authority issues a drug list, and the medicines prescribed by the doctor to the patient must be based on the list of the Hospital Authority. Yes, the management of the whole process is very strict.It is precisely because of this management method that the Hospital Authority has successfully separated doctors from pharmaceutical companies, and pharmaceutical companies have no political power to force the Hospital Authority to put expensive drugs in the catalogue, so Hong Kong Medicine costs are low.Although many people in Hong Kong receive public medical care, due to the low cost, public medical care can still be maintained until now.For rich people, it’s a different situation. Because they are rich, they don’t want to be like us. For example, for an operation, rich people don’t want to be crowded in a room with other patients. They want to live in a room by themselves, and it must be luxurious. Doctors and nurses must be the best, and they also need the best service.Rich people demand to use the latest drugs in the United States instead of drugs approved by the Medical Administration, so what should we do?Then you can find an insurance company to insure yourself. In this case, this rich person will supervise the insurance company. If your insurance company’s premiums increase, I can switch to another insurance company. Anyway, there are plenty of insurance companies.Therefore, the status of insurance companies in Hong Kong is completely different from that of insurance companies in the United States. Insurance companies in Hong Kong are insured by rich people, and then the rich people supervise the insurance companies. If your premiums are unreasonable, I will replace them with reasonable ones. .Through this system, rich people can find private doctors, and they can also use expensive medicines not approved by the Hospital Authority. Anyway, for these rich people, money is not a problem.Because my brother is rich, I can do whatever I like, so because of the existence of these two different medical systems, a successful Hong Kong medical system has been born. From the above examples of the United States and Hong Kong, China, how to effectively separate doctors from pharmaceutical companies is the first issue we must consider in our medical reform. Only by solving this problem first can our medical reform be successful. In my opinion, at present We simply don't realize it. In fact, China also has a good model, which the media calls the "Gaozhou Model".We are talking about Gaozhou in Guangdong. In the mountainous area of western Guangdong, this is a little-known second-level hospital, but it is very popular now.In fact, I think that Gaozhou is actually just an experience, not a model. First of all, let’s talk about the Pharmaceutical Affairs Committee of Gaozhou. Each of our hospitals has this kind of committee, but sometimes it is called differently. It is to randomly select a few doctors, and everyone will make a list together. However, when these doctors make the list , It is not allowed to contact anyone from any pharmaceutical factory.In fact, this is not the real reason for the success of Gaozhou Hospital. The real reason for success lies in the implementation of the system. The medicines prescribed by the doctors of Gaozhou Hospital must be within the scope of the catalog issued by the Pharmaceutical Affairs Committee. Other hospitals are more thorough, and the expert team has to go to the clinical department for random inspections every morning, so that effective supervision can be achieved.According to what their hospital said, after seven years, they saved 130 million yuan. In fact, I think there is another more important reason for the success of Gaozhou Hospital.The biggest highlight of Gaozhou's experience is that doctors and pharmaceutical companies were accidentally separated.The efficiency of the hospital is not good, so the salaries of the doctors are naturally low. In order to prevent the life of the doctors from being too difficult, the hospital decided to share a part of the profits of the hospital with the doctors, that is, the profits after deducting the costs from the income of the hospital. It can be divided into about thirty or forty percent.In this case, doctors naturally hope that the hospital can have better benefits.So how can we make the benefit of the hospital better?Naturally, more patients can come to the hospital for treatment, so how can we make patients choose to come to this hospital for treatment?The hospital thought of a way, and they put up a signboard at the door saying "Spend less money, cure diseases, and treat serious diseases".Of course, just setting up such a signboard is not enough, the key is still in execution.For the doctors in Gaozhou Hospital, if they follow the signboard, many patients will come to see the doctor, and the hospital's benefits will naturally improve, and the doctors will be able to share more profits.And if the price of medicine goes up, fewer people will come to see the doctor, the profit margin will be smaller, and the doctor's share will also be reduced. Therefore, doctors themselves are not willing to let the price of medicine go up, and they will drive down the cost on their own. , so they generally do not use imported medicines. In 2009, only 4.5% of all Western medicines prescribed by Gaozhou Hospital were imported, and injections below 44 yuan accounted for 83% of the total injection doses. Their purchases are simply more professional than Shenzhen’s foundries.Their control over costs, including inventory capacity, is very strong. The total inventory of Gaozhou Hospital is 0.015% of the total purchases. Maintaining such data is even more powerful than Toyota's zero inventory management. Why is their cost so low?It is because they share profits through doctors, and accidentally cut the collusion between doctors and pharmaceutical companies.In Gaozhou Hospital, if the doctor uses expensive medicines, you are against all other doctors. In other hospitals, the situation is just the opposite. If you, the doctor, use cheap medicines, you are against all other doctors.However, the result of Gaozhou's experience has actually increased the income of doctors.According to our data, the annual income of doctors in Gaozhou Hospital is about 100,000 to 200,000. This kind of small place can have an annual income of 100,000 to 200,000, which is considered very good.In addition, the profit of Gaozhou People's Hospital in 2009 was as high as 6.1%. In the end, it was the doctors who made money, and the hospital also made money.Moreover, financial subsidies only account for 0.11% of their total income, which is far lower than the national figure of 7.4%. In fact, I think Gaozhou’s experience is the result of hard work in the market environment. Think about it, if you want to succeed in running a hospital in a poor area, the first task is to run the hospital diligently and frugally, and to run the hospital diligently and frugally must cut costs. Low cost to win the market.The second is to work hard. Think about it, the medical staff of Gaozhou Hospital have a heavy workload every day.Because they have a lot of patients, from about 580,000 in the past year, it has suddenly increased to 780,000.Moreover, Gaozhou People's Hospital attracts not only some local patients in Gaozhou, but also patients from Inner Mongolia, Beijing, Jiangxi, Chongqing, Hong Kong and Macao Special Administrative Regions, and even the United States and Indonesia.Tourism in Gaozhou did not attract many people, but the hospital attracted many foreigners.In fact, from the experience of Gaozhou Hospital, it can be seen that "small profits but quick turnover" is also a market business model, but is it right to do so?I think we should do some reflection. In fact, there is no way to do this, because the government does not provide enough financial support for hospitals.But it has to survive, so it can only improve efficiency through small profits but quick turnover, so that's how it got its first pot of gold. In addition, I hope that we will not go to Gaozhou to study and inspect as soon as we see the media promoting the Gaozhou model. After learning and learning, we only learn the surface phenomenon in the end.I think the Gaozhou model has one of the most important ideas that we should all learn from, that is how to use a set of creative methods to separate medicine and doctors, so that not only does not cause any loss to both parties, but it can also benefit both parties.Because, you know, as long as any one of the interests is lost, it will be combined again.The Gaozhou model is to separate medicine from doctors carelessly through profit. Of course, this is not only an innovation in the system, but also because they have strictly implemented it and carried out effective supervision. This is the experience of Gaozhou. the essence ofIn fact, in the final analysis, cutting is not our ultimate goal. Our ultimate goal is to benefit patients.Our ancestors said that people should be treated like wounds. He meant that people should be cared for as if they were their own wounds. Therefore, the core of the medical reform is to let the people get benefits. The Financial Times) hosts an annual competition that pits new investors and market analysts against each other. In 2002, a 5-year-old girl in London randomly selected some stocks from the 300-page list of listed companies listed in the Securities Trading Column of the Financial Times. After a year, the little girl won handily.Her stock went up.In stark contrast, professional analysts lost their portfolios. Either the little girl is lucky and the analyst is unlucky; or the much-touted stock-picking skills don't appeal to all smart investors. Of the 100 million individual investors in the U.S. holding $8 trillion in stocks, more than $7.5 trillion of them are misdirected—investments used by some financial planners for what I call "overaggressive investing." Management", they try to outperform the market by selecting stocks and market forecasts. This is the investment of "dumb money". In stark contrast, trillions of dollars in assets such as pension funds, foundations, and college endowments are well-placed—financial managers invest them in stocks and bonds with broad market indices in an effort to capture market returns , This is "smart money" investing. Ironically, it is much easier for "smart money" to invest in market returns than overactive investments. Virtually all brokerage financial advisors and most independent financial advisors manage their money through "dumb money" management techniques.Financial advisors, financial planners, and mutual fund managers all try to outperform the market by engaging in what I call "overactive" management.I call these professionals "overactive brokers and advisors" because that's exactly what they are. The success of overactive brokers and advisors is not investment success but sales success.Their sales success is based on five misconceptions: 1. Overactive brokers and advisors can outperform the market. 2. Overactive brokers and advisors can successfully forecast markets. 3. Market prediction and stock selection are really important. 4. The more expensive the product or the higher the service fee, the higher the value must be. 5. High-end or brand-name items are more valuable. It's a demagogue, where they rely on millions of dollars in advertising to convince you to follow the advice of these "experts."Don't take them at their word, smart investors don't give their money to overly active brokers or advisors because that will only make them do things that are more beneficial to them. This article is excerpted from "The World's Smartest Investing Book" by Daniel R. Solin