Chapter 7 3. Disease-free forehead

In Shanghai, of course, it is impossible for everyone to win a lottery prize of 259 million with 200 yuan.However, if you live in Shanghai without illness and pain, you are actually very lucky.In Shanghai dialect, it means you have "high forehead". Forehead (egodou) originally refers to "forehead, forehead, the most prominent part of the human head".It is often used in conjunction with "peng" to express luck.A high forehead means good luck. ("Humorous Dictionary") Being free from disease and disaster is naturally a good thing for anyone.But once you get sick and need treatment, it is definitely a bad thing, especially in a city as expensive as Shanghai-a city where you can spend hundreds of yuan if you don't pay attention to treating a small cold.

Chen Xiaolan, a general doctor in a hospital in Shanghai, became one of the "Characters of "Moving China" in 2007" because of her 10-year unremitting struggle against medical corruption. In 1997, Chen Xiaolan, a physician working in the physiotherapy department of the Guangzhong Road Section Hospital in Hongkou District, Shanghai, began to report counterfeit and shoddy products—light quantum oxygen transmission liquid therapy devices and matching quartz glass infusion sets.So far, more than 20 kinds of medical devices have been exposed by her, of which 9 kinds of fake and inferior medical devices have been investigated and dealt with. In 2007, she reported the unscrupulous hospital, Shanghai Union Medical College Hospital, and the hospital was eventually closed down.

In 2006, when she was interviewed by People's Daily, she presented a list of medical expenses, which was the expenses incurred by a dying patient in hospital for 3 days.The deceased, Zhang Yinyue, was sent to a tertiary hospital in Shanghai due to "septic" shock at the end of 2005. He died within 3 days (64 hours in total). The total cost was 8645.62 yuan.Among them, the professional skill charge (diagnosis and nursing fee) of medical staff is 58 yuan, including 34 yuan for doctor's diagnosis and treatment fee, 24 yuan for nursing staff's nursing fee; 2827.16 yuan for medical equipment; 5591.46 yuan for medicine; and 169 yuan for other expenses.

Chen Xiaolan analyzed the list from the perspective of a doctor, in order to reveal the reasons why Shanghai is "expensive to see a doctor" and "ordinary people can't see a doctor": The first is that medicine is expensive. Of the 5591.46 yuan drug costs, antibiotics are 2510.72 yuan; large infusions are 749.88 yuan; rescue drugs are 191.06 yuan; other medicines related to rescue are 569.8 yuan; medicines not related to rescue are 1570 yuan. During the rescue, the hospital used a total of 5 kinds of antibiotics: gentamicin (0.38 yuan/bottle), imipenem (218 yuan/bottle, dosage of 7 pills), vancomycin hydrochloride (180.4 yuan/bottle, dosage of 3 stick), Rocephine (118 yuan/bottle, dosage of 2 sticks), ceftazidime (103 yuan/bottle, dosage of 2 sticks).

Chen Xiaolan said that the same antibiotics have vastly different prices.Experienced doctors know that for general infections, the more expensive the antibiotics, the better. Many infections can be cured with traditional cheap antibiotics such as gentamicin and penicillin.The medical records show that after using many expensive antibiotics, Zhang Yinyue's white blood cell count did not drop but rose, from the white blood cell index of 10,000 when he was initially diagnosed as "septic" shock to the white blood cell index 8 hours before death It reached 23,000, indicating that the infection is not under control.

The reason for the high cost of medicines is that in addition to the pursuit of expensive medicines, there is also the problem of abusing refills and increasing the total cost.The list shows that Zhang Yinyue received a total of more than 19,000 milliliters of infusion, totaling 19 kilograms, accounting for almost half of the weight of the thin old man, and most of the medicines entered his body through infusion. Chen Xiaolan said: "When I was a doctor in the early years, there was a clinical rule of medication: those that can be taken orally are not injected, and those that can be injected intramuscularly are not injected or intravenously dripped. At that time, we made fun of colleagues who were not high in professional skills. "Bottle" because whenever a patient comes, he always gives them a bottle of infusion. But now, there are "bottles" everywhere in the hospital!"

Chen Xiaolan introduced that the consumption of my country's large infusion industry has increased by 20% in recent years, and it has become "the one with the highest utilization rate of production capacity and the most stable development" among the five pillar industries of my country's pharmaceutical industry, and patients are the support for this industry. groups.Chen Xiaolan said that the medical records showed that Zhang Yinyue's kidney function had been lost when she entered the hospital, and the therapeutics required that when the patient was in a state of "oliguria", the infusion should be strictly controlled, but the patient was actually infused with more than 19,000 ml of fluid!

In addition, medical equipment is expensive.Among the 2827.16 yuan of medical equipment expenses, the laboratory fee is 934 yuan, the inspection fee is 62 yuan, the filming fee is 80 yuan, the oxygen delivery fee is 1095 yuan, and the disposable medical equipment and consumable medical materials are 656.16 yuan. "In the cost of medical equipment, I hope everyone can pay attention to the profit." Chen Xiaolan especially emphasized that when it comes to the operating mechanism of the hospital, it is often said that "medicine supports the doctor".In fact, in many hospitals, it has long been a history to support doctors with medicines. The current situation is to support doctors with "treatment" and "investigation".Whether it is "treatment" or "investigation", it depends on various medical devices in the hospital.According to her analysis, comparing medical device expenses and drug expenses, it can be seen that although drug expenses account for the majority of patients' medical expenses, a total of 5591.46 yuan, since drugs are only allowed to have a profit margin of 15% in the hospital, the total profit is only 838.72 yuan. Yuan.On the contrary, although the cost of medical equipment is only 2827.16 yuan on the surface, based on the 80% profit rate, the hospital can make a profit of 2261.73 yuan.

"Because there are many types of medical devices, some are used for inspection, some are used for treatment, their prices and costs are different, and the profits are also not the same. 80% is an approximate number I took, which is not high. Many The profit margin generated by medical devices can even be as high as 90%. Because there is no elimination mechanism for medical devices in my country, as long as they enter the hospital, they can still make money if they break down. In order to reduce costs, it is very common for medical devices to 'work while sick' in hospitals. Common." Chen Xiaolan said.

Obviously, under Chen Xiaolan's analysis, it is not difficult to find that the hospital is no longer simply a place to treat illnesses and injuries, but to a greater extent has become a business organization for self-interest and violence.A doctor is not just a doctor, he also has another identity: a businessman. Although we don't know whether the scandal of "reselling patients" like the one that broke out in Nanjing Hospital exists in Shanghai, or whether it is even common.However, it is not uncommon for doctors to receive red envelopes and kickbacks around the majority of patients.Shanghainese are such a shrewd group, and you can often see filial sons or daughters posting questions on forums asking, "Dad has a 10,000 yuan operation, how much red envelope is appropriate for the doctor" and similar questions.

Obviously, it has become a tacit unspoken rule in the industry that doctors receive red envelopes and kickbacks.In this regard, Zhao Guoxiong, who has done sales in many medical device sales companies, has a clear account in his heart.Similar to Chen Xiaolan, he is also the whistleblower of the shady scene of medical corruption in Shanghai. "It doesn't matter, you can just write my name directly, this industry is too dark, I need to talk about its shady scenes." Zhao Guoxiong did not shy away from his identity in an interview with "First Financial Daily" Exposure, he said, "When the doctor's rebate is high, he can get 20,000 yuan a day." According to industry estimates, more than 80 medical institutions in Shanghai perform more than 7,000 cases of artificial joint replacement operations every year.This number is equivalent to the number of appendicitis operations, which means that artificial joint surgery has actually reached a level with almost no technical content. Zhao Guoxiong provided a detailed price list, which shows that for the same artificial total hip joint, the cheapest domestic price is only 7,150 yuan, while the highest price of imported products is 36,923 yuan. In fact, according to industry regulations, whether it is domestic or imported artificial joints, the rebate for each surgeon is between 20% and 30%. Generally, the rebate for imported artificial joints is between 5,000 yuan and 9,000 yuan. The only ones are between 2,000 yuan and 4,500 yuan.Due to the huge price difference between the two, doctors only recognize imported products. Therefore, the orthopedics department of Shanghai's major hospitals is almost monopolized by imported products. Doctors use more expensive medical supplies in order to get more rebates. Correspondingly, patients have to pay higher medical expenses, so seeing a doctor is not expensive, no wonder! From September 2008 to January 2009, Zhao Guoxiong went to 28 public hospitals in Shanghai and collected 430 lists of medical expenses. A "field research" report on medical expenses that attempts to answer "how expensive is medical treatment and where is it expensive". Most cases (76%) have a single hospitalization fee of less than 15,000 yuan, and the average cost of all 430 hospitalized cases is 13,809.26 yuan per case. Zhao Guoxiong feels that these data are of little practical significance.Because, for non-patients, in the psychology of consumption expenditure, he always puts the reserve for medical expenses at the upper limit. For example, in the investigation of the list of hospitalization expenses, the highest hospitalization expenses in one case exceeded 260,000 yuan, which may happen to any family. Move closer to the level of 260,000 yuan, instead of going lower to the level of 15,000 yuan.If the savings level is only higher than 15,000 yuan, a family or an individual may be more anxious about medical expenses. Perhaps, only when the cash savings exceed 100,000 yuan, people will slightly forget about medical expenses when making other consumptions shadows. Zhao Guoxiong, after analyzing 43 cases of surgical expenses with the highest proportion of self-payment, concluded that the overall cost structure is that surgical implants accounted for 64%, high-priced surgical equipment accounted for 13%, and other items accounted for 23%.Since other items (23%) mainly involve nationally priced surgical fee standards and common basic surgical equipment, as well as ancillary costs in surgical costs such as blood transfusion, anesthesia, and monitoring, there is basically no room for cost flexibility adjustments.Therefore, surgical implants and high-priced surgical equipment have become the core high-cost group, and they are the main item factors of hospitalization medical expenses. Surgical implants include: stents, catheters, balloons, emboli, clips, patches, cardiac pacemakers, artificial joints, orthopedic and brain surgery internal fixation materials, artificial meninges, intraocular lenses, artificial bones, etc.This type of material originated in heart surgery, brain surgery, and orthopedics, and is now spreading to surgical operations in various parts of the body and systems.High-priced surgical equipment includes ultrasonic scalpels, staplers, disposable endoscopic equipment, vascular staplers, and more. Zhao Guoxiong pointed out that because the above-mentioned surgical materials are stimulated by commercial bribery, the more they are used, the more gray income the surgeon will earn, and the surgery is becoming more and more complicated in various names.Some traditionally basic operations, such as appendicitis surgery, cholecystectomy, fracture fixation, etc., cost dozens or even hundreds of times the previous level.What's more serious is that due to the temptation of huge economic benefits, some patients are being deceived and induced to undergo surgery that they did not need originally, or surgery beyond the scope. Hu Suyun, a researcher at the Population and Development Institute of Shanghai Academy of Social Sciences, agreed with some basic conclusions drawn by Zhao Guoxiong's investigation report.She said that the reality is that the pharmaceutical industry "makes a big fuss" about self-funded drugs and self-funded medical equipment, while doctors, under the influence of commercial bribery, often abandon medical insurance products that do not have much "oil and water". It is to recommend expensive self-paid medicines and equipment to patients. "This has formed a vicious circle. The scope of medical insurance is gradually expanding, while more and more medicines and equipment products are paid for by themselves, and the prices are getting more and more expensive." Why do doctors become businessmen and kickbacks become routine? The "Liberation of Doctors" feature published by "Oriental Outlook Weekly" in 2009 answered this question - because the normal way of income is too little. Luo Ailun, a 72-year-old famous doctor of Peking Union Medical College, said: "You can't think of it. I have been a doctor for 48 years, and my retirement salary is only 3,140 yuan, and the subsidy is less than 4,000." A friend of hers who is practicing medicine in Hong Kong has doctors in the United States, Shanghai, and Hong Kong. House, and a monthly pension of 180,000 Hong Kong dollars after retirement. "People see us like they see paupers." "Why do some doctors want to get red envelopes regardless of dignity? Because his income is low. The annual salary of anesthetists in the United States is 80,000 US dollars, and the annual salary of anesthesiologists is 250,000 to 300,000 US dollars, so you are insulting him by giving him red envelopes. If a few people receive red envelopes If 80%-90% of doctors rely on gray income to maintain a relatively good life, then the government needs to pay attention to formulating policies." Huang Yuguang, director of the anesthesiology department of Peking Union Medical College Hospital, said. "The hospital is a knowledge-intensive unit. The young resident doctors in our hospital are all doctors or above, and the nurses are all undergraduates. But we are almost all overworked. I once asked the pilot why your salary is so high. He said it was for Safety is to let the pilot think only about flying. In fact, the doctor is the same, why can't he be given a high salary and let his mind only think about seeing a doctor?" said Xu Wenbing, deputy director of the Department of Respiratory Medicine of Union Medical College Hospital. It's a pity that patients know that doctors need to fill their stomachs before they can concentrate on seeing a doctor, so they consciously line up to give red envelopes, but the government doesn't seem to understand this truth.The so-called "medical reform" has been repeated wave after wave, but there is no obvious effect after reform.Red envelopes and kickbacks are still flying all over the sky. In order to treat injuries and illnesses, ordinary people not only have to pay regular expenses, but also have to pay additional "salaries" to doctors that should be borne by the government. Shanghai has been talking about the operation of community hospitals to alleviate the problem of "difficulty in getting medical treatment in large hospitals".However, the hospital has been built, but ordinary people are unwilling to go to the community hospital at their doorstep for medical treatment. Because these hospitals are "not good enough". "The dispensing of medicines here is very good, and you have to go to a big hospital to see a doctor." The 65-year-old old man Zhang said that he suffers from high blood pressure and knows what medicine he takes, and he goes to the community health service center to have it dispensed. A reporter from "Xinmin Evening News" went to several community health centers and interviewed more than 10 citizens who came to see a doctor. Almost everyone said this to the reporter. In the lobby of every community health service center, all doctors are "listed" on the wall.Among them, there are usually only 2-3 undergraduates, and the proportion is quite small.There are a total of 31 doctors in one center, only 2 of them have a bachelor degree, and the rest are all graduates of universities, junior colleges or technical secondary schools.A nurse at the pre-diagnosis desk said that "undergraduate" refers to full-time university graduates, and "university" refers to night colleges or other adult colleges. "My wife came to draw blood, but the nurse failed to pierce it right after several times. The pain made my wife gasp." Such a level discourages many patients. The distribution of medical resources is uneven, and small hospitals cannot retain talents. This is the key. "The salary of the community hospital really can't keep people." The director of a community health service center said that there was an undergraduate student in the hospital who graduated from Soochow University. The holiday benefits are only 3,000 yuan a month on average. "How can this little money be enough for her to get married and buy a house? They will definitely leave." Almost all the doctors interviewed by "Oriental Outlook Weekly" believe that one of the fundamental reasons for the uneven distribution of medical resources is that Chinese doctors are attached to hospitals, rather than belonging to the whole society. The result of the doctor's attachment to the hospital is that "doctors of the same level and doctors in different hospitals have a great gap. Maybe the chief physician of a certain county hospital is not as good as a resident doctor here. How can a doctor be judged by his professional title?" The real level? If a doctor becomes a freelancer, the title is actually not very useful. Doctors in the United States do not have a title, and whether I hire you or not depends on your ability." Wang Yongjun, vice president of Beijing Tiantan Hospital, said. He said that doctors in most countries in the world are freelancers, and hospitals in the United States are just empty shelves. Doctors' qualifications are assessed by the doctor's trade association, and a qualification is obtained after passing an exam.In addition, in the association, every medical accident of a doctor is recorded, and the insurance company is particularly tight, and these records are all connected to the Internet. "The United States stipulates that hospitals must hire doctors. Half of the doctor's medical liability insurance is paid by the hospital, and some hospitals pay all of it. If you have frequent accidents, the cost of hiring you will be high, and it will be difficult for this doctor to find a job. So The level of doctors should not be evaluated by hospitals, but by third-party industry associations." This really liberates doctors from hospitals. Therefore, the new medical reform allows doctors to practice more, which is on the right track.However, "Multi-site practice is not mainly to solve the problem of income, but to solve the problem of full utilization, healthy development and rational flow of talents, and the problem of uneven distribution of medical resources." Wei Tianni, vice president of Beijing Sixth Hospital, said. In fact, in response to repeated medical reforms, Huang Tianyu said that what doctors need is not money, but policies.