Guo Taihong: Separate the four divisions by medicine

The 'four separates' accurately captures the shortcomings of the current medical field and reflects the objective laws of the operation of medical institutions. As long as it is implemented accurately, comprehensively and completely, it will surely lead out the path of medical relations that is in line with most advanced countries in the world. ”

The implementation of four divisions is the decision of the Central Committee of the 16th CPC Central Committee on the "Decision of the Central Committee of the Communist Party on Several Major Issues Concerning the Construction of a Harmonious Socialist Society" and the top-level decision of the 17th CPC National Political Report on the establishment of a basic medical system and improvement of the people's health. However, over the years, apart from the 2011 Ministry of Commerce promulgated the “Outline for the Development of the National Pharmaceutical Distribution Industry (2011-2015)”, there has been no substantive advancement in the separation of medicines and it has fallen into a mandarin and a cliché. What is more, misunderstood the original meaning of the separation of medicines, and made plausible false articles only in terms of zero margin, cancellation of drug addition, revenue and expenditure, pharmacy trusteeship, and so on.

Whatever the so-called medicine, it is the combination of the doctor (the hospital's drug purchase right and the doctor's drug prescription right) and the drug (the patient's drug purchase right). The legitimate economic consequence of medicines is that the price difference of drugs is used to compensate for hospital expenses. The illegal economic consequences are behaviors such as drug purchase rebates, prescription rebates, and rebates when selecting distributors. Now that all forms of medicine are separated, they have only eliminated the legitimate economic consequences of medicine, while retaining the unlawful economic consequences.

Last week, the six ministries and commissions of the Ministry of Commerce jointly issued a document clarifying that “multiple methods are used to advance the separation of medicines”. The pharmaceutical industry has finally waited for the long-awaited spring. However, to truly understand the meaning of the separation of medicines, we must proceed from “four separates”. This overall scientific understanding.

1. Separation of government affairs - separate functions

In the field of medicine, one of the functions of the government is to make the common people see the disease, see the disease, and see the disease; the second is to standardize the market order, establish the institutional mechanisms for normal operation and development of various market entities; the third is to arrange a reasonable Financial expenses ensure the survival and development of public welfare non-profit medical institutions; Fourth, establish mechanisms for the use of market allocation of resources and give play to the necessary role of the government, so that all relevant parties follow objective laws and health operations; Fifth, the responsibilities of relevant government departments are clear, Responsibility for supporting the right to perform their duties. Institutions such as medical institutions, whether profit-making or non-profit, should exert their enthusiasm and subjective initiative under the system and mechanism determined by the government, and effectively assume social functions, including managing their own units and improving service capabilities. And the level of service provides reliable health protection for the whole society. The two functions cannot be dislocated or confused.

2. Separate management and management - separate responsibility

It mainly means that the responsibilities of hospitals and hospitals should be separated. The responsibility of the government and its departmental hospitals is to create a standardized external environment, establish institutional rules for the operation of hospitals, arrange necessary financial support funds, supervise their operation according to laws and regulations, coordinate major health emergencies, and establish public health mechanisms. The hospital should be set up by the relevant conditions of the investor (including state-owned, public, public, private) to set up hospitals, enjoy the relevant policies given by the government, to comply with the relevant government regulations, and independently assume legal responsibility.

Some people think that the management office can be divided, as long as it solves the problem of what and how to manage it. This kind of understanding ignores the mechanism of the balance between operation and supervision, and the traditional thinking of planning the economy and the government. It is wrong. The purpose, responsibility, and means to be used for running a hospital and managing a hospital are not completely the same. Only separate management and management can form different responsible entities, and form an effective supervision mechanism for the hospitals by the government and its departments to prevent and reduce Possible mistakes to protect the legitimate rights of hospitals, patients and other related parties.

3. Separate medicines - separate mechanisms

Non-for-profit hospitals other than for-profit hospitals are public-sector institutions. Its operating mechanism should be the government's management of prices, the hospital's self-collection or self-support, or revenue and expenditure, the government's grant of sufficient economic subsidies, and provision of medical and health services to the society. It must not be possible to seek open and obscure economic benefits by selling drugs.

Drugs are different. Pharmaceutical companies are required by the government to review the establishment standards of their companies and market access for their products, and to supervise the safety and quality of their products. Production and operations are autonomous by the company, and profits and losses are also at the company’s own risk. Therefore, in the field of medicine, the separation of medicines means that the hospital no longer purchases or sells medicines, including that the hospitals no longer earn the difference between normal medicines and selling prices (in fact, this earning is normal and reasonable, at best, it is only 15% of the medicine price, not medicine. The main constitution of harming fairness and damaging the economy is that the drug purchasing power is no longer required to require pharmaceutical companies to provide sponsorship fees and rebate rebates. Physicians no longer use prescription rights to receive kickbacks. The funds required by the hospital and the doctor’s legitimate economic income are arranged by the financial audit. The drugs in the prescription are mainly supplied by the social pharmacies in the form of market allocation. In other respects, medicine and medicine should still cooperate in many forms and contents, including medical academic exchanges that should be done by medical representatives who are now dissimilated and suffer from many ills.

4. Separate profit and non-profit - separate policies

Now, some people who have become rich before have demand and also have the ability to pay for the economy to enjoy a higher level of medical and health services. For-profit medical institutions featuring high-end services, high-end services, and high-end services emerge as the times require, and it serves the public as a public service. Sexual medical institutions co-exist in the market and are indispensable to each other. The emergence of profitable, non-profit medical institutions is a product of diversified market demands. For non-profit medical institutions, the government must control its medical service prices, wage levels, project investment, and give financial subsidies. For profit-making medical institutions, they generally do not give financial subsidies. Instead, they adopt the same strict medical quality supervision measures and relatively loose economic management policies as non-profit medical institutions, allowing investors to obtain quality services and open and fair market competition. Reasonable return on investment.

The “four separates” accurately captures the shortcomings of the current medical field, reflects the objective laws of the operation of medical institutions, and represents the voice of the society. As long as it is accurate, comprehensive, and fully implemented early, it is believed that the reform of the medical and health system will be found correctly. The approach will certainly lead to a path of medical relations that is consistent with most advanced developed countries in the world. At present, it is hoped that the entire "four separations" will be promoted through "separation of medicines."