the health is a professional job, change is the medical system, the dynamic ideas and interests. Medical treatment under the chaos, therefore, most didn’t of economics, management professional trained doctors, dean’s advice often only look at phenomenon remedy to the case, hazy, specious.
the modern social division of labor is very fine, not their professional things, look not to understand is not a shame. Take it for granted is that they think of truth, can’t let people agree with. The article is to throw cold water on to push, but also a hard, share with you.
recently, medical, web celebrity big V Po published an article on the ridiculously wrong “cancel consumables addition, careful imphal ZhanYiShi reform”. He is wrong, mainly because of the lack of common sense of economics and management. This is out of his field of transboundary discuss problems often make the mistake: say is just rubbish, believed in truth. Many doctors and health officials, including the part of the public hospital, discuss the health problems are easy to make the mistake. They are medical professionals, in their own specialty doctor is adept, jump out of their own specialist areas in the diagnosis of disease, also know to proceed with caution. But had not received in your system, and even did not trained in economics and management of economic and management issues on quality, and think of truth, not knowing the complete myself is just rubbish.
I, this article will explain the treasure the doctor know wrong two major problems.
one of state-owned unit behavior characteristics: soft budget constraint
two days ago, Po WeChat doctor ask me a famous 3 armour hospital income and expenditure data. I reply to him: the hospital total about $4.8 billion in 2014, the financial investment of 550 million yuan, medical business income of about 4.2 billion yuan, the balance is 150 million yuan.
about ten minutes, Po said: that is to say, if there is no government funding, the hospital will loss more than four.
I immediately smiled, this is just rubbish.
on the surface, the public hospitals gross income is 4.8 billion yuan in 2014, the funding of 550 million yuan, total is 4.65 billion yuan, if not the $550 million fiscal subsidies, certainly will be a loss of 400 million yuan, where is wrong?
I reply Po: can’t do this.
one of the reason is that the state-owned unit as the typical & other; The soft budget constraint & throughout; Characteristics, that is to say the state-owned units is not need to spend how many money, spend how many money; But can be and how much does it cost to the government, will spend how many money.
, for example, a price of 2 million device can meet the requirements of a public hospital work, but if it can and government applications to 10 million yuan, it will buy $10 million worth of equipment, although significantly more than needed.
the state-owned unit to apply for funding, feature is a high demand, is also the real demand of 1 million will quote 23 million even higher budget, the commonly known as & other; Fishing & throughout; ; Characteristics of the two is high budget every year, economics called & other; Ratchet effect & throughout; ; Characteristics of the three is the money must spend as much as possible, otherwise the government will be very angry, and would reduce the next issue of funding.
considering the Po don’t understand economics, also like knows nothing but pretends to know. I explained to him with the patience of a primary school teacher & other; The soft budget constraint & throughout; Principle: the treasure is you can earn much money (income), how much to spend (spending), which is surely with closing, this is the hard budget constraint. Your son is not how much they can earn money to spend how many money, but can ask you for how much money he will spend how many money; You gave him 1000 yuan a month pocket money, he spent 1000 yuan; You gave 3000 yuan, he spent 3000 yuan, he even dare to spend 5000 yuan, because he knew that he borrowed money you’ll have to help him also. & other; Never again & throughout; Threat, is no deterrent and binding between father and son, this is & other; The soft budget constraint & throughout; , colloquially called again on economics & other; The father loves the socialist & throughout; , namely the relationship between the government and state-owned units, is very similar to the relationship between the father and son.
to go back to the 3 armour hospital, funding of 550 million yuan, their income is 4.25 billion yuan, he is spending 4.65 billion yuan, fiscal also did not give a penny, but if he is only an income of 4.25 billion yuan, that he will only spend 4.25 billion yuan or so, maintain the balance of payments, so many never loss 400 million yuan.
the state-owned units, including public hospitals, the managers of logic is: will spend how many money can get much money. Without loss of the colleagues, oneself also not form too big loss, otherwise will be replaced by the competent department of; But don’t form the balance is too big, more balance, one would be to reduce funding even taking balance by the government, this call on economics & other; Beating fast cattle & throughout; ; Second, it is easy to peer envy and replace position. So, state-owned unit the leadership’s logic is & other; The doctrine of the mean & throughout; Give leadership to trouble, don’t loss (too big), fellow jealous don’t balance too much so as not to lead.
I said financial input in the other articles will all compensation to employee performance, not to reduce patients to collect fees, truth is here. Public hospital’s logic is to increase income to employees as much as possible, as far as possible some spending with funding to pay, run out of income can increase employees’ income. To do so, of course, the amplitude depends on the degree of local government fiscal well-off. Shanghai shenzhen financial abundance, public hospitals around 20% of revenues from the fiscal subsidies; Henan, sichuan, chongqing, shaanxi (except in xi ‘an and yulin), guizhou and other places of local government fiscal position, public hospitals also will be less than what funding, namely can raise, also can support himself.
of course, public hospitals can also formed the tacit understanding, together with debt, finally let the central government. Note that must be & other; Together & throughout; Do, form & other; For accountability throughout the &; The situation, individual aggressive easy to lose their jobs.
this kind of thing, will occur once every and the coming year.
cancel drug consumables bonus will not affect the public hospital income levels: monopoly behavior characteristics
next, Po and ask me to the second question: public hospital drugs and consumables in the proportion of its revenue, the abbreviation for medicine industry accounted for proportion and consumable materials.
I answer him, different regions, different hospitals are different. Roughly speaking, the public hospital medicine proportion than in the north south, the northern public hospital medicine accounted for about 35-40%, clinic medicine proportion between 50-65%, nanfang hospital about 5-10% lower. Consumption data of than not very system, because there is no separate statistics low-value consumables, but included in the examination; In general, consumables of the highest tertiary hospital, high value, low value added together could reach 20%.
the treasure really care about is drugs and consumables bonus income of hospital income proportion, ask to cancel without compensation after drugs and consumables addition, hospital losses have how old?
so, see I give these data, he immediately asked: cancel the drugs and consumables addition effect on hospital income? Should be almost all public hospital will be directly into the cavalcade losses.
I know, he made a crossover analysis of this problem in the field. And, of course, he this assumed conclusion is very common, common to the health care policy adjustment medicine prices are based on this criterion. & other; Total amount control, structural adjustment, mixed, gradually in place throughout the &; Is the product of this kind of take it for granted that health care reform policy specialized level need to improve.
I replied directly: cancel the bonus will not lead to loss of hospitals.
illustrate this principle. The principle of public hospital today to see the doctor fees, assume that patients with 500 yuan to see outpatient service, the registration fee for 5 yuan, the doctor gave him four boxes of 115 yuan of medicine (purchase price is 100 yuan, 15% bonus is $115) spent 460 yuan, a total cost of 465 yuan, leaving patients took a taxi home cost 35 yuan. Cancel after drug addition, four boxes of drug cost patients of 400 yuan, it is to open a RMB 60 colour to exceed examination, patients and cost 465 yuan. 15% bonus to allow drugs, regardless of the invisible rebate and rebates, hospital drug addition profits 60 yuan. Cancel the drug addition, without the bonus to profit, colour to exceed examination of the gross profit margin is 60 yuan, because the colour to exceed variable cost is almost zero.
note that cancellation of drug addition and consumables addition, does not affect the invisible rebate and rebates.
Po immediately retorted: you this lame, added colour to exceed 60 yuan is your hard, there is no basis. Public hospitals is not putian (putian is a rare back in the pot, thanks to it, otherwise a lot of blame who comes back?)
I have a large amount of data in hand, always stick with facts and figures to speak, that’s why Po and my brother, need the data and information, I want to find directly. This time the feeling be nasty, forgot about it.
& other; Of course I have, I give you take out the data & throughout; And I replied.
below is directly under the national health department comprehensive public hospitals in recent four years fee structure change of data:
apparently, medicine proportion fell by 4%, increase of material cost accounted 3%, check cost ratio increased by 1%. Public hospitals can completely by adjusting the fee structure to ensure the same income level, does not need to increase the fiscal subsidy (of course, this does not hinder their citing cancel bonus will loss to fiscal subsidies, health development planning commission as a public hospital & other Father & throughout; To the government, will also help them to. Need a reason to ask the government for money, the reason is not important, finance rich, so want to give a reason to make money, finance have no money, reason to fully will no money; The between father and son and also really are very much alike.
in order to further confirm this, I gave the article “cancel the drug addition & ndash; analysis of the influence of the medical insurance fund & ndash; based on the practice of jiangsu province”, the data, the paper published in the journal of the Chinese medical insurance 7, 2017, the authors from health research institute of jiangsu province. In November 2015 in the province of jiangsu province is analyzed in public hospitals to cancel after drug addition, the change of the public hospital fee structure, this paper compares the five cities of jiangsu province a year after the reform of public hospitals (November 1, 2015 – October 30, 2016) and the reform of the previous year (November 1, 2014-2014) on October 31st, the cost structure of the data, presented here in this part of the data table:
it can be seen that although the drugs cost decreased, but still about 10% total cost growth, huaian even reached 15%.
and the data table 5 indicate that the five cities public hospital outpatient service total cost has increased, but the cost structure of growth, such as nanjing is outpatient visits and time cost has increased, nantong people fell, the second all costs rise, huaian is people sharp growth, all cost is decreased. Table 8 shows that hospital visitors and all costs are rising. DetailPic
in table 6 and table 9 shows the cancel after drug addition, the causes of the rising trend in the cost of the public hospital, also confirmed me the way. Although cancelled drug addition to drug proportion to drop, but public hospitals by increasing inspection inspection fees, fee and cost of raw materials, to maintain the income level. null