Chinese medical reform has caused many international jokes

From the unprecedented severe SARS crisis of 2003 until today, people still complain that it is difficult and expensive to see a doctor. Few people have noticed that the new round of medical reform has already gone through a decade.

“Our reforms in recent years are only at the grassroots level, accounting for less than 20% of the total medical services. In the environment of profit-producing profits, although the small sesame seeds at the grassroots level are whitewashed, watermelons are still eating expansive agents and desperately growing. On April 26, at the "China Economic Watch" forum held at the Peking University Runyuan Garden, Professor Li Ling of the Peking University Development Institute responded to the loss of many people.

Ten years and the fate of the fate. It was also in 2003 that Li Ling abandoned the goldfish bowl of the tenure of the University of Maryland and became a firm researcher and promoter of the new medical reform.

Ten years of medical reform, and controversy and advance. As a firm supporter of the government-led model of medical reform, Li Ling advocates that the positioning of health care is a public welfare undertaking. "Slightly conscientious people should not regard health care as a profitable industry." Referring to the international mainstream medical system model of the United Kingdom, Japan, etc., Li Ling bluntly stated that due to the "market-only" facts of the domestic economy, China's medical reform has caused many international jokes. Up to now, such jokes have continued, and the introduction of private capital into public hospital reforms is an example.

“If you want to attract private capital to expand the supply, you should go to a hospital, and what do you want to do to replace an existing hospital? Private capital is not a fool. No one wants to run a hospital on their own, and they all want to make money. This is the last piece of the public hospital. Can we solve the problem of people's medical treatment?"

Even if private capital voluntarily establish hospitals, medical and health resources should be strictly planned. “Excess is more terrible. It calls for the supply of induced demand in the health and economics. How many doctors there will be, how many patients there will be, minor illnesses can be cured, and illness can be cured.”

According to Li Ling, starting from the successful attempts of the Anhui and Sanming modes, the new round of medical reform must emphasize comprehensive governance and rebuild a new system that contains a series of policies. In this sense, the reform of medical reform to the overall path of the future is about whether or not the golden opportunity for China can be grasped.

In fact, Li Ling’s knowledge and vision are also accompanied by her research object, social governance and democratic exploration.

When she said that she should be a leftist intellectual, Li Ling smiled.

"I went to the United States to attend academic conferences. My peers all approved me. Now people like me have become left. It shows that we Chinese are really right to extreme."

Suddenly, she said, "I think I am a Chinese school."

Return to health property

"The occurrence of 'SARS' may also be inevitable. Our health care system has reached a point where it cannot be changed."

Li Ling made a set of data comparisons. In 1978, the position of medical and health care was welfare. Individuals paid less than 20%, the government paid one-third, and society paid the rest. By 2000, individuals paid more than 60%, government and social payments fell, and the government paid only 15%. China’s medical fairness ranks fourth to the bottom of the globe, and it has suddenly become a bad example from a good example of the year.

Before determining how to reform, Li Ling believes that the problems of modern medical care should be understood first.

As a product of modern civilization after the industrial revolution, modern medical care based on Western medicine has grown by leaps and bounds, and malpractice has continued to grow, ignoring the integrity and self-healing ability of life. “It depends entirely on external forces, relying on equipment, equipment, and drugs. By surgery." Caused more and more expensive medical expenses, reaching the level of the economy is difficult to support.

“The United States is the most typical example. The per capita annual medical cost is as high as nearly 9,000 US dollars, 18.5% of GDP is invested in the medical field, and 1/3 people are bankrupt because of a doctor. Why does Obama want to promote medical reform? No change, high labor costs, companies Without competitiveness, the country loses its competitiveness."

Why is it so expensive to see a doctor in the United States? In Li Ling’s view, precisely because the United States uses more market mechanisms, various new drugs, new instruments, new equipment, and new inspections are constantly stimulating, and a large amount of expenses are incurred in the final stages of life, and it is completely inefficient.

The design of the medical and health system should better contain the so-called high-precision and indiscriminate expansion of modern medicine. It must be able to afford it and strengthen the macro-governance of population health. The public welfare system and the market system, the efficiency of the former is almost the same, but the cost of the latter is too high, "Lastly the country must be destroyed."

The biggest speciality of medical care is that "your medical care, doctors call the shots." The key lies in what kind of incentives are given to doctors. Unlike market-based incentives, "in the public health care system, the incentive for doctors is to let them see the people for the disease with the least amount of money." Consistent with many peers' views, Li Ling believes that the choice of the public health care system is "the right to use the two evils."

Li Ling often takes Britain for example. As a veteran market economy, the United Kingdom adopts a deregulated public health care system. The per capita cost is only 1/3 of the United States, and the average life expectancy per capita is much higher than that of the United States. The British people are proud of this and are also specifically showing it to the world at the 2012 London Olympics. Japan, which prohibits profitable medical institutions, has the world's leading life expectancy.

Li Ling believes that microeconomic efficiency alone cannot be used as a criterion for judging the health care system. The efficiency now mentioned refers more to the micro-efficiency of medical institutions, and more attention should be paid to macro-efficiency, that is, how a country uses less money to protect the health of ordinary people.

Some domestic “market-only” economists do not understand the characteristics of the health economy and have made a lot of jokes about the medical analogy of the catering industry.

In 2007, global medical reform experts gathered in Beijing to review the Chinese medical reform program. After listening to the “market theory” of some Chinese economists in the first half, foreign experts could not sit still. During the break, they automatically stood together and after the discussion, they found Ma Kai, leader of the Medical Reform Leading Group at that time. “We can give us 10 minutes in the second half and we share a few points of consensus.” The basic consensus is that medical care is a serious market failure area and cannot be solved by market mechanisms; medical insurance is also a serious market failure area; commercial insurance can never solve the problem of universal coverage; drugs are commodities, not ordinary goods, and no country depends on The market to solve the problem of drugs must be strictly regulated....

"It's like a slap in the face, but you can still talk after you finish." Li Ling was helpless. Some experts who talked about medical reform did not even read the most basic health economics articles.

To her great relief, the medical reform plan formally introduced on April 6, 2009, finally determined the government-led model, and clarified the public health attributes of health care.

Li Ling is not opposed to the market factors in the medical system. In her view, it should first protect the national team in the medical field and solve the majority of people's medical problems. In fact, the domestic medical field has been liberalizing the market and the number of private medical institutions has surpassed that of public hospitals.

“After more than a month after the World Bank’s experts visited China, they came to the conclusion that China has no real public hospitals at all, and none at all.” Because the hospitals are all profitable in China, the relationship between doctors and patients has changed. So nervous.

The focus of the new round of reform is on public hospitals. The direction of reform is not to sell them to private capital. If this is the case, in Li Ling’s view, it may bring about a Chinese-style subprime mortgage crisis, and those who need to guide should be those private capitals that are truly charitable.

“The Suqian model has proved to be a failure. When the Suqian municipal government sold the best local people’s hospital for 70 million yuan, it now costs nearly 2 billion yuan to pay for the hospital construction. How much does it cost?”

Reform needs macro governance

The medical reform plan introduced in 2009 was the only reform that had been designed for the top level and was issued jointly by 16 relevant ministries and commissions. However, the operability of this program is not strong, but set goals, principles and directions.

Li Ling and her colleagues once joked that China’s medical reform is a “Special Olympics”. A group of people with bad brains are in the Special Olympics Games, firing a gun, running around, and participating but irresponsible.

However, the path of reform may be bred.

In Li Ling’s view, the Anhui model started with primary medical care has broken the old system of “taking drugs to support medical care” and created a set of government-based medical treatment systems, personnel systems, distribution systems, drug procurement and procurement systems, and financial input systems. The new system is a comprehensive reform, and it is also a macro-government. It is like “taking the old system to the new system”.

The most central part of this system is to clarify the government's medical treatment mechanism. Not only to solve the business establishment and financial investment, but also set standards, set the rules, do a good job of medical and health resources planning.

The second is the personnel system, changing the personnel system of the “big pot” in the past, implementing a competitive personnel system, deciding on the basis of uncertain positions, signing contracts with doctors, and doing well to renew contracts.

The distribution system has set up a comprehensive evaluation system for selecting good doctors. It is highly rewarding to see if he is providing services for the people, whether it has better medical skills and if it has more noble medical ethics.

In the past, the procurement of pharmaceuticals was actually a bogus tender. “A drug has hundreds of successful bids, and only one dummy price is used instead of a guaranteed amount. These manufacturers have to go to hospitals and doctors for public relations.”

Anhui used the “double envelope” model, where the first envelope was comprehensively scored and the poorly-quality drugs were screened out first, while the second envelope was chosen for low-priced drugs. "A drug that only recruits one person and trades in the market. What kind of public relations do you go to?" This squeezes the virtual component of the pharmaceutical circulation field.

The financial input mechanism has established a set of "good hospital" standards through a complex set of incentive mechanisms. "Equivalent to setting up a square box, in the framework set by the government, it is necessary to give the hospital enthusiasm, and it must not make it active."

Due to the good implementation results, the Anhui model quickly attracted high-level attention and was pushed to the whole country in 2011. The effectiveness of the promotion is also very good. “According to a national rural assessment conducted in 2012, over 85% of farmers were satisfied.”

Confronted with the problems and doubts in operation, Li Ling believes that when judging a reform, it mainly depends on the general direction. It is not a matter of looking at the details. It takes a long time to establish, consolidate, and improve a system.

The Sanming model is aimed at the reform of public hospitals at or above the county level and is also a set of macro-governance. The highlights of the reform are focused on the zero-sum rate of medicines, the unification of three guarantees, and the annual salary system of the dean's doctors. The so-called "three-unity reunification" means that the city will achieve the unity of the three types of handling agencies: urban employees basic medical insurance, urban residents medical insurance, and new rural cooperative medical insurance.

One year after the reform, Sanming’s financial burden did not increase, saving more than 700 million yuan in medical expenses. The conflict between doctors and patients was greatly relieved. “Patients send local doctors to doctors and send pennants”.

In Li Ling’s view, the government should make every effort for the medical treatment of the people. It has proved to be not difficult. In the poor places where Sanming did not want to spend much money, the average person spent only 1,000 yuan to solve the problem of ordinary people's medical treatment.

Li Ling has a belief that in the future competition with the United States, China's biggest advantage lies in medical and health care.

At present, Obama’s medical reform has basically stopped and the profit-seeking mechanism still exists. Under the influence of aging, medical care will drag the United States. In contrast, China once created a good system, and the foundation of this system is still there.

“Now the whole world is sick. The treatment of the world's diseases requires the methods of Chinese medicine. The Chinese culture behind Chinese medicine is characterized by a comprehensive system.”

Li Ling believes that comprehensive cooperation should be promoted to spread health culture and healthy lifestyle. In addition to the 2009 medical reform plan, the Health Channel was set up in Central China. Why isn't Weixin setting up a public platform for health education?

At one of the meetings, Li Ling also criticized the leadership of the Health and Development Planning Commission. "If President Xi goes out to eat steamed stuffed buns, why don't you send a nutritionist to give advice? Let him eat five meat buns and eat a bowl of fried liver. Now it's changed. It's all high-fat and unhealthy!

Li Ling believes that China’s greatest hope lies in the unification of the social system and the Internet’s Chinese culture. If we can integrate the three innovations, we will bring about the greatest institutional innovation.

The reform of the social security system including medical reform is an important starting point for future reforms.

Taking the reform of the household registration system as an example, Li Ling believes that the household registration system itself is not a problem. The problem lies in the protection systems that are involved in medical care, education, and retirement. In the future, with the reforms, the level of co-ordination is getting higher and higher, and the country is all the same. What is the relationship between household registration?

Once this is done, the status quo of fragmented and fragmented Chinese society will be changed, people’s hearts will be united, and society will be able to rebuild.

According to Li Ling, China has caught up with unprecedented opportunities for development.

“Ten years ago, when Bush Jr. aimed at China, a 9/11 release to China. Last year, Obama announced his return to Asia, and he also targeted all of China. Now he comes to the Ukrainian crisis and once again explains to China. set."

Opportunity At present, the greatest risk lies in China's stubborn habits.

"Everything in the West is right, all markets are right, and they have become new and 'everything'." If in the 1980s China needed a market for enlightenment, now it needs another New enlightenment.

One China sent a second understanding On March 26, at the provincial and ministerial level medical reform forum, Liu Yandong, vice premier of the State Council, stated that it would expand the county-level public hospital reform pilot to 1,000. According to Li Ling, the key to the success of the pilot program is that the leader of the reform should be a local government, not a hospital.

Li Ling still has concerns about the new round of reforms. Medical reform is a comprehensive reform and requires a general headquarters to be responsible for overall planning. In the past two years, “it was the tossing of private capital, the command of the Medical Reform Office was destroyed, and the Health and Planning Commission was made.” The good news is that the headquarters has quickly returned, but “toss a big circle, what is this? cost?"

"Looking at the deepening of the leading group for medical reforms and the comprehensive deepening of the reform group chaired by Chairman Xi can really straighten out the relationship. If so, the medical reform will be a piece of cake."

"Really, a piece of cake", Li Ling's tone is full of firm expectations.

China's God-given opportunity

As a 60-year-old after being educated by idealism, many of Li Ling’s choices did not start from the best of individuals, but from the choices of the country’s needs and society. But looking back, she believes that this choice actually helped her achieve her personal best choice.

Before going to university, Li Ling was a literary youth. At the time of the college entrance examination in 1978, the country called on interested young people to “save the country through science and technology,” and she learned physics. 9 years of physics study has laid a brand new capacity for her cognitive world. Later, it was discovered that the country’s most lacking talents are economic and management personnel. She transferred to the economy and moved from the macro economy to the health economy, just in time to catch up with China’s new round of medical reform.

When Li Ling decided to return to China in the 16 years he went to China, in 2003, the most difficult choice was the adaptability of her 14-year-old daughter. For her generation, "it is still related to education, regardless of the physics economy, including studying abroad, one idea is to hope to do something for China." It is difficult for her to make choices for her growing children. Fortunately, her daughter's return to China not only quickly adapts to domestic learning, but also grows with China. She was admitted to Harvard University from home and returned to China after her undergraduate and postgraduate studies. She has been working in China for nearly two years now.

After returning home for 10 years, Li Ling laughed that he was indeed tortured, depreciation was fast, and the sense of accomplishment was very strong. On the one hand, he did his best to promote social development. On the other hand, because of his long-term research at the grassroots level, Li Ling felt that her cognitive ability had surpassed medical reforms, and her knowledge of the world and society had reached a new height.

This understanding of sublimation reflects the re-understanding of China, the West, and economics.

The miracle of development in China for 30 years cannot be explained simply by the market. China's industrialization is an integrated innovation. With abundant human capital, a generation suffers from two generations of people. The status quo of China's "pan-marketization" should continue to be brainwashed in the past 30 years, and it must be truly objective and fair to understand history, understand the world, and recognize China today from the historical, international, and realistic dimensions.

According to Li Ling, Western-style democracy is experiencing its own crisis. Although democracy is the only way to go, but for the Chinese who have always lacked the democratic gene, they can explore a new path: the deliberative democracy of the "selection." The goals of the future Chinese governance system are the organic integration of promising government, effective markets, and organic society.

In the eyes of Li Ling, Western economics has gradually become a mathematical game in the ivory tower. Its guiding significance to reality is very weak. It can be called "vulgar economics." China's practice has gone ahead of the theory and it is urgent to form a local school of economics.

"We should abandon the ideological disputes of the left and right sides, take long-term development as a priority, and seize the heaven-sent opportunity of the Chinese nation. Otherwise, it will be a historical sinner." This is probably the greatest voice of the Chinese faction.