From January 15 onwards, all government-run community hospitals in Jiangsu implemented a new list of basic drug prices. Due to the adoption of the new tendering principle, the bid price in this round fell by 33.75% compared with the previous round. However, what attracts the most attention is that hospitals and pharmacies in Jiangsu Province can disassemble and package certain essential medicines, and they are allowed to collect “zero-removal service fees†for 1 cent. In fact, the zero-demolition drug is a "small-paper package" drug that we are familiar with before. It has been rare in recent years. Yesterday, Express reporter visited a number of hospitals in Nanjing found that community hospitals already have a lot of "small paper bags" of zero-clearing drugs.
In addition, some experts suggest that major surgery in large hospitals should also adopt the “pharmaceutical†method, which saves the cost of medical expenses and is one of the effective ways to solve the expensive medical treatment.
Survey by reporter
There are more than ten kinds of medicines in "small paper bags"
The reporter visited Baixia Chinese Medicine Hospital at the first stop. Lu Ying, head of the pharmacy department, said: "We have calculated that prices of about a hundred kinds of drugs have dropped to varying degrees. In particular, there are more than 10 types of Chinese-foreign joint venture drugs that have fallen by about one yuan. The last round of essential drugs There are 559 generic names for medicines and 2183 items in the catalogue. There are 588 kinds of products in this round, and there are 1600 multi-products. There are about 700 kinds of medicines in our hospital, which should be said to meet the needs of residents."
"Compared with the previous round, there was indeed a lot more medicine in this round of small paper bags. I took a closer look. There are many medicines that are packaged in one thousand bottles, and there is no way to sell them without removing them. Vitamin B6, B2 and
Other vitamin drugs are all packed in 100 capsules and must also be removed. According to statistics, the total number of drugs in the hospital's pharmacy has more than 20 kinds, more than a dozen more than the original.
Lu Ying said that although there are not many sales of medicines in small paper bags, it is very convenient for patients. “There are one hundred bottles of chlorpheniramine, and only three cents for each tablet if sold separately. There are vitamin A, etc. They are commonly used drugs by the public, they cost less, and they are very effective."
Community demolition drugs are divided into three categories
The reporter then went to Bai Xia Jian Zhong Zhong Hospital, which is located in Nanjing, and it is also the Zhi Ma Ying Community Health Service Center. It carries out zero sales of essential drugs, and there are more than 800 drugs in the pharmacy department.
In the pharmacy of the hospital, several medicine cabinets have been set up to display the zero-opening medicines. This is also known as the “small paper package†medicine. There are a total of 30 Chinese and Western medicines. According to the person in charge of the pharmacy department, the community's zero-clearing drugs are divided into three categories: First, under the current policy, hospitals must dispose of medicines for sale. There are about a dozen of medicines in this part of the country. “For example, patients with public funds in the province are book-keeping, but the total amount of restrictions given to community hospitals each year is limited. We have calculated that if publicly funded patients buy medicine, one prescription is the most. 25 yuan, so we can only sell drugs at zero, and the most common one is 'commercial living joy', a commonly used drug for the treatment of high blood pressure is about 30 yuan, at which point it must be opened for sale; In the pharmacy, the largest package of norfloxacin has 50 plates, 12 plates per plate, which is sold as a plate and sold at a price of 6.6 yuan, and the third type is commonly used drugs in small bottles. Some medicines are used by many people, but there are about 100 bottles per bottle, and it is also wasteful for patients to buy them back.
Hope to have more "small paper" medicine
Ms. Li, who is currently visiting Baixia Hospital of Traditional Chinese Medicine, is 52 years old. She often comes to the hospital to prescribe some small paper medicines. “Doctors are required to add half tablet hydrochlorothiazide tablets while they are taking antihypertensive drugs. This medicine is worth more than one minute. It's really cheap."
The doctor of the community hospital told the reporter that the drug mentioned by Ms. Li also had the diuretic effect and was particularly suitable for demolition and sale. "For example, if someone came over to do a B-ultrasound test, they would need to take two pills. However, letting patients buy more people would not be much more likely to be re-used, so it is more suitable for removing the zero." Ms. Li told reporters, hoping that the hospital could have a little more such small paper. In fact, she also hopes that hydrochlorothiazide tablets can be made smaller. The best dosage is 10 milligrams per tablet, so you don't have to cut half of it before each dose. "This drug is soft, easy to cut into powder, take not very convenient."
Some experts believe that for the zero-clearing drugs, the production enterprises must also take active actions, and they must find ways to easily remove the zeros on the packaging. "For example, the first-aid medicine for coronary heart disease, nitroglycerin, is only 2-3 yuan per bottle, the price is very cheap, but the drug is easy to absorb moisture, once it is easy to enter the air, the rest of the drug will expire in a few days. If the production company will bottle Changing the charge into aluminum foil packaging will solve this problem. Of course, the cost will increase slightly."
High cost, a little "contradictory" to remove the zero
During a visit to the survey, experts from a large-scale top-three hospital in Jiangsu stated that currently there are very few small-packaged drugs in the hospital. In addition to medical insurance policy restrictions, some patients cannot purchase more than a certain amount of money, and hospitals have to dismantle and sell drugs. Most drugs It is not for sale. The key point is that the cost is too high. At present, the relevant departments in Jiangsu do not stipulate which drugs can be removed. The pharmacy supervisory department only requires pharmacies to set up counters for zero-clearing. It does not impose any rigid requirements on which varieties are removed. The same is true for hospitals. “However, whether it is a pharmacy or a hospital, there is a natural 'contradictory' mentality to the zero-opening drugs.â€
In this implementation of the new list of essential medicines, the price notification department of Jiangsu Province clearly stated that: To encourage the use of cheap drugs, the dosage forms are tablets, capsules, large quantities (50 tablets/grain and above), and single tablets ( The basic medicine whose bid price is lower than 0.03 yuan (including 0.03 yuan) and takes medication within 3 days (including 3 days) can be charged 0.1 yuan/time in the case of providing a one-time packaging bag and indicating how to use the medicine. Zero service fee. An expert from the Community Health Service said that at present, community hospitals have not added this cost to the zero-clearing drugs. "A total of a few cents of medicine, plus a year can not sell a lot of zero-opening drugs, community hospitals may take into account the needs of nearby patients, will take part in the demolition of some drugs, large hospitals do not suffer patients, with little enthusiasm."
Another reason for the conflict is the medical disputes and complaints triggered after the drug is removed. Because consumers can't see the medicine packaging box, they have no way of understanding the side effects of drugs, or taking taboos, and are prone to accidentally taking drugs. “It's okay if nothing happens, and once things happen, the consequences are very serious. Therefore, we dismantled the drugs only. Focus on some common drugs," said an expert from the top three hospitals.
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Most drugs in expired medicine
According to a survey of large cities in East China, an average of 215 expired drugs were found in each urban household, of which 30% to 40% exceeded the validity period of more than 3 years. Due to expired medicines, the waste will reach 15,000 tons a year.
The reporter interviewed five patients, including Ms. Li, in the hospital. They told reporters that the small medicine boxes in the home were filled with various types of cold medicines, cough medicines, and digestive medicines. However, a batch of medicines, including cold medicines, were regularly cleared. It is the most serious waste. Ms. Li said: “Cold medicines are now divided into white and night films, but almost every type of cold medicine is white film and many overnight films. Sometimes I eat night films at night and I don’t need to eat white tablets the next day, resulting in white. The film could not find the night film. In order to eat the night film, it was necessary to buy a box again and the cycle began again and again."
There is a serious waste
Surgical supplies more need to "remove zero"
It is a good thing that people can enjoy the benefits of zero sales of drugs, but at present, there is not only a small variety of drugs for demolition, but most of them are concentrated in basic drug varieties. In fact, in large hospitals, there is a serious waste of surgical supplies. It is even more necessary to “remove zeros†and even introduce a “pharmaceutical†model.
Mo Xuming, director of the Department of Cardiac Surgery at Nanjing Children's Hospital, told reporters that at present, China's operating room supplies high-value consumables with a strict bar code system and realizes “one person and one numberâ€. Once the consumables are opened, they cannot be used by other patients. The purpose of doing so is to improve the safety of the patient's surgery, but also to facilitate the hospital to carry out goal assessment and scientific management, but this inevitably brings the problem of waste of resources and increased burden on the patient. Take the artificial blood vessels of the heart as an example, the general one is 10,000 to 20,000 yuan, and different patients use different lengths. “Manufacturers are all manufactured according to a uniform specification, but the needs of each patient are different. Even if only one-tenth is needed, it must be purchased. In other words, even if this patient uses only a few centimeters, the remaining must be discarded. This caused a huge waste." He said that the same situation still exists in the heart catheter, a cardiac catheter examination needs tens of thousands of yuan, once used is no longer used, but now the quality of good heart catheter can be used repeatedly "If you pay attention to the safety issues such as good disinfection, you can save the patient the cost, but the current regulations do not allow the hospital to do so."
Scientific allocation can save big expenses
Surgery "pharmacy" Huimin better
Mo Xuming said that in the economically developed European and American countries, many years of high-value consumables batch accounting systems have been implemented and they have achieved very good results.
"The advantage of this system is that high-value consumables can be used by more than one person." Director Mo suggested that if China can also scientifically allocate surgical high-value consumables, it can completely save a significant expenditure. Of course, high-value consumables should also be subject to strict safety process management to prevent cross-infection.
“The high-value consumables are not particularly large, as long as the declaration and filing system is implemented, and then there are no problems in the formulation of disinfection use regulations, disinfection regulations, and safety regulations. Take Nanjing Children’s Hospital as an example, the annual operation volume is as high as 16,000 person-times, only the heart Surgical procedures can be performed up to 1,000 times a year. If surgical supplies can be unpacked and batched, this alone can save a considerable amount of money. Compared with the purchase of basic medicines, the Huimin effect will be even more effective. Significantly."
Three or four children with one medicine
There are precedents in the domestic "pharmacy" of major hospitals
In fact, major hospitals "fighting drugs" are not new in the country. There are such precedents in many places such as Lanzhou and Nanchang. In a hospital in Lanzhou, three or four children with one drug are used together, which not only saves money but also avoids the waste of medicines. A 40-day-old baby girl, when her family settled after treatment, found that her family had saved nearly 2,000 yuan in drug costs. Since children in the neonatology department of this hospital generally have predominantly preterm infants, many of them are preterm infants weighing less than 1 kilogram. These infants use very little daily doses, and many of the most expensive antibiotics are One third of the encapsulated dose is used because the drug can only be used on the same day after it is opened. This causes the remaining drugs to be discarded and becomes medical waste. As a result, local doctors came up with ways to fight drugs.
An expert told the reporter that in fact, many foreign countries charge fees according to the type of disease, and our country charges according to the project. “After charging by type of disease, the same disease will have the same price, so the hospital will think of ways to save costs, but now it is Project fees. Not long ago, Minister of Health Chen Hao accused the project charge of being a tumor. However, doctors and doctors still have a sense of distrust each other. In such an environment, doctors do not have the means to fight drugs for exemption."
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