Abstract: The medical reform is still in progress. The next step in the reform of public hospitals is to establish new mechanisms and to eliminate the use of drugs to make up for medical services, so that public hospitals can truly return to public welfare. This is a very difficult task. It is no longer simply doing additions but subtraction. The process involves major adjustments of interests and the reform will face many obstacles. However, this hard bone is not to blame.
The lack of trust in patients for doctors has become an increasingly prominent issue in today’s society.
What is the root cause of this phenomenon? The hospital's profitability, the doctor's gray income has become a recognized shady. Since the patient knows that the doctor may use various opportunities to make money from himself, especially when the patient holds a settlement statement of thousands of dollars, how could it be to the doctor? Do you have any doubt about the diagnosis and treatment plan?
Due to the serious information asymmetry in the medical field, we know that doctors and patients have agency relationships and doctors act as patient agents to make decisions instead of patients. The patient's decision-making power to the doctor is based on the trust of the doctor. Therefore, once the doctor's decision is made in place of the doctor, the patient's trust in the doctor will no longer imply that the principal-agent relationship is in jeopardy.
Why doctors and patients' trust-and-agent relationship will be incorporated into the interests of doctors, this is not a doctor's problem, but an institutional problem. Most doctors want to be qualified agents for patients, to be good doctors, to uphold medical ethics, and to maximize the health of their patients. However, under the pressure of income, they have to distort their behavior. It is the hospital's income-generating system that has changed the incentive mechanism of doctors, such as "doing medicine to supplement medicine." After the reform and opening up, government subsidy to public hospitals has been greatly reduced. In the case that the price of medical services is limited, public hospitals can only use the medicine supplement medicine policy to increase income and support themselves. As a result, the doctor’s income is linked to the income of the department and the hospital’s income. The more you see, the more expensive the medicine you open and the higher your income. Drug rebates, corruption, and so on are also breeding. The doctor is no longer the agent of the patient. The income of the hospital and the income of the department influence the diagnosis and decision of the doctor. The patient also knows this, and therefore he is also increasingly distrustful of the doctor.
Once the doctor's incentive mechanism is distorted, the impact is far from doctor-patient relationship. Physicians see more patients and prescribe more medicines, and they will continue to push up medical expenses. The total cost of health in our country has grown from approximately 25.8 billion in 1995 to 476.4 billion in 2000, and to nearly 2 trillion in 2010. It has increased by about 10 in 15 years. Times, the growth rate greatly exceeds the growth rate of GDP, and is expected to quadruple in 10 years; the intricate interest chain of medicine circulation links with the corruption phenomenon such as drug rebates, which creates a lot of social costs and causes many social problems; more What is important is that the abuse of large infusions, over-the-counter prescriptions, and antibiotics will cause great hidden dangers to the health of the people and will affect the future of the entire nation and the country as a whole.
Establishing the correct incentive mechanism for doctors to return doctors to their posts is the core of medical reform. However, to solve the problems existing in the doctor's incentive mechanism, it is necessary to start from the mechanism reform. Since the introduction of the medical reform program in 2009, although governments at all levels have done a lot of work in improving the coverage of medical insurance and establishing a basic medicine system, few places have actually broken the “remedy of medicine†or that of doctors. Income is decoupled from the income of departments and hospitals.
Medical reform is still in progress. The next step in the reform of public hospitals is to establish new mechanisms and to eliminate the use of drugs to make up for medical services, making public hospitals truly return to public welfare. This is a very difficult task. It is no longer simply doing additions but subtraction. The process involves major adjustments of interests and the reform will face many obstacles. However, this hard bone is not to blame.
The lack of trust in patients for doctors has become an increasingly prominent issue in today’s society.
What is the root cause of this phenomenon? The hospital's profitability, the doctor's gray income has become a recognized shady. Since the patient knows that the doctor may use various opportunities to make money from himself, especially when the patient holds a settlement statement of thousands of dollars, how could it be to the doctor? Do you have any doubt about the diagnosis and treatment plan?
Due to the serious information asymmetry in the medical field, we know that doctors and patients have agency relationships and doctors act as patient agents to make decisions instead of patients. The patient's decision-making power to the doctor is based on the trust of the doctor. Therefore, once the doctor's decision is made in place of the doctor, the patient's trust in the doctor will no longer imply that the principal-agent relationship is in jeopardy.
Why doctors and patients' trust-and-agent relationship will be incorporated into the interests of doctors, this is not a doctor's problem, but an institutional problem. Most doctors want to be qualified agents for patients, to be good doctors, to uphold medical ethics, and to maximize the health of their patients. However, under the pressure of income, they have to distort their behavior. It is the hospital's income-generating system that has changed the incentive mechanism of doctors, such as "doing medicine to supplement medicine." After the reform and opening up, government subsidy to public hospitals has been greatly reduced. In the case that the price of medical services is limited, public hospitals can only use the medicine supplement medicine policy to increase income and support themselves. As a result, the doctor’s income is linked to the income of the department and the hospital’s income. The more you see, the more expensive the medicine you open and the higher your income. Drug rebates, corruption, and so on are also breeding. The doctor is no longer the agent of the patient. The income of the hospital and the income of the department influence the diagnosis and decision of the doctor. The patient also knows this, and therefore he is also increasingly distrustful of the doctor.
Once the doctor's incentive mechanism is distorted, the impact is far from doctor-patient relationship. Physicians see more patients and prescribe more medicines, and they will continue to push up medical expenses. The total cost of health in our country has grown from approximately 25.8 billion in 1995 to 476.4 billion in 2000, and to nearly 2 trillion in 2010. It has increased by about 10 in 15 years. Times, the growth rate greatly exceeds the growth rate of GDP, and is expected to quadruple in 10 years; the intricate interest chain of medicine circulation links with the corruption phenomenon such as drug rebates, which creates a lot of social costs and causes many social problems; more What is important is that the abuse of large infusions, over-the-counter prescriptions, and antibiotics will cause great hidden dangers to the health of the people and will affect the future of the entire nation and the country as a whole.
Establishing the correct incentive mechanism for doctors to return doctors to their posts is the core of medical reform. However, to solve the problems existing in the doctor's incentive mechanism, it is necessary to start from the mechanism reform. Since the introduction of the medical reform program in 2009, although governments at all levels have done a lot of work in improving the coverage of medical insurance and establishing a basic medicine system, few places have actually broken the “remedy of medicine†or that of doctors. Income is decoupled from the income of departments and hospitals.
Medical reform is still in progress. The next step in the reform of public hospitals is to establish new mechanisms and to eliminate the use of drugs to make up for medical services, making public hospitals truly return to public welfare. This is a very difficult task. It is no longer simply doing additions but subtraction. The process involves major adjustments of interests and the reform will face many obstacles. However, this hard bone is not to blame.
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