The doctor who recommended drugs outside the hospital was suspended

"Public hospitals are not allowed to open for-profit pharmacies, and doctors can guide patients to buy outside, but they cannot specify which hospital, especially not financial transactions."

The author | Xiao Xiang

Source| Medical Community (ID: vistamed)

The doctor who recommended drugs outside the hospital was suspended

Not long ago, the Guangdong People's Voice Hotline exposed that a doctor in a third-class hospital in Guangzhou recommended patients to buy drugs outside the hospital, designated pharmacies and drugs, and the price of drugs recommended by pharmacies was much more expensive than online. In the secret interview screen, the doctor said that it (the pharmacy) is profitable, but only said that it is hung to the hospital, like a company under the hospital, it is to make money.

On February 18, in response to the response of all parties to this incident, the Guangdong Minsheng Hotline reported again. It is understood that Li Jun, a fourth-level researcher of the Drug Administration Department of the Guangdong Provincial Health Commission, said that the provincial health commissioned a special person to investigate and verify, and found that there was no interest relationship between the doctor and the pharmacy, and the hospital severely punished the doctor involved, suspended the doctor's professional qualifications, and carried out the rectification of the hospital's style, strengthened the management education of medical staff, and the hospital guaranteed that similar things would not happen again.

At the same time, the Provincial Health Commission, together with the Guangdong Pharmaceutical Quality Management Association, the Provincial Pharmaceutical Affairs Management and Pharmacotherapeutics Committee, after repeated discussions by experts, formed the "Guiding Opinions on the Administration of Purchased Drugs by Medical Institutions", which clarified the scope of purchased drugs and how to issue the process of purchasing drugs, and also explained that the scope of qualifications of outsourced pharmacies was also clarified, and at the same time, it was emphasized that patients choose pharmacies by themselves, which have been issued to major medical institutions in the province.

Zhu Hong, secretary of the party group and director of the Guangdong Provincial Health Commission, said: The state has clear regulations that public hospitals are not allowed to open for-profit pharmacies, and doctors can guide patients to buy outside, but they cannot specify which hospital, especially no economic exchanges.

Zhu Hong said that no matter what form of pharmacy a public hospital opens, as long as it is for-profit, it is not allowed to have economic relations with the hospital. "Next, I hope that all public hospitals will conduct self-examination first, local health bureaus (committees) will supervise and inspect, and finally the Guangdong Provincial Health Commission will also conduct inspections."

It is reported that on February 22, the official website of the Guangdong Provincial Health commission issued another announcement issuing four strict orders: First, standardize the management of pharmacies in medical institutions, clearly adhere to the public welfare nature of pharmacies of public medical institutions, public medical institutions must not contract or rent pharmacies, may not entrust pharmacies to for-profit enterprises, and must not open for-profit pharmacies in any form; second, strictly manage the purchase of drugs by medical institutions, require medical institutions to clarify the scope of purchased drugs, adhere to the principle of informed consent of patients, and must not guide patients to purchase drugs in designated pharmacies in violation of regulations The third is to continue to strengthen the rectification of medical institutions' work style, carry out self-examination and self-correction of violations of the "Nine Guidelines for the Integrity of Medical Institution Staff", and increase the accountability for violations of the "Nine Guidelines" such as the "kickbacks" of medical personnel receiving drugs; the fourth is to promote the implementation of the national essential drug system, continuously optimize the allocation of drugs in medical institutions, and strengthen the rational use of drugs in medical institutions.

Alternative "in-hospital pharmacy"

Previously, there were medical representatives in Guangzhou who posted that the local hospital pharmacy has not been prosperous for a long time, and many self-funded pharmacies in the hospital have been closed.

In this regard, Xu Yucai, former deputy director of the Health Bureau of Shanyang County, Shaanxi Province, introduced to the "Medical Community" that the so-called pharmacy in the hospital is a pharmacy opened in the hospital or close to the hospital. These pharmacies are divided into two models: one is a self-funded pharmacy opened in the hospital, formerly a self-built pharmacy of the hospital, after the implementation of the policy of separating medicines, the hospital subcontracts or hosts them; the other is a pharmacy opened by the hospital's own newly established company, opened in the hospital or adjacent to the hospital.

Regardless of the category, the operators of these two types of pharmacies have a very close relationship with the hospital, or the relatives and friends of the hospital leaders, or the commercial companies that have had many years of cooperation with the hospital. Hospitals usually derive benefits in two ways: either by charging high rents to their homes, or by directly participating in the company's profit sharing.

In essence, these pharmacies are similar to pharmacy trusteeships and are the first beneficiaries of the policy of separating medicines. However, the pharmacy in the hospital looks at it from the outside, and the chain of interests seems to be more hidden.

The emergence of pharmacies in hospitals can not only reduce the proportion of hospital drugs, but also more thoughtfully "meet" clinical drug needs, looking more like medical separation, but also intercepting the outflow of prescription drugs, so it is easier to get the recognition of the hospital.

In terms of categories, such pharmacies are either highly overlapping with hospital varieties, what hospitals sell, or highly complementary, introducing a large number of varieties that cannot enter the hospital, including falling standards, abandoning varieties, and also including some new drugs, special drugs, and high-priced drugs needed for clinical treatment.

In many hospitals, on the one hand, through the form of electronic prescriptions to prevent the outflow of prescriptions to social retail pharmacies, on the other hand, through the hospital checkout system, the prescriptions are quietly diverted to self-funded pharmacies or escrow pharmacies, which not only obtains the profits brought by drug sales in disguise, but also does not increase the proportion of drugs.

For self-funded pharmacies in the hospital, patients often mistakenly think that they are the pharmacies of the hospital, and for such pharmacies with independent brands, patients are often more trusted because the pharmacy is opened in the hospital or the doctor verbally guides them to get medicines, so the business of these pharmacies is very good, and patients line up in long lines to pay for medicines.

Policies and moral hazard coexist, and many places are closed one after another

Xu Yucai said that although the pharmacy in the hospital is cloaked in the cloak of separation of medicine, in fact, there are many policy risks and moral hazards in this measure.

The first is to increase the burden on patients. Because the pharmacy in the hospital is mainly for the purpose of the hospital itself, it is necessary to avoid the proportion of drugs and the zero difference rate of drugs, which seems to be convenient for patients, but in fact, the drugs in the medical insurance catalog may be replaced by drugs outside the catalog, and the winning varieties of the collection are replaced by the flow standard varieties, which increases the burden of drug costs for the masses in disguise.

Second, there are policy risks. One of the purposes of the new medical reform is to promote the separation of medicines, cut off the interest link between doctors and drugs, and reduce the burden of medical expenses on patients, but the pharmacy in the hospital has not achieved this purpose, and provides a "secret channel" for circumventing the drug procurement and use policy, reducing the positive effect of policies such as centralized procurement, and more importantly, this alternative pharmacy essentially hedges the zero-difference rate policy of drugs or consumables.

Perhaps based on this, in recent years, many places have closed in-hospital pharmacies. According to the "Medical Circle", just in January this year, some netizens reflected on the political platform that there was a problem of "self-funded pharmacy" in a hospital in Fengnan, Tangshan. The district party secretary replied that the hospital had investigated the issue and shut down the self-funded pharmacy.

Xu Yucai suggested that the pharmacy in the hospital has reached the end of the time, "the hospital and doctors should also be prepared for this, do not wait for patient complaints or superiors to investigate and deal with it, it may not be worth the loss, pull out the radish and bring out the mud." (This article is published by "Medical Circles", reprinted with permission, and the author and source are indicated at the beginning of the article.) ）

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