Hangzhou Yuhang High-priced repo hospital highlights the dilemma of medicine-raising medicine

The core of the Yuhang in late October, Hangzhou, a big overhaul of health care.　　Some media have described its health-care path as "drawing a circle."　　7 years ago, the Yuhang government will be subordinate all township hospitals, 75.84 million yuan sold to private capital operation, 7 years later, the government at nearly 300 million of the price of the full recovery.　　The first Sell-off, because township health centers generally loss, staff Shing, bloated, and has an industrial output of more than 50 billion of the local government and its investment is not enough; now the recovery is due to the privatization of hospitals, drug-raising, resentment, and medical reform requirements: every county must have public hospitals. In the interview, Professor Guo Qing said the hope that after the Yuhang health reform in the circle, the local government can understand the health and its public properties, especially for the prevention of health care for citizens, the government must pay for this responsibility.　　So, this circle is not white painting.　　The repurchase action of Yuhang Township Health Center has lasted for 21 months since December 2008.　　To September 30 this year, the last two willing to return to the township hospital and the town government signed a repurchase agreement, this was once put to private 28 township hospitals, all were withdrawn.　　About half a month later, Xinhua news agency, said that the 7-year Yuhang health reform is worth rethinking, and caused widespread concern.　　October 28, Yuhang "Public house" building 5 floor, the Secretary of Health Office, the secretary Huang cover the door, refused to interview, while saying "I have said the talk, and then there is nothing to say", the side hurried away. Zhejiang Health Department, a deputy director of the Huang can understand the mood.　　Reporting Yuhang health reform is tantamount to exposing others to the pain, he said. Economic strong counties, health centers in 2001 Yuhang revenue of more than 1.2 billion yuan, into the health centers 900,000, more than half of the loss of health centers, has become the reason for the Sell-off Zhu Shengjin is now Huanghu Town Community Hygiene Service Center Director. According to her, seven years ago the reform of the dumping of hospitals, induced factors are the township health centers in the large area of losses.　　In 2002, more than half of Yuhang's hospitals were in a loss state. Zhu Shengjin is 1998 after graduating from secondary school, came to Huanghu Town Township Health Center.　　At that time, the hospital had a total of 19 medical staff, the highest degree is secondary school, and most of the staff were transferred from the barefoot doctors. In Zhu Shengjin memory, at that time, there was basically no medical equipment, only a microscope, a most common X-ray machine, a nine-lead ECG machine, "These devices are also the corresponding support of the major hospitals updated after the gift." "Health centers have been losing money, still in Shing, the general medical staff one months and 900 yuan up and down, even if it will delay," often this month's salary, it will be two or three months before the hair down.　　"This is not a problem for the Huanghu Town Hospital. Xu Buyun, Yuhang Health Bureau director, in a "hospital Reform performance evaluation" in the statistics, Yuhang a total of 29 township hospitals. 2000, there were 11 losses, to 2002 years and 15 losses.　　Yuhang regional difference between East and west obviously, the township hospitals in western mountainous areas of the most serious losses.　　In this article also shows that at that time Yuhang finance for health centers, housing renovation, equipment acquisition, such as collective subsidy funds, 900,000 yuan per year. "Before the joint-stock reform, township hospitals self-financing, tens of thousands of yuan a year of subsidies, for workers Stoufe, barely live."　　"Former Huanghu Township hospital Dean Shen recalls. And Yuhang is not no money into the hospital, it is the famous land of fish and rice, silk House, after the reform and opening-up, several times among the hundred counties. 2001, Yuhang revenue of 1.281 billion yuan.　　2003, Yuhang industrial output value of 57.7 billion yuan, listed in the National Comprehensive Strength hundred counties (city, district) 20th place. "Government money does not necessarily mean public health."　　Guo Qing, vice president of Hangzhou Normal University. Guo Qing is a new type of rural cooperative medical expert Technical guidance group experts, starting from 1986, engaged in rural primary health care research.　　In his view, the government's lack of input to public health was due to the fact that primary health care was not really a livelihood project.　　"Against the Wind" Selling hospital health Bureau of Hangzhou against the privatization of hospitals, worried about the restructuring of its inability to assume public health functions; Yuhang still will "sell" when Yuhang Health Bureau director Xu Buyun remembers, the hospital joint-stock reform is in 2001 years. Before restructuring, Yuhang has sent officials to the province outside the Suqian and the province of Wenzhou, Xiaoshan and other fields to study and visit. Suqian in 2000 to the township hospitals all to the market, and the main price orientation, "who bid high who get". Wenzhou health reform is to promote the internal ownership of the board.　　Xiaoshan health reform, only part of township hospitals privatization.　　In order to avoid the phenomenon of "Butcher's Hospital" in Suqian medical reform, the health care system is only sold to professionals in the Yuhang. "On the one hand want to reduce baggage, on the other hand also want to revitalize resources."　　"Yuhang Health Secretary Huang had previously been interviewed to explain the original motives for restructuring." There was also a dissenting voice.　　Former Huanghu Township Hospital Dean Shen is one of the few open opponents. "Health Bureau meeting, I have several times openly questioned that the hospital share system must be mistaken."　　"At that time 29 hospitals, only 2 against shareholding reform, Shen also wrote to the Department of Health, Zhejiang Province, to express different views."　　Shen said that at that time, objections, mainly two points to consider, "health centers to engage in joint-stock will increase the economic burden of people to see a doctor";　　Hangzhou Health Bureau, the head of the office told reporters, Yuhang at the time of health reform, the city board is also opposed, because at that time has taken into account the reform of private hospitals can also undertake preventive health care, chronic disease management, health supervision and other public functions. The official said, but because the health system in the executive is not vertical management, so the District Health Bureau only business guidance, and the District Health Bureau of Personal belongings by the district government to solve, so ultimately can not stop Yuhang "Selling "health centers."　　2001, the big curtain of Yuhang health reform opened. According to the evaluation and calculation of the district Health Bureau, the total authorized assets of 29 Township hospitals in the region are 84 million yuan and the liabilities are 33.55 million yuan.　　In the end, these hospitals are transferred to the system for operation in a total of $75.84 million. The sale of this premium, so that township hospitals Real estate appreciation of 50%.　　Except for the replacement of employees, the stripping of retirees and the cost of housing subsidy, the balance was held 50% by the two governments of the district and township, and the Fund of Rural Health Development was established. Why do Rich Yuhang "sell" hospitals?　　Guo Qing said that because the macro-economic background was to take a market economy, and that health institutions should also take the market economy. The State Council's decision on further strengthening rural health work (Zhong FA [2002]13) puts forward that the reform of township hospitals should be promoted, the reorganization and restructuring of township hospitals should be carried out, and the various operation forms of invigorating hospitals should be explored, and the public ownership should be established as the leading,　　The Rural Health Service network developed by various forms of ownership.　　Guo Qing said that at that time the government did not realize that primary medical care after the full market will bring about what problems. Hospital hospitals after the reform of your health centers a box of stomach medicine than the District hospital is nearly 20 yuan, to drug-nourishing medicine, and few people to carry out the prevention and care of hospitals after privatization, and not immediately exposed to problems.　　On the contrary, Yuhang health reform in the economic level has also achieved significant effects. In the 2004, only one year after the restructuring, the loss of township hospitals left only two.　　The statistics report shows that the total business income of 29 hospitals has reached 101.026 million yuan, up 54.5% from 2000. Zhu Shengjin recalls that Huanghu Township hospital in November 2003 to complete restructuring, the total assets evaluation price of more than 2.6 million yuan, at that time all employees are holding shares, common risk, the backbone of business more than ordinary workers less.　　She held 4 shares, 26,500 yuan per share. After the restructuring, Huanghu Township Hospital hardware investment began to increase, shareholders pooled 180,000, the purchase of semi-automatic biochemical instrument, semi-automatic blood analyzer, blood glucose meter and other conventional inspection equipment.　　The enthusiasm of hospital staff and the volume of medical service have obviously increased.　　When some health centers turn to profit, the problems ensue. Yuhang Although the introduction of documents, the provision of hospital reform, is still a non-profit medical institutions, but shareholders in order to maximize the benefits, "drug-raising" is very rampant, and more serious than the district hospitals. Yuhang Health Bureau party secretary Wang Weiming introduced, the district is a hospital, although there is medicine to keep the medicine, but the district is the hospital price is stipulated not to exceed the price of 15%.　　and township hospitals to carry out the price of medicine is the highest price.　　For example, omeprazole (a kind of stomach medicine), at that time the hospital according to the price bureau of the highest price sales, 40 yuan/box, pharmacies price as long as more than 20 yuan. Wang Weiming said, later appeared such a phenomenon, go to the big hospital to look after the doctor, the medicine price is lower, the expense is cheaper instead; go to township health centers, small hospitals to see a doctor, feeMore expensive. After reforming the township hospitals, the proportion of drug income to total income is getting higher.　　In 2004, the proportion of drug revenue in Yuhang hospitals was as high as 78.21%.　　Bolu Township Hospital Bulletin board showed that the hospital this June's total business income of 1.3159 million yuan, of which drug income of 990,800 Yuan, the drug accounted for 75.3%.　　Moreover, before the reform, the health Bureau of Hangzhou worried about the problem also appeared, Township health Care epidemic Prevention, family planning publicity and other public health functions have been seriously weakened.　　Shen said that the rural chronic disease management, farmers health files and other public health projects, each hospital is to cope with a few rural doctors to go to the countryside, health centers, medical personnel are not in the countryside.　　Shen said that the reason is very simple, public health projects do not make money, no profits, medical staff went to the countryside, the health center is no one to see a doctor, there is no income, affect efficiency. Guo Qing that, the public function of health centers and its market-oriented nature, both of which are contradictory. Citizen preventive Health care is done well, the patient is less.　　The market-oriented hospitals of course hope that the more patients the better. Cost nearly 300 million of the full recovery of the Zhejiang provincial government requirements: A township must have a public health hospital, Yuhang take the opportunity to buy all the township hospitals to the Township hospital privatization, although relying on "medicine to keep the medical", the operation has improved, but not last.　　At the beginning of system reform, there were only 2 loss hospitals, then the loss hospital gradually approached 10. According to Yuhang Health Bureau party secretary Wang Weiming introduced, Yuhang Hospital about 1/3 achieved a surplus, 1/3 flat, another 1/3 losses.　　Most of the loss-making hospitals are located in relatively remote areas with low economic development level. Huanghu Township Hospital is located in the northwest mountainous area of Hangzhou.　　The original Huanghu Township hospital Dean Shen recalls, later patients are not in hospitals dispensing, they come to hospitals, take the prescription to pharmacy dispensing.　　By the year 2007, the macro-policy environment has also changed.　　Zhejiang provincial Government issued the "No. 69th" article on the establishment of Health strong district requirements: an organized township must have a governmental community health Service Center. "The provincial government has decided to buy the hospitals that have been sold," he said.　　"But it's not easy to buy it back and sell it," says a head of the Yuhang Health Bureau.　　Yuhang's second health reform began in 2008.　　September 2008, Yuhang decided to reform the scheme, the government wholly-owned hospitals to buy shares, and based on the amount of investment to give certain interest compensation and 15% of investment compensation.　　September 30 this year, a total of 28 township hospitals and the Yuhang government signed an agreement, the agreement price of 278 million yuan, in addition to the original cost, but also includes 119 million yuan input. As for the huge money gap in the buying and selling, there is public opinion questioning whether there is a loss of state-owned assets.　　Wang Weiming explains that this is all from debt service and 15% compensation.　　Investors in township hospitals do not think the price is too high.Jing Shan Township Hospital director Hong Honglian said that in 2003, he and 7 shareholders invested a total of 3 million yuan, and then a few years additional investment of more than 2 million yuan.　　This time, the Government fully bought their shares and added a 15% increase in value, a total of more than 6 million yuan a lump sum. Former Cang Qian Zhen hospital Dean Lu Hongping and Hara Township Hospital Dean Li Jianrong all said, "2003, if we put 75 million into the housing market, do not say 300 million, now 700 million have."　　Wang Weiming told reporters that the government had also considered introducing a Third-party assessment agency to assess the assets of the hospital, and bought it at an evaluation price, but did not choose the package. Because it's so complicated, it's difficult to operate, he explains.　　After 7 years of development, 29 reform hospitals have appreciated the assets, but the east-west, urban and rural areas vary greatly, the scale of appreciation is different, if the government to engage in third-party assessment, not too realistic. "Of course, the government is doing it to save money," he said.　　Yuhang, a head of the health bureau.　　is repurchase equal to the public good? Some drawbacks have arisen after repurchase, experts believe that the government to perform public health functions can also choose other means Huanghu Township hospital is the first "back" of the hospital.　　It signed a repurchase agreement with Huanghu town on December 31, 2008. Huanghu Township Hospital was bought back after the first thing to do is to reduce the price of medicine.　　For example, see a cold, joint-stock, a prescription to 120 yuan ~130 yuan, repurchase, a prescription to 70 yuan ~80 yuan.　　Zhu Shengjin recalls that at the beginning of 2009, the surrounding township hospitals in the implementation of joint-stock system, because the Huanghu drug price drop, so there have been villagers "across the town to see a doctor" phenomenon.　　"This is why most hospitals are willing to be bought back," said Lu Hongping, dean of the hospital. "If the car is not up to the reform, do not go back, and the public health centers in the competition, they engage in the basic drug system, the implementation of drug 0 difference, how can we private hospitals survive?"　　"Lu Hongping said. "The role is also changing after the hospital was bought back," said Zhu Shengjin, who used to sit in the office and wait for patients, who are now in the morning to see a doctor and go to the countryside in the afternoon.　　Now the Government stipulates: prevention, medical treatment, health care, rehabilitation, health education, family planning technical guidance, six large blocks are to be completed in the hospital.　　After the repurchase, the Yuhang government renamed the hospital as a Community health service center, and increased the investment.　　According to the plan, these hospitals will become the full financial allocation, "two lines of income" management of Community health service centers, and through competition to redefine management. Yuhang will be in accordance with the "every million service population with 13-15 people, 0.7 more per bed," the establishment of provincial standards, and investment of about 400 million yuan for Community Health Service Center hardware construction, high standard with color B Super Health examination "six large".　　On the software side, the government has pledged to increase the annual expenditure of $6000 per capita, and to grant grants to professionals with undergraduate and above qualifications. After repurchase, the malpractice of administrative means is also obviousNow: A hospital in the previous year's electricity costs more than 10,000 yuan, now only one months will be 12,000 yuan.　　Gu Xin, a professor at Peking University's School of Management, sees that the government's role in public health and basic medical care is not the only option to fully take over medical institutions. "For example, we can reform the payment method, allow the rural patients to choose the hospitals freely, and bind the public health funds to the new farmers, promote the healthy competition between township hospitals and improve the efficiency of Medicare funds." "In any case, it is a good thing to buy a hospital home today," Guo Qing.　　Because the government has seen what should be done, what should be borne, the details of the management can be adjusted.　　Wang Weiming said Yuhang is exploring the development of performance appraisal system to circumvent the repurchase of the hospital to raise lazy people, do not worry about doing things. -newspaper reporter Liu Zhejiang Hangzhou report