Song Dali believes that after the pharmacy is entrusted, the trustee will be responsible for drug management, and introducing the advanced management model of the enterprise into the hospital will play a certain role in improving the efficiency of hospital pharmacy, freeing pharmacists from procurement and daily management affairs, and making pharmacists devote more energy to pharmaceutical services, thus promoting the transformation of hospital pharmacies from "drug supply-centered" to "patient-centered" modern pharmaceutical service model.
1.4 in the custodian: pharmacy custody promotes enterprise profit growth.
East China believes that China's pharmaceutical commercial enterprises have the characteristics of large quantity, small scale, high cost and low profit, and generally face the situation of low efficiency or even bankruptcy. In the supply chain of pharmaceutical products, pharmaceutical commercial enterprises are in an important position, and their operating conditions can greatly affect the operating efficiency of the whole supply chain. The emergence of pharmacy trusteeship model has brought opportunities for pharmaceutical commercial enterprises to increase profits. After hosting pharmacies, enterprises can gain more market share through exclusive drug purchase and sale, resulting in scale effect, increasing the chips that squeeze the upstream interest space and bringing huge direct profits to enterprises. Feng et al. It is also believed that custody enterprises can have more say in the supply chain by virtue of their exclusive status, thus saving a lot of operating costs such as public relations and advertising, and indirectly promoting corporate profit growth.
Gao believes that after accepting custody, we should share the cake of drug profits in outpatient pharmacies while ensuring the stability of hospital drug income, but we can only seek a lower profit rate. Therefore, changing the profit-seeking behavior of operators and truly benefiting the people has become the main factor in investigating pharmacy custodians. After pharmacy trusteeship, the scientific management mode of enterprises is introduced into hospitals. The trustee can rely on professional drug management and shorten the circulation channels to reduce costs, and make profits by unblocking channels and increasing sales. We can ensure the quality of drugs by implementing GSP and advanced logistics facilities, play the role of information link, recommend the latest scientific and technological products to hospitals, organize the training of doctor Yamatonokusushi and academic exchanges with hospitals, and ensure rational drug use.
In addition, under the new model, trust enterprises can create a variety of new businesses based on the new supply chain system. For example, in-depth patient health services, research and development support of pharmaceutical companies, or hospital management services. These business innovations can bring new profit growth points for hosting enterprises, thus improving the economic benefits of hosting enterprises.
(The above-mentioned "benefits" are sorted by policies, people, hospitals and custodians according to the viewpoints in the literature. Personally, I agree with these views: 1) pharmacy trusteeship is only a buffer form at present: I think the form can certainly be explored and cannot be achieved overnight, so there will be transition and buffer. The key is to learn from experience and lessons. As for this kind of chaos. 2) It is beneficial to reduce the cost and enhance the competitiveness of hospitals: from the perspective of pure economics, if the burden is thrown out, the cost will be low, and the net income will definitely increase under a certain income, not to mention the increase in income, so that the net income will be more, which can be used to develop hospitals and naturally enhance the competitiveness of hospitals; 3) Solving the problem of expensive medical treatment for the masses: the data is true. If it is to create appearances, the actual hospitals and custodians have to seek profits and then lower the prices of pharmaceutical companies, then various problems will arise; 4) Promoting the custodian's profit growth: there are advantages and disadvantages. Of course, it is impossible to provide services for free. Personnel funds and management should be guaranteed. It is good to increase profits and improve management. But the problem is the degree of growth and balance point, which may be balanced by multiple companies. However, under such a hosting framework, it seems unnecessary. Even if it can be controlled, it is not only by controlling the trustee that the problem can be solved. )
"Pharmacy trusteeship" seems to have many advantages, but it also has many disadvantages:
2. Deficiencies
2. 1 Legal issues of pharmacy trusteeship
Pharmacy trusteeship is a paid management. The hospital establishes a relationship with the entrusted pharmaceutical commercial enterprise by signing a custody contract, and defines the rights and obligations of both parties. However, there are some problems in the connotation of pharmacy trusteeship and the division of responsibilities and interests between hospitals and trustees, such as the unclear concept of trusteeship, the difficulty in distinguishing the responsibilities between drugs and pharmaceutical services, and the unclear division of interests between principals and trustees. In view of the fact that the custodian pharmacy aims at maximizing profits and is limited by the public welfare nature of the hospital; In addition to being bound by the law of free competition in the market, entrusted pharmacies should also take the protection of the health of the broad masses of the people as their social responsibility. Therefore, pharmacy custody can not be completely explained by trust behavior law, enterprise custody law and entrusted contract law.
2. 1. 1 pharmacy trusteeship is different from pharmacy entrustment operation.
The entrusted pharmaceutical commercial enterprise obtains the agency right through the entrustment contract signed with the pharmaceutical structure of the entrusting party. The entrustment contract is concluded by both parties on the principle of equality and freedom and should be recognized and protected by law. However, the Contract Law does not define the entrustment contract of pharmacy custody as a famous contract. From the characteristics of the division of rights and obligations in the pharmacy custody contract, the custody contract is similar to the entrustment contract. The profits earned by the entrusted pharmaceutical commercial enterprises by giving full play to their own advantages shall be owned by the enterprises, except for the part turned over to the medical institutions as agreed. This form can be understood as the remuneration paid by the client's medical institution to the trustee, and it also conforms to Article 405 of the Contract Law that "the client shall pay remuneration to the trustee after completing the entrusted affairs". Article 396 of the Contract Law stipulates that "an entrustment contract is a contract in which the client and the trustee agree that the trustee will handle the client's affairs". In the process of signing the entrustment contract, it is clear that the entrusted pharmaceutical commercial enterprise, as the trustee, should undertake the obligations of the medical institution (the entrusting party)-the management of pharmacies and drug stores, which can also be understood as the scope of the contract law.
However, according to Article 399 of the Contract Law, "the trustee acts according to the instructions of the client", but the drugstore trust gives all the management rights of pharmacies and drug stores to pharmaceutical commercial enterprises to operate independently, which is not binding. In addition, the entrusted pharmaceutical commercial enterprise is not bound by the provisions of Articles 402 and 403 of the Contract Law that the trustee acts in his own name. According to the pharmacy trusteeship contract, the entrusted pharmaceutical commercial enterprise should buy and sell drugs in its own name and independently bear the responsibilities arising therefrom. It can be seen that pharmacy trusteeship is not the same as the entrusted operation of pharmacies subject to contract law.
The entrusted pharmaceutical commercial enterprise enjoys the authority in the above two aspects, which makes the pharmacy custody contract similar to the disciplinary contract in the contract law in a sense. Because Article 4 14 of the Contract Law stipulates that the trustee-trader in a brokerage contract acts in his own name, Article 42 1 of the Contract Law stipulates that the trustee-trader shall independently assume rights and obligations when concluding a contract with a third party. Of course, according to Article 4 14 of the Contract Law, brokers in brokerage contracts must engage in trading activities, and the management behavior in pharmacy custody is not a trading activity in most cases.
2. 1.2 pharmacy trusteeship is not equal to pharmacy trusteeship.
"Trust Law" stipulates that "trust refers to the act that the principal entrusts his property rights to the trustee based on his trust in the trustee, and the trustee manages or disposes in his own name for the benefit of the beneficiary or for a specific purpose according to the wishes of the principal." The definition of trust is embodied in the pharmacy trusteeship system: first, medical institutions are based on the trust in the powerful strength of entrusted pharmaceutical commercial enterprises. Second, medical institutions entrust profitable pharmacies and warehouses to entrusted enterprises. The third is to entrust pharmaceutical commercial enterprises to purchase, supply and provide medical services in their own name. Fourth, the business of pharmaceutical commercial enterprises is to achieve profits (profits turned over to medical institutions) and specific purposes (to protect the health of the broad masses of people and reflect social goals), and medical institutions can be understood as beneficiaries.
However, the trust legal system is developed around the trust property, which has become an independent business property since the establishment of the trust, completely separated from the trustor, trustee and beneficiary. Once the client delivers the property to the trust, he loses the ownership of the property. If pharmacy trusteeship is a kind of pharmacy trust behavior, the medical institution signs a "trust contract" with the entrusted pharmaceutical commercial enterprise. After the trust contract is signed, the client (medical institution) and the trustee (entrusted pharmaceutical enterprise) will be completely separated from the entrusted pharmacies and pharmacies, and pharmacies and pharmacies will become trust property in the legal sense. Obviously, this is not in line with the nature and characteristics of pharmacy trust-medical institutions (hospitals) maintain the ownership of pharmacies and pharmacies and only transfer their right to use and operate, so pharmacy trust is not the same as pharmacy trust.
Pharmacy trusteeship lacks legal support and guarantee. Although there is a contractual relationship similar to entrustment, it cannot be adjusted according to the classification relationship of contract law. Moreover, with the diversification of the relationship between medical institutions and entrusted pharmaceutical commercial enterprises, more legal ties will be formed between them, and once disputes arise, the disputes will be even greater.
2.2 Policy issues of pharmacy trusteeship
2.2. 1 "separation of medicine" hospitals and doctors who compensate?
The new medical reform puts forward "four separations", in which "separation of medicine" is to break the practice of supporting medicine with medicine. Obviously, medicine has been abolished. Who will support the hospital and the doctor, and who will compensate? For a long time, the government's investment in public hospitals has been insufficient, even zero, and even turned over to public hospitals to support government work. Where does the fund of public hospitals come from? It's basically drugs! We should know that the drug income of township hospitals accounts for more than 70% of the total income, and according to the statistical yearbook of the Health and Family Planning Commission, the drug income of government-run medical institutions in China accounted for more than 4 1% of the total income from 2007 to 2009. In fact, it is not just the concept of 15% at all. Even if the government fully compensates this 15%, it is still not enough! What's more, this/kloc-0.5% family will not make up for it, because the plan is to "change the three channels of public hospitals from service charges, drug additions and financial subsidies to two channels of service charges and financial subsidies", that is to say, service charges and financial subsidies will be borne together. Generally speaking, service charges are the bulk, and financial subsidies only account for a small part, which is also shared by governments at all levels. How much can be implemented is unknown! For example, the recently adopted Work Plan for Price Reform of County-level Public Hospitals in Guangzhou shows that 80% of the benefits of hospitals depend on raising the price of medical services, and 20% on government financial subsidies, which are two levels of financial subsidies in Guangzhou. The gap of several hospitals in Conghua is more than 70 million, and the government financial subsidy is only150,000. Therefore, the wool is still on the sheep! In contrast, Guangzhou's water control is 100 million a day. . . (0.0004 1 1 billion yuan/day VS 1 billion yuan/day) well, everyone will know!
In fact, it is king to fundamentally solve the problem of "who compensates and how much to make up"! Unfortunately, the health department is not a god of wealth, so "separation of medicine" is not a matter for the health department alone! Facts have also proved that as long as the government is in place, all the tasks of reform can be well completed. Therefore, only by increasing government investment, establishing compensation mechanism and returning to the value of doctors can we achieve the reform goal of "separating medicine from medicine"-solving the problem of expensive medical treatment. Otherwise, no matter how many schemes and explorations, they can only be in vain! Of course, under this premise, today's "pharmacy trusteeship" is congenital deficiency, and it is very difficult to truly realize the purpose of "separation of medicine"! The market view of pursuing profits and reducing costs is inevitable!
2.2.2 Who will carry out the pharmaceutical affairs management under pharmacy trusteeship?
The Interim Provisions on Pharmaceutical Affairs Management in Medical Institutions pointed out: "Pharmaceutical affairs management in medical institutions refers to pharmaceutical technical services and related drug management based on hospital pharmacy and centered on clinical pharmacy to promote clinical science and rational drug use." After the hospital implements pharmacy trusteeship, according to the requirements of trusteeship, all drugs and corresponding pharmacy personnel will be entrusted by trustees, which will involve all aspects of hospital pharmacy management. So, is the custodian capable of fulfilling it? The answer is no, it is not only the management of special drugs, the development of clinical pharmacy, the collection report of adverse drug reactions, the evaluation and consultation of rational drug use ... These daily pharmaceutical affairs, the trustee has no corresponding ability, and it is impossible for a foreign pharmaceutical trading company to communicate and coordinate with clinical and other functional departments alone, but these certainly involve the management of personnel and drugs.
2.3 The design orientation of pharmacy trusteeship: attaching importance to drug management and neglecting rational and safe drug use.
For the exploration of the form of "separation of medicine", the problem of rational and safe drug use was ignored from the beginning, and the focus was blindly on drug management. This design orientation also determines that "pharmacy trusteeship" weakens the people's most important guarantee-the safety and quality of drugs, and weakens the hospital's management of drugs.
The pharmacy is out of the hospital's control. How to ensure the safety and quality of drugs supplied by the custodian? With the emphasis on drug management, profit is the primary consideration of the custodian, so low-priced drugs will become the first choice. Driven by interests, excessive choice of low-priced drugs will also become an act. This brings a problem, only low is not quality. The person in charge of the pharmaceutical company himself admitted: "I also know that brand drugs are effective, but if you don't do it, you will lose money. Our goal is to make money, and we can't enter fake drugs with conscience. " Then, this drug without safety and quality assurance is used by patients. Once a patient has a drug problem and a dispute, who will be responsible? Is it a hospital or a trusteeship? There are gaps in laws and loopholes in policies.
At present, what we can do is to protect the drug supply from the source and supervise it. Without supervision, it's like a wild horse running wild on the grassland. To supervise, you need to supervise the expenditure! Paid by the hospital, the hospital will say, "There is a cost to trust you, and the pharmacy and pharmacist have given it to you. You have to ensure safety and quality when you sell medicine to me! " If it is paid by the custodian, it is not willing. Which profit-seeker wants others to "destroy"? Therefore, the government can only pay the bill, and it is also the most appropriate for the government to pay the bill, because this is the responsibility of the government-to protect people's health! (suddenly found that the efficiency of this hosting is a bit low? )
In addition, pharmacies are not under the control of hospitals, and pharmacists are completely out of clinical practice. Its function is to trade drugs. In this way, the just-started clinical pharmaceutical service suffered a devastating blow, and the responsibility of hospital pharmacists to provide patients with all-round pharmaceutical technical services disappeared. At this point, the protection of rational drug use and safe drug use for ordinary people has been cut off.
2.4 pharmacy custody inspection index setting problems
For pharmacy trusteeship, the government mainly investigates whether the cost of drugs has decreased, and the specific indicators include the proportion of drugs and the prescription value.
What should I do if I want to reduce the proportion of drugs, but I want to make a profit? The hospital will ask patients who come to see a doctor to do more examinations and tests, and the income will be directly owned by the hospital without going through the trustee. Therefore, some hospitals will send special personnel to supervise clinicians and urge them to give patients civilized checklists and inspection reports. I want to try to eliminate the "medicine for medicine" and "big prescription" through pharmacy trusteeship, but it has caused a more serious "big inspection"! Secondly, such "supervision", where is the professional autonomy of doctors?
The proportion of drugs is also related to the price of drugs. According to the data from Nanjing, the overall drug price has dropped by 5%- 10%. However, we have to see that this data not only includes the Nanjing Municipal Government's compulsory demand for price reduction of 3%-5% (by directly discounting prescriptions and giving vouchers), but also includes many large-scale actions by the state to reduce drug prices and crack down on commercial bribery. Therefore, it is impossible to define which part of this data is brought by pharmacy custody!
The "prescription value" as another indicator is actually the value of a single prescription. The so-called "there are policies at the top and countermeasures at the bottom", this evaluation index is very empty! To reduce the prescription value, doctors can completely divide the original prescription into two or more, that is, the lower the prescription value, the better. Therefore, the reliability of data such as "the outpatient prescription value of each unit has dropped sharply" can be imagined!
2.5 pharmacy trusteeship is "medicine for medicine"
Before pharmacy custody, the hospital can buy drugs from all parties and enjoy the profit of 15% drug addition; After the pharmacy is managed, the hospital can only buy it from the custodian. After deducting the expenses of the custodian, the hospital and the custodian shall share the expenses according to the proportion agreed in the custody contract. It can be said that public hospitals have achieved such rapid development under the condition of insufficient government investment for many years, and it is indispensable to support doctors with medicine, which has solved the worries of hospitals and is a first-class hero! But now this profit has to be divided with the pharmaceutical company, the trustee who was killed halfway! In the final analysis, pharmacy trusteeship requires hospitals and enterprises to share a piece of cake, which is not difficult for hospitals!
What's more, on the surface, the relationship between drugs and hospitals has been cut off, but in fact, the interest chain between doctors' prescriptions and drug sales has not disappeared because of the custody of pharmacies. What was before, what is now. Instead, it is because hospitals have to divide pharmaceutical companies. However, under the premise that the government investment has basically not increased, the hospital will make greater profits in order to maintain at least the drug income before pharmacy custody and ensure the normal operation order of the hospital. For example, doctors will continue to use prescription power to seek rent, and "big prescription" is even more unscrupulous, because only by prescribing more drugs and more expensive drugs can the total profit of bonuses be increased, and then the share of hospitals will increase. Of course, this result is also welcomed by pharmaceutical companies, because their profits are also high. Therefore, this not only did not cancel "nourishing medicine with medicine", but also evolved into another new form-"nourishing medicine with medicine". In the end, we ordinary people will suffer-they have to pay for all this, and they don't obviously feel that this has reduced their medical expenses and economic burden. The wool is still on the sheep! "Separation of medicine" is a formalistic manifestation of self-deception!
2.6 Pharmacy trusteeship is a wolf in sheep's clothing-monopoly and corruption.
Pharmacy trusteeship is just a change of pharmacy manager, and there is no real "separation of medicine". Moreover, there is only one pharmaceutical company in the custodian, and the one-to-one and one-to-many model leads to the monopoly of the custodian. There is a saying: absolute monopoly leads to absolute corruption.
From the international experience, according to the right restriction relationship, government medical insurance institutions or insurance companies, medical institutions and patients can form a triangular right relationship. Patients apply for insurance with insurance companies, which calculate reasonable medical expenses and pay them to medical institutions, which provide treatment under the supervision of insurance companies. The relationship between the three parties is clear.
However, under the custody contract of profit sharing between hospitals and pharmaceutical companies, hospitals will continue to make profits in order to maintain at least not less than the drug income before custody; Pharmaceutical companies take the market-oriented road, pursue profit maximization, will continue to make profits, and will not supervise the medical behavior of hospitals from the standpoint of patients. The two hit it off and formed a common interest. Therefore, the "pharmacy trusteeship" that tries to "separate medicine from medicine" and solve the problem of "expensive medical treatment" is actually a "wolf in sheep's clothing", and monopoly and corruption will intensify.
2.6. 1 One of the processes of monopoly and corruption: forming a new interest chain.
Because there is only one custodian in pharmacy custody, the custodian has become the biggest goal of pharmaceutical manufacturers. In the past, drugs entered the hospital, and medical representatives had to pass through the dean, department director and pharmacy director. Now as long as the "concentrated firepower" is captured, the problem will be solved. At the same time, because the decision-making power in drug sales lies in the prescription power of doctors, doctors and hospitals are still the goals that drug manufacturers continue to overcome, and will not reduce the excessive use and abuse of drugs at all. Therefore, in fact, pharmacy custody does not squeeze the unreasonable interest structure and price moisture of circulation channels, but makes the interest chain longer, more moisture and more serious corruption.
2.6.2 The second process of monopoly and corruption: the second bargaining.
With the absolute advantage of exclusive procurement and sales, the custodian has mastered the absolute right to speak in the supply chain, and all pharmaceutical manufacturers can only let it go in order to sell drugs, which is very passive. Even a number of pharmaceutical companies, that is, custodians, formed a price alliance to confront and bargain with pharmaceutical manufacturers through negotiations. In fact, this is the second bargaining, and such an alliance is a more intense group-based second bargaining. The purpose of each custodian is to lower the price and earn more profit space. In fact, hospitals can't control the economic benefits of pharmaceutical companies, but can only create benefits for pharmaceutical companies. The actual profit of pharmaceutical companies may be greater, and there may be a black part.
2.6.3 Monopoly and corruption process III: extreme way of "sheep hunting group".
In Ezhou, Hubei Province, after the implementation of pharmacy trusteeship in related hospitals, the patient's drug cost was reduced by 5% on the basis of the original drug price. Within 10 months after the implementation of trusteeship, the direct benefit prescription was nearly 3 million yuan. The overall level of drug expenses has also decreased significantly due to the decrease in the use of large prescriptions and high-priced drugs, and the proportion of drug expenses has dropped by 4 percentage points from the average of 47% in the same period before implementation to 43%. In July this year, after the pharmacy trusteeship pilot project was further expanded to all four public hospitals in Ezhou, it is estimated that the scale of the four public hospitals will be about 30 million yuan per year, and the hospitals themselves will save about 20 million yuan per year.
Under such data that ordinary people benefit and hospitals save costs, what is hidden is the profit-seeking of pharmaceutical manufacturers, which means that pharmaceutical manufacturers have to bear greater pressure of price reduction. The trust contract determines that the interests of the hospital and the trustee are the same. In order to make a profit, the hospital will still make a big prescription, and the trustee will make a "second bargaining" for profit. However, in order to benefit the people, the profits of hospitals and trustees have to remain unchanged or even more, so the drug prices of pharmaceutical manufacturers can only be further lowered. You know, it didn't come down a little bit, which is really a devastating blow to pharmaceutical manufacturers. In this way, the hospital and the trustee jointly make profits, forming a poor "sheep hunting group". The pharmacy trusteeship is a wolf, and the pharmaceutical production enterprise is a sheep. However, pharmaceutical production enterprises have pre-tender and post-trusteeship. Poor sheep!
2.6.4 The result of monopoly and corruption: pharmaceutical manufacturers do not supply goods, and hospitals do not have good goods.
Under such "coercion", the living space of pharmaceutical production enterprises in some places has been severely squeezed and compressed. People also run in the market, chasing less profits and having problems in survival. Can he still guarantee the safety and quality of drugs? Arabian nights! Besides, who will do business at a loss? Therefore, pharmaceutical manufacturers no longer supply the trustee.
In addition, such monopoly and corruption are also an act of bad money driving out good money. Only drugs with low production cost and poor safety and quality can survive in such a competitive environment, and then enter the hospital and sell them to the people. Hospitals don't have good goods, ordinary people don't have good medicine, a vicious circle!
It can be seen that pharmacy trusteeship is a "wolf in sheep's clothing", a political monopoly that violates the laws of the market and a political measure that encourages corruption in the industry!
2.7 Pharmacy custody highlights lax supervision.
On the other hand, after custody, the hospital can get 40% of the revenue share, and the custodian also bears the staff cost and inventory pressure of the hospital pharmacy. Pharmaceutical companies can't be unprofitable, and hospitals should earn more. Where do the benefits of ordinary people come from? If there is no trusteeship, isn't it possible to give the trustee's "profits" to the people?
I dare say that the design of pharmacy trusteeship policy is not considered from the perspective of separation of medicine at all. I can also say that "pharmacy trusteeship" led by the discipline inspection department has different meanings from the reform of medical system and mechanism. The key to stop unhealthy trends in the medical industry is to strictly enforce supervision, not who cares who. What the discipline inspection department should do is to strengthen supervision and punishment.
To sum up, who is worried about pharmacy custody? Don't! Since there isn't, who will like it? "Separation of medicine" is a formalistic manifestation of self-deception! Political monopoly that violates market rules! From "fair" corruption to monopoly corruption! All in all, typical bureaucracy, patting your head and making decisions!
Pharmacy trusteeship is not really "separation of medicine". If there is no excess profit space, who will manage it? Probably not! Even if you really want to trust, you should also look for state-owned enterprises, at least the profits will not be lost! If the price is the same as that of social pharmacies, who will take care of it? I guess there is no more!
Some people have solved the worries of the past, but who will bear the responsibility today? "separation of medicine" needs the cooperation of system and mechanism, and the government needs to fully reflect its responsibility! Measures of "separating medicine from medicine":
1. The law guarantees the government to increase investment and implement two lines of revenue and expenditure.
To truly separate medicine from medicine, it is necessary to solve the problem of government investment. The government should subsidize hospital funds through reasonable financial expenditure, reflect the value of doctors, and implement the management of two lines of drug revenue and expenditure. However, in the absence of clear fiscal expenditure measures by the government, there can be no real "separation of medicine". In other words, explorations such as "pharmacy trusteeship" without government investment are all "flowers in water". "The government will increase investment" is not a word, but it must be implemented! Only in the form of legal provisions can it be guaranteed, otherwise, air to air, the market will continue to make profits, and wool will continue to be on sheep. This is only formalism.
2. Cultivate high-quality pharmacists
Simple "separation of medicine from medicine" cannot guarantee the safety of medication. To control rational drug use, it is necessary to train high-quality pharmacists. Only qualified pharmacists can engage in drug quality management and even drug procurement in hospitals. Of course, this is not a "monopoly" of clinical pharmacists, but a cross-examination with doctors to ensure the safety of medication. At the same time, establish a supervision team to supervise and manage pharmacists' dispensing behavior.
3. Carry out the socialized reform of pharmacies and gradually realize the separation of medicines.
On the premise of increasing government investment, greatly improving the value of doctors and expanding the number of pharmacists, we can learn from Japan's experience of "separation of medicine" to separate outpatient pharmacies from hospitals, so that doctors can become pure therapists and exchange corresponding income by conducting diagnosis and treatment and filling out medical records. Ordinary people can take prescriptions to any pharmacy to get medicines and enjoy certain medical insurance benefits. If the doctor accepts the kickback, his license will be revoked.
4. Strengthen supervision
Unsupervised bidding will inevitably produce new interest chains and new hotbeds of corruption. Supervision is not equal to "foolproof". At present, the bidding is not satisfactory, which shows that the effect of supervision is very weak. Moreover, unsupervised "pharmacy trust" bidding is more likely to lead to new corruption, because businesses aim at maximizing profits. Therefore, it is necessary to strengthen the supervision of all aspects of "separation of medicine", including the supervision of drug prices, drug access and doctors' drug use norms in the whole process of production, supply and marketing. Only through layer-by-layer supervision can we reduce corruption and ensure the safety and quality of drugs.
Finally, I quote an expert's comment: "pharmacy trusteeship is not the reform direction of separating medicine from medicine at all." It tries its best to get money from suppliers and manufacturers to maintain the interest pattern of "taking medicine to support doctors". This is an intensive practice of "taking medicine to support doctors". It is medical institutions that force upstream suppliers to raise drug prices, continue to exploit consumers and make it more expensive for ordinary people to see a doctor. Therefore, this model will definitely end. " Although this statement is heavy, it is to the point! I hope that the pharmacy trusteeship which has neither solved anyone's worries nor separated medicines will end as soon as possible. I hope that the government can really invest money in public hospitals, and that doctors and patients will truly become the same stakeholders, not the victims of reform!