Wake up（226）

 

226

 

Bai Bingqing and Liu Hanyu talked about China's medical and health care to Chai Jianhua. They both talked about the publicity and marketization of public health care in mainland China.

Bai Bingqing said that in the 30 years after the founding of the People's Republic of China, mainland China has basically developed a state-owned economy, attached importance to public welfare, emphasized collectivism based on mobilizing the masses, and the spirit of social equality. Deliberately downplay the role of the market. It's not that there is no market at all, but try to reduce it as much as possible. Therefore, under such circumstances, the public health medical system in the first 30 years was based on the principle of "prevention first, treatment as supplementary", and there was cooperative medical care. In a collective way, barefoot doctors stood in the local township or people's commune. From the standpoint of farmers/villagers, to promote sanitation and medical work, it pays great attention to rural health care and the integration of traditional Chinese and Western medicine, but it is not so medical, and it is the combination of mass movement and health care work. At that time, the public health and medical systems of most countries in the world followed the Western model. This model focused on medical care, focused on personal medical services, relied on high-tech specialists, and emphasized high medical technology standards. However, after the founding of the People’s Republic of China, the CCP abandoned this mainstream Western model at that time and created its own unique public health medical system.

Bai Bingqing also said that after 1978, especially after Deng Xiaoping's southern tour, what we saw was market-oriented reforms. The original public sector, enterprises and institutions are either privatized, or they are responsible for their own profits and losses and let them seek their own way of survival. The disintegration of the rural people's communes emphasizes individual responsibility—if there is a problem, it is because you are not working hard enough, so you must be self-reliant and tolerant of social inequality. The social inequality in mainland China is very serious now. Compared with other countries in the world, the social inequality in mainland China is also very prominent.

The public health and medical system in the last three decades has undergone a major reversal, and it has turned its head to follow the path of the Western model. Before 1949, not only mainland China, but also most developing countries in the world followed the Western model. However, after the founding of the People's Republic of China, the mainland chose to go its own way: the public health and medical system rejected the Western model and established its own unique model, which made the world look at it with admiration. The mainland dares to stand alone in the case of most countries adopting the mainstream Western model, stand on the standpoint of the people, and establish its own unique public health medical model, which is quite structured and courageous. However, after the reform and opening up, the mainland actually embraced the Western model that it had rejected in the past: treatment was the main focus and prevention was the supplement; communes and cooperative medical care were disintegrated, barefoot doctors disappeared, and rural doctors were forced to provide medical products to obtain their own resources. Income; medical resources shift to cities; more emphasis on Western medicine; and the government is paying more and more attention to the establishment of medical departments, and providing personal medical services has become the main task of the public health medical system; the government makes public hospitals responsible for their own profits and losses; after the 1990s, public health medical institutions They have to make profit their primary goal; the public health medical system no longer emphasizes meeting the basic health needs of the people, nor does it focus on promoting public health through mass movements, but instead focuses on medical technology and medical technology.

Liu Hanyu added: But people can't bear not being able to get medical services anytime and anywhere. Back then, going to a hospital to see a specialist required a referral. In the mid-1980s, the government removed these barriers, allowing people to be treated in hospitals. At the same time, China embarked on economic reforms that led to the disintegration of the entire healthcare system. Government subsidies have been slashed, and hospitals have had to find ways to generate revenue.

Medical students were drawn to hospitals as they began investing in high-tech equipment and expanding to meet new financial needs. Many believe that being a specialist guarantees them an "iron job" and that specialist jobs come with extensive security, including housing and pensions.

Liu Hanyu sighed: Not long ago, a man had an argument with the doctor about his daughter's treatment and attacked the doctor. A month ago, a father slashed a pediatrician 15 times after his daughter died shortly after birth. The doctor did not survive. A few hours ago, a patient surnamed Lu stabbed a doctor who had treated him for rhinitis with a knife at Peking University People's Hospital, and then fled. After the police caught him, he was sentenced to 13 years in prison.

Liu Hanyu said: The reason for this kind of violence is the same, that is, distrust of the medical system. This goes back to the market reforms introduced by Deng Xiaoping in the 1980s. Doctors are being forced to find ways to generate income after the government cut subsidies to hospitals. Many received kickbacks from drug companies and gifts from patients. I've heard of outpatient doctors collecting tens of thousands of yuan in kickbacks from drug companies, bundles of cash in a plastic bag.

Corruption has become endemic. In 2014, GlaxoSmithKline paid a $500 million fine for kickbacks to doctors and hospitals that prescribed the company’s drugs, at the time the largest penalty ever imposed in China. Eli Lilly, Pfizer and other global drug giants have also settled with regulators for similar conduct. In fact, these factors combined to create violence. Many hospitals are starting to take steps to protect staff. For example, Guangzhou Zhongshan Hospital employs taekwondo coaches to teach doctors self-defense skills. Hospitals in Jinan paid for security companies for protection.

In order to solve the problem of difficult medical access, the Chinese government aims to increase the number of general practitioners per 10,000 people from the current 1.5 to two to three, and finally to five. But to get there, at least first, China needs to train thousands of doctors who have no idea how primary care is done and no interest in leaving their comfortable jobs in public hospitals.

There has been a change in the proportion of government financial subsidies and hospital business income in the total income of public hospitals. In the past 10 years, the proportion of government financial subsidies to the total income of hospitals is less than 10% in most years, and only a little more than 10% in some years. As much medical service as possible to generate income, to supplement the income needed by the hospital, and to cover the expenditure of the hospital. Such data and trends reflect that although these hospitals are state-run or public, 90% or nearly 90% of their operations need to be self-financed from the business income from providing medical services, that is, they have Although it is called state-run or public, it is actually not much different from self-financing and private hospitals. The role of the state in the management and operation of state-run/public hospitals has basically been almost completely abdicated. That is to say, as a result of the reform and opening up, public hospitals, like private hospitals and clinics, need to earn profits from the medical market by providing medical products in order to maintain their survival or accumulate and expand their capital. This is China The main connotation of medical commercialization and marketization.

Before 1980, that is, before the reform and opening up, almost all of the funding for the prevention department of the public health system came from the government. At that time, this department did not need to provide paid services to earn income. However, with the advancement of reform and opening up, the proportion of government subsidies in the total income of prevention institutions dropped sharply from almost 100% before the 1980s to 59% in 1990, and even 42% in 1997. It rebounded slightly in 2002, but then unexpectedly dropped to 25% and 30% in 2004 and 2006. Even the lowest point was 19% in the year when the Asian financial turmoil occurred. There is a tendency that the Chinese government will almost completely give up its responsibility for the prevention department of the public health system.

At present, more than half of the income of China's preventive health institutions must be self-generated. Moreover, we know that the outbreak and epidemic of SARS had a great impact on mainland society, and the public began to reflect on the problems of the public health system. Instead, it significantly reduced its subsidy funding for the prevention sector.

Before 1980, the preventive department did not need to earn business income by itself, because its expenditure was paid by government funds. Therefore, during this period, the proportion of business income was almost zero. However, with the pace of market reform going forward, the prevention department began to use its own business income—that is, to earn income from providing paid services—to generate income and increase the total income. After the 1990s, it rose sharply, and by 2004, this proportion had risen to 75%. It can be said that the outbreak and epidemic of SARS not only failed to urge the government to pay attention to the prevention department of the public health system, but even allowed it to be responsible for its own profits and losses, earn funds from business income, and let it fend for itself. After 2012, although the proportion of increasing business income by providing paid services has slightly decreased, more than 50% of the prevention department's funds still have to be earned from the business income of providing paid services. Moreover, after three years of the tragic impact of the new crown virus epidemic, this trend has not been fundamentally reversed.

The mission of the public health system is to promote and maintain the health of the people, and the mission of the prevention department of the public health system is to prevent diseases before they occur. Preventing the occurrence of diseases is the most cost-effective and labor-saving method. On the contrary, it is the most laborious, costly, and unwise to seek medical treatment when the disease occurs without daily prevention. There are clear precepts, such as the "Internal Classics" which emphasizes that "the sage does not cure the disease and treats the disease before it", and the genius doctor Bian Que put forward the concept of "prevention is better than cure" more than 2,000 years ago.

The health of the whole people is the basis for the sound development of a country. However, the mainland government not only did not strongly support the prevention department, so as to practice the ancient wisdom of "prevention is better than cure" in Chinese culture, but instead promoted the policy of "paid services", which made the government give up its commitment to the prevention department and the health of the whole people. Promote and maintain due accountability and leave these preventive institutions to fend for themselves.

Liu Hanyu sighed: Over the past decades, I have studied and paid attention to the development of the public health system of various countries in the world, and I have never seen a country that has clearly abdicated from the development of the prevention department, let the market enter the market, and left it to fend for itself! By the end of March 2020, more than 80,000 people in mainland China have suffered from the new coronavirus disease, and more than 3,000 people have died from severe new coronavirus pneumonia. The impact of the outbreak and prevalence of this infectious disease on the mainland's economy, society, culture, people's lives, and their physical and psychological health is immeasurable. Due to the weakening of the prevention department and the inability of the prevention and health institutions to effectively prevent and control the epidemic of the new crown virus, what a price the people of the mainland have paid! But they have no choice. The whole people must pay for this huge price. The mainland government's policy of promoting marketization in the public health system has made serious mistakes, and the cost is high, from the damage caused by the epidemic of the new crown virus infection to mainland society, it is self-evident.

Veteran Chinese doctor Chai Jianhua is 96 years old, and Bai Bingqing and Liu Hanyu are both in their early 50s. There is an obvious generation gap between Chai Jianhua, Bai Bingqing and Liu Hanyu, and there are actually regional cognitive differences. The mainland's brainwashing propaganda and education have naturally had a deep impact on Chai Jianhua. Bai Bingqing and Liu Hanyu, who have lived in Hong Kong for a long time, accept Western values of democracy and freedom.

When Chai Jianhua first arrived in Hong Kong, he already felt this.