The new book has been sent to the editor-in-charge today, and it is estimated that it will be uploaded around the 10th. Pen @ fun @ pavilion wWw. ｂｉｑUｇE。 ｉｎｆｏ

The foundation of medical reform should be to make the widest range of people affordable to get sick and take medicine. The first is to respect the medical skills of doctors, and good doctors and poor doctors use the prescription grading system to reflect the income gap, for example, separating doctors from level 1 to level 9 according to their medical skills; It can't always be a rough policy. You can't make the policy look beautiful, but the people can't feel it. Only by taking a two-pronged approach can we solve the contradiction between doctors and patients, which is expensive and difficult to see a doctor.

Because poor people have lower incomes, they are more sensitive to drug prices and are more likely to give up treatment. Therefore, placing the heaviest financial burden on the poorest in health is perverse. As a result, most countries exempt or reduce VAT on medicines, but Huaxia does not. Value-added tax and customs duties are the same.

1. The WHO clearly pointed out in the drug pricing guidelines that essential drugs should not be subject to VAT, and even if it is levied, it should not increase the burden on the public

There is controversy internationally over the issue of drug taxation, but many countries will open up the net to reduce some of the burden on patients, so as not to push patients into a desperate situation.

It is precisely based on this consideration that the World Health Organization (WHO) has put forward two recommendations in its drug pricing guidelines: first, there should be no sales tax (business tax) and value-added tax on essential medicines, and second, if some countries choose to impose sales tax or value-added tax on essential medicines, then these taxes should be designed very carefully and should not increase the burden on the public.

When tax exemptions or reductions are introduced for essential medicines, they need to be monitored to ensure that the savings go to patients or health insurance payers, and not to be absorbed or profited from other parts of the drug supply chain.

The World Health Organization declared: "Governments should tax items that affect people's health, not medicines that are beneficial to health." ”

2. Most countries exempt or reduce VAT on drugs, but Huaxia does not. The average pharmaceutical value-added tax rate in Europe is about 8.8%, and China collects a full pharmaceutical value-added tax at 17%, which is almost twice the European average

In 2014, the Federation of European Pharmaceutical Industry Associations (EFPIA) released data clearly shows that most of the European countries surveyed have implemented VAT exemption or less VAT policies for medicines.

The VAT in the United Kingdom (provided that it is purchased in pharmacies), the United States, Australia and other countries is 0%, and in Sweden, where the VAT rate is 25%, the pharmaceutical goods are also reduced, and the Swedish pharmaceutical VAT is 0%.

In addition, the highly taxed French standard VAT rate is 20%, but only 2.1% and 10% VAT are levied on prescription and over-the-counter drugs, respectively.

The standard VAT rates in the UK and Switzerland are 20% and 25% respectively, and both countries have introduced VAT-exempt measures for prescription drugs that are in urgent need of patients. The average European value-added tax rate for pharmaceuticals is about 8.8%, while Huaxia levies a value-added tax of 17% on pharmaceuticals like other goods, which is almost twice the European average.

3. In addition to VAT, there are also customs duties. With the exception of anti-AIDS drugs, China has imposed tariffs of 5%-8% on most imported drugs, and the price of imported drugs has risen by at least 20% before they reach hospitals

In addition to VAT, the tariffs imposed by Huaxia on imported drugs have also affected the price of drugs to a certain extent. In addition to the exemption of tariffs on anti-AIDS drugs and hormonal contraceptives, Huaxia generally levies tariffs of 5%~8% on most imported drugs.

Most of the objects exempted from import tariffs on drugs in China are ASEAN countries and South American countries, but the drugs imported by China are mainly from India, Europe and the United States, and cannot enjoy tax exemption. Customs duty plus VAT has exceeded 20%. Before the imported drugs reached the hospitals, the price had already risen by a fifth.

4. In poor households, the decline in drug use due to increased tax revenues is more pronounced, and the price of prescription drugs increases, making it more likely to abandon treatment

According to a survey by Goldman, a researcher at the University of Southern California, although prescription drugs are necessary for patients to treat diseases and save their lives, patients are no less sensitive to the price of prescription drugs than general commodities.

When the price of prescription drugs increases by 10%, the use of drugs will decrease by 2%~6%, and patients with chronic diseases will become less able to adhere to medication, treatment will often be interrupted, and the start time of chronic disease treatment through drugs will be delayed.

At the same time, because poor people have lower incomes, they are more sensitive to drug prices and are more likely to abandon treatment. Reducing the VAT levied on pharmaceuticals will increase patients' motivation for treatment and improve the overall health of the population.

5. On the contrary, reducing the VAT levied on drugs will increase the enthusiasm of patients for treatment, usually for every 25% reduction in tax on prescription drugs, it can increase demand by 5%-25%.

Some studies have pointed out that for every 25% reduction in tax on prescription drugs, the demand can be increased by 5%~25%.

In 2002, Siman studied the impact of tax cuts on malaria in African countries. When soaking nets with insecticides, it was found that when taxes on pesticides fell from 42% to 0%, and taxes on raw materials used to make nets fell from 40% to 5%, the chances of local residents buying nets increased by 27%.

6. Placing the heaviest financial burden on the poorest in health can be counterproductive, with infant mortality and morbidity falling by 44 per cent between 2002 and 2009 following the abolition of tariffs and taxes on malaria treatment products in Kenya

Placing the heaviest financial burden on the poorest in health is highly regressive, if not perverse. Increasing the price of medicines has reduced the use of medicines, leading to more diseases.

Five years ago, countries such as Colombia, Ethiopia, Malaysia, Nicaragua, Pakistan, ******** and Uganda dramatically reduced or even eliminated tariffs and taxes on medicines, and the results were remarkable, with infant mortality and morbidity reportedly falling by 44 per cent between 2002 and 2009 following the abolition of tariffs and taxes on malaria treatment products in Kenya.

The price of Chinese drugs is generally inflated, how much is the "system cost"?

A Jinling couple was prosecuted for purchasing anti-cancer drugs in India, which once again attracted the attention of the huge price difference between domestic and foreign anti-cancer drugs.

In fact, the phenomenon of inflated drug prices in China does not only exist in imported patented drugs, the high prices of patented drugs are mostly due to their patent fees, and the generally high prices of drugs are caused by various "institutional costs" imposed on drug prices, and a large number of data reflect how the Chinese drug market is out of balance due to institutional reasons.

Less financial subsidies for hospitals to "use medicine to support medicine"

The ratio of total public health expenditure to gross domestic product (GDP) in the same period can reflect the country's investment in health in a certain period, as well as the importance that the government and the whole society attach to health and people's health.

According to the statistics of the World Health Organization, in 2012, China's public health expenditure accounted for only 3.03% of GDP, about 1/3 of the Netherlands and France, while most European and American countries accounted for more than 7% of GDP.

For more than 30 years, the Chinese government has been cutting subsidies for hospitals, and the current system is effectively encouraging public hospitals to prescribe large quantities of high-priced drugs to generate revenue, that is, "medicine for medicine".

High value-added tax on drugs has pushed up drug prices

The high value-added tax on pharmaceuticals has also pushed up the price of Chinese drugs to a large extent. Data from the OECD Health Committee and the Federation of European Pharmaceutical Industry Associations (EFPIA) show that most countries have very low VAT rates on medicines, while others have concessions on medicines despite higher standard VAT rates.

The United States, Austria, Cyprus and other countries do not levy VAT on drugs, the UK, Sweden, Australia and other countries also have a VAT rate of 0% for prescription drugs, the Netherlands, France, Belgium and other countries have a VAT rate of less than 1/3 of the standard VAT rate, while the VAT rate of Huaxia Pharmaceutical is as high as 17%, about twice the European average (8.8%).

The circulation order is chaotic, and the dealers and hospitals have multiple premiums

In addition to institutional and medical and health system factors, the chaotic order of drug circulation, multiple premiums by distributors and hospitals, and invisible hidden kickbacks have further pushed up drug prices.

The logistics and business expenses of pharmaceutical giants account for 7%-8% of the drug price, of which the logistics fee is about 2%, and the distributors involved are generally about 3, with a premium of 5%-7% for each distributor, and a premium of 7%-8% in the last procedure, that is, the chain from the last distributor to the hospital.

In addition, according to the regulations, mainland hospitals can also increase the price by 10-15% on the basis of the actual purchase price. For example, in the People's Hospital of Jingcheng University, the winning bid price of Herceptin for the treatment of breast cancer is 21,613 yuan, and the retail price is yuan, a 15% increase, that is, for every box of Herceptin sold, the hospital can make a profit of 3,242 yuan.

In recent years, the National Development and Reform Commission has reduced the price of drugs more than 30 times, but the problem of inflated drug prices has not been solved.

In fact, due to the complex circulation mechanism of drugs, it is difficult for the government to reduce drug prices even if it gives up the right to set prices for drugs and leaves them to the market for regulation.

To solve this problem, on the one hand, it is necessary for the government to increase financial expenditure on medical and health care, and on the other hand, the government must rely on the power of the legal system to establish a standardized and healthy drug market order, and gradually bring the medical and health industry back to the track of low profits and public welfare.

A thought-provoking true story - "The helplessness and reality of overseas purchasing counterfeit anti-cancer drugs"

Seeing his father's body weakening day by day, taxi driver Wang Qiang (pseudonym) decided to "take a risk" and process anti-cancer drugs by himself.

His ingredients are very simple: a precision balance bought for 120 yuan, several blue and white capsule shells, and an illegally processed pharmaceutical raw material purchased online. He is going to make his own anti-cancer drugs for his father in a dosage form of 4 grams per capsule. Compared with the price of tens of thousands of yuan for a course of regular drugs, this "copycat capsule" will reduce the cost by 2/3.

"I know it's illegal, but I can't help it. The Northeast man said helplessly. As an ordinary farmer living in Suihua, his father, who suffered from lung cancer, did not have much income. Previously, the patient had been taking anti-cancer drugs purchased from India by his son's network, and the price was only 1/10 or even lower than the original drug.

However, according to the "Online Drug Purchase and Consumption Tips" issued by the State Food and Drug Administration, Wang Qiang's approach is extremely risky.

The tip, published on May 7, said: "Regular online pharmacies will not set up such businesses if they claim to purchase prescription drugs such as foreign anti-cancer drugs through suspicious channels, and there is no guarantee of the authenticity and quality of the drugs."

According to the experience gained by the local drug regulatory authorities in the past investigation and handling of cases, about 75% of the overseas anti-cancer drugs purchased online are confirmed to be counterfeit drugs, which can delay the disease at least and cause greater harm at worst. Therefore, it is completely untrustworthy and undesirable to purchase overseas drugs online. ”

"I'm actually gambling. Wang Qiang told a reporter from China Youth Daily, "For many families like me who can't afford to pay for medicine, this is almost the last way." ”

Molecularly targeted therapy drugs are a special drug for some cancer patients, but Wang Qiang's family can't even afford a box of genuine drugs

Compared with being diagnosed with cancer a year ago, Wang Qiang's father, who is in his 60s, has improved. He coughed less and was "willing to talk to people." In Wang's view, these changes are due to an anti-cancer drug called "Iressa".

As a molecularly targeted therapy, Iressa stops cancer cell growth by acting on specific molecular targets necessary for tumor growth. Unlike traditional chemotherapy drugs, this drug does not accidentally injure the cells of normal tissues while killing tumor cells. In the past 10 years, molecularly targeted therapy drugs have gradually become the new favorite of cancer treatment.

Liu Duanqi, former director of the oncology department of the General Hospital of the Beijing Military Region, told a reporter from China Youth Daily that molecular targeted therapy drugs such as Iressa are specific drugs for some eligible lung cancer patients. "For some patients, Iressa even has an immediate effect, prolonging the patient's life to varying degrees. He said.

The miraculous effect is matched by the high price of the drug. It is understood that at present, the molecular targeted drugs sold in China are basically imported drugs. For example, Iressa, whose manufacturer is the British pharmaceutical company AstraZeneca, currently costs 15,000 yuan for one tablet a day for a month.

For Wang Qiang's family, this is undoubtedly an astronomical amount.

His father's source of income was 10,000 yuan a year from 9 acres of farmland. In 2013, when he was diagnosed with advanced lung adenocarcinoma with liver metastases and lymphatic metastases in Heilong Provincial Cancer Hospital, the family's entire savings were only 50,000 yuan.

When the doctor suggested chemotherapy followed by surgery, Wang Qiang reluctantly refused. In addition to worrying that his father would not be able to withstand the toss of surgery, he admitted that the more important reason was that he could not afford the operation fee of 60,000 yuan.

But the cancer cells didn't stop attacking. After returning from the hospital, Lao Wang's body collapsed quickly, "I can still walk two steps today, but I won't be able to do it tomorrow." Last autumn, Wang Qiang came to Beijing to seek medical treatment on his own. A doctor told him in a vague way, "Try Iressa."

Holding a handwritten note from the doctor, Wang Qiang almost ran to the nearby pharmacy, but did not find the drug. It wasn't until he checked the Internet that he found out that in addition to buying genuine drugs from hospital pharmacies, there was also a generic drug from India that was being sold privately.

Generally speaking, due to the high cost of drug development, pharmaceutical companies will apply for patents before new drugs are marketed. According to the rules of the World Trade Organization, all its member countries are expected to comply with the relevant provisions of the patent system.

However, it was not until 2005 that India began to recognize the patent protection system, and the scope of protection was very limited, such as Iressa. This gave local pharmaceutical companies an opportunity to take advantage of the fact that the price of the 500 yuan Iressa pill was only 50 yuan for the Indian copycat.

According to the provisions of China's "Drug Administration Law", this kind of copycat drug has not obtained the permission of the relevant departments, and should be regarded as a fake drug and prohibited from being sold. However, in the face of huge price differences, a channel for Indian generic drugs to flow into the country has been opened.

Mr. Wang said that when he discovered the business in a dimly lit internet café in the capital, "it was like seeing a ray of light in the dark."

"I can't afford a box of genuine Iressa. The Northeast man sighed. Since my father was diagnosed with cancer, the family has not added a new piece of clothing, and they always choose the cheapest grocery shopping.

After 9 days of researching information on the Internet, studying and researching, Wang Qiang decided to try this fake drug. Molecularly targeted drugs are said to be effective in targeting specific patients with genetic mutations. Before taking it, patients should have a genetic test. But Wang Qiang gave up on this step on the grounds that "genetic testing is too expensive."

It is possible to buy only counterfeit drugs in the sense of unapproved registration, or it is possible to buy genuine counterfeit medicines

Wang Qiang's experience is by no means an isolated case. Gao Fengxia, who lives in Weifang, was found to have lung adenocarcinoma in 2011. In September last year, a patient in Shenzhen sent her an Indian version of Iressa. After taking generic drugs for nearly a year, Gao Fengxia feels that she is "no different from ordinary people". Now, the medicine that her daughter buys for her through the Internet is sent to her home regularly.

The Sichuan people Lao Qi were cautious and cautious. In order to buy the targeted drug "Herceptin" for his wife suffering from breast cancer, he flew to Hong Kong by himself. That was his first trip to Hong Kong. Because he was worried that the liquid would not be able to be checked in, he deliberately put a bottle of Nongfu Spring in his bag when he went, and only bought it with confidence after boarding the plane smoothly.

Wang Qiang said that in a QQ group of 200 people discussing cancer, all of them claimed to have taken generic anti-cancer drugs. A doctor also told reporters that more than 90% of the patients he came into contact with could not receive targeted drug treatment through formal channels due to the high price.

"I think it's understandable that patients buy this kind of foreign medicine with a certain curative effect when their economic situation is limited and there is no way out, but it poses a difficult problem for the health management department: how to deal with these drugs that have certain efficacy and are illegal at the same time?" said Liu Duanqi, who has been a doctor for 46 years.

In today's world where cancer is on the rise, it means a large group of people are in trouble. According to the 2012 China Cancer Registry Annual Report, one person is diagnosed with cancer every six minutes in China, and 8,550 people become cancer patients every day. It is estimated that by 2020, the total number of cancer deaths in China will reach 3 million, and the total number of cases will reach 6.6 million.

"As doctors, we face the dilemma of how to deal with patient inquiries about buying counterfeit medicines. On the one hand, the patient's life may be prolonged, and on the other hand, the dignity of the law is desecrated. Liu Duanqi told a reporter from China Youth Daily.

An inspector in charge of prosecuting counterfeit medicines reminded that India is one of the world's largest sources of counterfeit medicines, so it is difficult to ensure that you do not buy counterfeit medicines even if you buy them locally. He said: "Purchasing overseas drugs is a bit like gambling on the size, you may only buy counterfeit drugs in the sense of unapproved registration, or you may buy genuine counterfeit drugs." ”

Wang Qiang is not unaware of this risk. "At first, I posted on QQ groups and forums, and two or three people came to my door for each one, but I didn't dare to buy it at all," he said, "After all, it's a life-saving thing!" Later, after several patient recommendations, he found a purchasing agent, the price was 1,000 yuan a box, and the package came with a newspaper in India on the day of delivery.

In the transaction of purchasing drugs that are not protected by law, the newspaper is only one of the means of "verifying the identity". The reporter found a store through an Internet search, and even provided a video showing "the whole process of the staff purchasing for you in a pharmacy in India". While Indians take the goods and prescribe medicines, a voucher with the purchaser's name, variety and date will be displayed in each video.

Many drugs that should be covered by medical insurance are not entered, and patients have to use illegal means to get lucky.

Even if she chooses the cheaper Indian version of Iressa, Gao Fengxia says she has little savings left. In a shopping mall in Weifang, the 40-year-old woman and her husband guard a three-square-meter stall selling socks and underwear, "earning up to three to four thousand yuan a month."

She still considers herself lucky. When she was diagnosed with stage 4 lung adenocarcinoma three years ago, the doctor told her, "I can live for three months at most." Today, she has miraculously survived 12 rounds of chemotherapy.

Her brother-in-law, a lung cancer patient living in a rural area, gave up treatment because he couldn't afford the medical bills, and stayed at home on painkillers until he died.

In order to have medical security and retirement security, the Gao couple participated in the social security plan of the local labor and social security department, paying 7,000 yuan per year. Because of his own treatment, his wife can't pay the money this year.

What makes Gao Fengxia incomprehensible is that for cancer patients like her, targeted drugs are obviously the last life-saving drugs, why can't they enter the medical insurance?

"The medicine of the medical insurance is useless, and the useful medicine is not included in the medical insurance. Wang Qiang also said. Today, his father, who is involved in the "New Rural Cooperative Medicine", is taking generic Iressa and buying some "drugs to protect the liver and heart" at his own expense.

"There is a lot of room for improvement in China's medical insurance system, and many drugs that should be covered by medical insurance have not been entered, resulting in patients having to use illegal means to hit the luck in order to survive. Liu Duanqi told reporters. He pointed out that for patients with advanced cancer who have applicable criteria, only the corresponding targeted drugs have the potential to prolong life, and there is no other effective alternative. It is understood that at present, only three cities in China have included molecular targeted drugs in the scope of medical insurance.

Now, due to the problem of drug resistance, Wang Qiang's father has symptoms such as cough and chest pain. Wang Qiang had to try another targeted drug for his father. But the drug is not available on the mainland, and the nearest way to buy it is in Baodao, where it costs about 11,000 yuan a box.

He had to take another risk and make his own medicine. "I also know that it is illegal, and it is certainly not pure, but it is a temptation for me to continue my father's life. Wang Qiang said.

Recently, the sales of "counterfeit medicines" from India have been affected by the crackdown, and Taobao stores that could be searched in the past have either changed their faces or disappeared altogether. This made Wang Qiang, who spoke heartily, a little hesitant. He refused to disclose the name of the drug he processed to reporters, fearing that the purchase channel would be strictly investigated if it was exposed.

"In that case, I can really only watch my father die. Wang Qiang said, "I love my father more than everyone else." ”

Many elderly parents must remember a long time ago when doctors prescribed a few cents of medicine. The doctors at that time were real angels in white. Those who can take medicine and injections will never let the patient be hospitalized.

Medical reform, how to let a good doctor use his wisdom, his medical skills, and his prescription to widen the income gap, this is what needs to be considered repeatedly and thought twice when formulating the system. A good system will allow doctors to form correct thinking, and the higher the income will be if they are more skilled, forcing all doctors not to think about prescribing more drugs when receiving patients.

For example, the doctor's grading system, from level 1 to level 9, income increases with the increase of medical skills. It's a right step up.

In pharmacies, the drug is managed in a detailed and hierarchical manner, and the policy supports some pharmaceutical factories to produce life-saving drugs necessary for the people, such as diabetes drugs.

And anti-cancer drugs, rather than allowing cancer patients to risk gambling to purchase on their behalf, the official came forward to introduce them, wouldn't it be better to have a joint venture?

Medical education laws are the last three barriers and bottom lines for a country's long-term peace and stability.

When it comes to cancer treatment, let's finally talk about TCM treatment for cancer. Traditional Chinese medicine uses Hongshengdan to treat cancer, which is a method of fighting poison with poison, but traditional Chinese medicine is declining, and it is still necessary to find a regular manufacturer or real Chinese medicine to use it correctly.

Hongshengdan and Baishengdan are both traditional Chinese medicine drugs for the treatment of cancer, and the refining and use methods of Hongshengdan and Baishengdan are found in the book "Yizong Jinjian".

"Yizong Jinjian" is a series of books on Chinese medicine edited by Wu Qian, the imperial physician, in the fourth year of Qianlong in the Qing Dynasty. The name "Yizong Jinjian" was also appointed by Emperor Qianlong.

"Yizong Jinjian" was included in the "Siku Quanshu", and it has a high evaluation of "Yizong Jinjian" in the "Summary of the Siku Quanshu".

Since the book was written, this imperial imperial hospital textbook has been reprinted again and again. The book is divided into 90 volumes, which is one of the more complete and concise comprehensive Chinese medicine books in China.

The book collects the essence of medical books from the Spring and Autumn Period and the Warring States Period to the Ming and Qing dynasties. Diagrams, sayings, formulas, and theories are available, and there are songs to be recited, especially for clinical practice. It is extremely widespread. (To be continued.) )