It is everyone’s most basic wish and need to have medical treatment.
People's expectation is that all doctors can help the world, rejuvenate and cure all diseases. There is a famous saying in clinical medicine, To Cure Sometimes, To Relieve Often, To Comfort Always. (Sometimes it can be cured, it can often be relieved, and it can often be comforted.)
Not only doctors face complex diseases The ability is limited, and not everyone can afford the high medical expenses. If one person gets a serious illness, the whole family may fall back into poverty overnight. I saw a study today. Even in the United States, which leads the world in medical standards, the number one reason why people go bankrupt is the inability to pay for medical expenses.
The medical technology in the United States is advanced, so it stands to reason that it should make it easier for people to see a doctor. Why do you see bankruptcy when you see a doctor?
How high are medical costs in the United States?
According to estimates, the per capita GDP of the United States in 2018 was approximately US$62,500, but the per capita medical expenditure was US$10,000 per year; while the per capita GDP of China was approximately US$9,900, and the per capita medical expenditure was US$500. This means that the money that Chinese people earn in a year is not enough for Americans to pay for medical treatment in a year. Even if calculated proportionally, the per capita medical expenditure in the United States accounts for 16% of GDP, which is five times that of China. This is equivalent to creating a GDP of 20,000 yuan per month and earning a monthly income of 10,000 yuan, but you have to spend every month. 1600 It turns out that seeing a doctor costs nearly 20,000 yuan a year.
In my country, according to common sense, it feels wrong, because it is almost impossible for a person who does not have a major disease to spend tens of thousands of dollars on medical treatment every year. , a common minor illness can be cured by a prescription of several dozen yuan, and including examination fees, it only costs a few hundred yuan. Assume that a Chinese person spends an average of 300 yuan on each minor illness. 20,000 yuan is enough for him to see a doctor 67 times. He only needs to see a doctor once every 5 days in a year to spend so much money.
The sky-high medical expenses that we cannot afford without food or drink for a year are also an unbearable burden for the American people.
Foreign media have reported on many things about extremely high medical expenses in the United States. For example, a girl broke her hand and went to the emergency room of a public hospital in San Francisco. Later, she received 24,000 yuan. bill in U.S. dollars. Although she bought commercial insurance, the insurance only reimbursed US$3,800. Later, she went around asking the media for help, and the hospital, under pressure, changed its story and only charged her $200.
As soon as this news was reported, more than 2,000 readers sent the media with sky-high medical bills, and the various complaints were jaw-dropping. Someone went to the hospital for abdominal pain, and the doctor suggested natural treatment (that is, returning to normal life without medical intervention), but then sent him a bill of 8,000 US dollars; parents took their baby to the emergency room, and the doctor's treatment was to let the baby sleep After taking a nap and drinking a bottle of milk, I was charged US$18,000 in the end...
This is not the behavior of some unscrupulous hospitals, because in the United States, calling an ambulance for emergency treatment is very expensive, and the United States The pricing of medicines is neither fixed nor transparent. Different states, different hospitals, and different treatment methods will have different prices, and the gap is huge. Just for medicines, pharmacies sell them for tens of dollars, and it’s not uncommon for doctors to charge thousands of dollars for the medicines they prescribe. As for surgery, a treatment method with no reference, it is even more difficult to compare prices.
I went to a tertiary hospital to see an ophthalmologist some time ago and found a sign on the wall that stated the pricing of myopia correction surgery, laser treatment, full femtosecond treatment, etc. The price of a single eye was clearly stated. It is impossible to see a sign indicating the cost of xxx surgery in American hospitals. The cost is based on the final bill received by the patient.
What’s even worse is that there are high and low levels of medical treatment in the United States. Those with high-priced commercial insurance can make an appointment with a doctor first, while poor people without commercial insurance often ask for medical treatment. Waiting for several months to make an appointment with a doctor can turn a minor illness into a serious one, not only damaging your body, but you will also end up having to bear more medical bills.
The difference between the Chinese and American medical systems
Our culture emphasizes morality and always says that doctors are benevolent; while developed countries rely on selecting elites to be doctors and giving them an average salary of 4-5 With twice the income, no matter how you look at it, doctors’ abilities and ethics will not cause widespread major problems, so doctors are not the key to making medical treatment difficult or expensive.
The key to the problem actually lies in the medical system.
To put it simply, the medical system is the relationship between patients, medical providers, and payers. In China, the bill is paid by social security and self-pay; in the United States, the bill is mainly paid by commercial insurance.
The United States has designed an insurance model based on commercial insurance, leaving only a relatively small proportion for patients to pay for themselves. The original intention is actually good. However, there are fatal loopholes in the system itself. As long as insurance companies and medical institutions join forces, they can coax patients into getting better and better.
It is actually very simple to take advantage of the loophole. The insurance company only needs to persuade the medical institution to issue a sky-high bill. The original treatment fee of 1,000 US dollars is billed as 20,000 US dollars, and then the patient pays 900 US dollars out of pocket, and the insurance The company pays US$100, and the medical expenses are perfectly passed on to the patients, and most of the premiums become profits.
Someone may ask, isn’t it enough to cancel self-payment?
No, if all the costs of medical treatment are paid by insurance, the result will be that patients overuse medical services, resulting in a waste of medical resources. In order to prevent the price system from getting out of control, the United States is now adopting the method of separating insurance companies from the payers who pay the final bill. However, this will inevitably lead to longer processes, lower efficiency, and ultimately higher costs.
However, after four years of hard work, Obamacare was overthrown and started over by Trump. This shows the difficulty of implementing universal health care in the United States and the vast number of interest groups involved. .
How did my country achieve social security as the main payer?
In the early years, China's medical resources were very backward. The first priority was to provide medical treatment to most people, so nationalized and unified regulation was implemented reasonably. After the reform and opening up, for the sake of social stability, medical care did not dare to arbitrarily market prices. When some parts were marketized, they became the Putian system that we are now criticizing. At the same time, it is difficult to promote commercial insurance because Chinese people are generally unwilling to buy insurance for unknown needs. Without insurance, many people cannot afford to pay for themselves alone. Without social security, tens of thousands of people will be affected. Common people.
Although social security is a major advantage, China’s medical system is not without its problems. Blindly limiting prices will make the proportion of labor costs in medical expenses too low, and the registration fee of a few yuan per time will be too meager for doctors, thus giving rise to the phenomenon of "supporting doctors with medicines", which is commonly known as taking medical expenses. rebate.
It is equally difficult to see a doctor all over the world. From an economic point of view, medical price and medical quality are always contradictory. Just like when playing mahjong, there is always someone who loses and someone wins, or no one wins. Make money, but not everyone can make money. Cherish the relatively cheap and easily available medical resources. Of course, the most important thing is to take care of yourself and try not to get sick.