In the context of grading diagnosis and treatment, the list of basic drug products is gradually aligning with the top three, and many drugs can return to the grassroots. However, with the expansion of the use of primary medicines, the supervision of prescription behavior has not kept up, which will make many of the strict supervision systems for the top three face a large gap, and ultimately fail to achieve the effect of the policy. Taking the limit resistance order as an example, the infusion of inpatients in large hospitals is gradually decreasing and gradually canceling the transition to the future, but the management of antibiotic use in the primary health care system is still very weak.
A major core challenge in medication safety is the use of antibiotics. There have been media reports, "The State Food and Drug Administration survey shows that the proportion of unreasonable use of antibiotics in China exceeds 46%, and antibiotics account for 10 of the top 15 drugs in terms of usage and sales." The use of antibiotics in rural areas is even more serious. It has been reported that “78.5% of rural residents take antibiotics when they have a cold, and in a similar study in Germany, only 10.5% of rural residents take antibiotics.â€
The short-term manifestation of antibiotic abuse is to increase unnecessary medical expenses and increase the burden of medical insurance and personal care. However, the long-term effects of antibiotic abuse will be greater. Once drug resistance occurs, it means that the difficulty of treatment increases, the course of disease may become longer, and the cost of treating chronic diseases will multiply. Moreover, the long-term impact is not as direct as the digital display, but it adds to the burden of payment to a greater extent.
One of the reasons for the use of antibiotics in rural areas and grassroots is the problem of doctors’ income. Doctors can't support themselves through service fees. They can only increase their income by running. Antibiotics are naturally a higher profit. This is also reflected in the departments with relatively low drug income. For example, the proportion of total anti-infective drugs used in pediatrics is the highest at the grassroots level, close to 30%. In addition to doctors' drug revenues, another reason for explaining the high proportion of grassroots antibiotics is the ability to use drugs. In the absence of doctors' ability to judge specific diseases, broad-spectrum antibiotics are often used, as is the case in the United States.
According to a survey conducted by RAND in 2015, the doctors of Teladoc, the first telemedicine company in the United States, used a broad spectrum of antibiotics at the time of prescription, which was higher than that of offline doctors. Although most of the clients of the remote consultation are young and middle-aged patients under the age of 50, and the main problem is the cold and other minor diseases, the proportion of antibiotics used in the remote consultation service is still 3 percentage points higher than the offline. From this example, it can be inferred that when doctors lack face-to-face understanding of patients and long-term medical history information, they may choose to compare insurance methods, resulting in an increase in the proportion of broad-spectrum antibiotics.
Therefore, in order to control the expenditure of antibiotics, it is necessary to start from the two aspects of doctors' motivation and ability. The proportion of primary care in the past few years has declined the fastest, mainly because the government has increased the use of basic drugs and introduced low-cost drugs at the grassroots level. The proportion of drug income in township health clinics dropped from 44% in 2009 to 28% in 2013. However, the average drug cost in outpatient clinics has not decreased, and the per capita hospitalization fee has increased by nearly 100 yuan. The main reason behind the decline in the proportion of drugs is that the denominator has become larger. In addition to the increase in the cost of drugs, the expenditure on drugs has not decreased. The reason is still the motivation of doctors. If you can't change the structure of your doctor's income, you won't be able to avoid the economic benefits of their diagnosis and prescription. The hard indicators that try to lower the proportion of medicines can't change this situation. In the long run, drug abuse represented by antibiotics will increase long-term medical expenses.
However, adjustments based solely on income structure are not enough. In rural and grassroots markets, to avoid irrational use of drugs, to improve the ability of doctors, and to equip the necessary technical means is to help doctors make the correct diagnosis. It can be seen from the example of telemedicine in the United States that doctors are more likely to make over-medical decisions because of insurance in uncertain situations, which is similar in China's grassroots. If the ability of the primary doctors is not improved and the various diagnostic support systems are not established in time, then the doctor is likely to overreact because of uncertainty. Therefore, if the triage is to be effectively implemented, it is the key to effectively improve the ability and income of the primary doctors. Otherwise, even the strong supervision at the grassroots level cannot limit the abuse of various drugs represented by antibiotics, and cannot improve the users to the grassroots. The trust of the doctor.
In summary, as an important part of drug expenditure, the use of antibiotics is closely related to the increase of medical expenses. In recent years, the control of drug proportion has not reduced the amount of drug charges, especially at the grassroots level, doctors have insufficient capacity and insufficient information. Factors such as poor inspection conditions lead to overreaction and the abuse of antibiotics. In order to change this situation and reduce the waste of drugs, it is necessary to change from the doctor's economic power and service ability in order to achieve long-term control of drug expenditure.
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