Lei Jufang: We Need to Reflect on the “Drug-to-Treatment Ratio”

　　“Traditional ethnic medicine plays an important role in preventing and treating diseases, alleviating pain, and improving the quality of human life. In health poverty alleviation efforts, we should fully encourage and leverage the role of local traditional medicine as well as the distinctive advantages of ethnic medicine.” Lei Jufang, a member of the National Committee of the Chinese People's Political Consultative Conference and Chairperson of Tibet Qizheng Tibetan Medicine Co., Ltd., suggested that we should carry out extensive pilot programs nationwide and strongly support the establishment of specialized traditional medicine clinics for diseases with distinctive ethnic medical advantages in regions where these diseases are highly prevalent, equipping them with appropriate medical equipment to effectively contribute to health poverty alleviation.

　　Since 2012, the central government has allocated a total of 79.4 billion yuan in special central investments to support infrastructure development at 110,000 health and family planning institutions in poverty-stricken areas, significantly improving healthcare and family planning service conditions in these regions and enabling patients to access high-tech medical services right at their doorstep. However, county-level hospitals still lack sufficient capacity to treat serious illnesses, resulting in high referral rates outside the county. Moreover, the burden of preventing and controlling endemic and infectious diseases in poverty-stricken areas remains heavy, and the number of patients with chronic diseases continues to rise year after year, making the problems of falling into poverty due to illness and relapsing into poverty due to illness particularly prominent.

　　Lei Jufang pointed out that leveraging the distinctive features of traditional ethnic medicine in health poverty alleviation can help reduce the financial burden on patients and ease the strain on social security safety nets. For instance, in treating rheumatic diseases, a Tibetan medicinal bath therapy involves two courses per year, with each course costing roughly 2,000 to 3,000 yuan, resulting in annual expenses of about 6,000 to 7,000 yuan. When receiving treatment at grassroots medical institutions, the state covers approximately 85% of these costs, leaving patients to pay only around 1,000 yuan. In contrast, if rheumatic diseases are treated at large urban hospitals, patients typically undergo multiple courses per year, with each course costing between 20,000 and 30,000 yuan. The state’s reimbursement rate for such treatments is only about 40% to 50%, which not only increases the financial burden on patients but also places greater pressure on the national medical insurance system.

　　Leveraging the distinctive strengths of ethnic medicine in health poverty alleviation efforts can help promote the inheritance of ethnic medicine at the grassroots level. Through mentorship-based education and extensive clinical practice, we can ensure the continuation and professional growth of ethnic medical practitioners.

　　Leveraging the distinctive strengths of ethnic medicine in health poverty alleviation can help maximize its advantages—from prevention and treatment to rehabilitation. Ethnic medicine has demonstrated remarkable efficacy in areas such as chronic disease rehabilitation, mind-body regulation, and health preservation, and it typically does not require prolonged hospitalization. By reducing both societal and individual medical expenses, ethnic medicine enables those receiving treatment to develop healthy lifestyle habits, ensuring the effectiveness of therapies is sustained and long-lasting.

　　Reporting media: China Journal of Traditional Chinese Medicine

　　Report link: http://www.cntcm.com.cn/zhuanti/2017-03/05/content_27180.htm

　　On March 2, Lei Jufang, a member of the National Committee of the Chinese People's Political Consultative Conference and Chairwoman of Tibet Qizheng Tibetan Medicine Co., Ltd., told our reporter in an interview that, among a series of healthcare reform measures, perhaps it is time to reflect on the issue of the "proportion of drug costs." This is because the resulting impact is a general lack of confidence within medical departments, which in turn can lead to a decline in the quality of medical services.

　　Lei Jufang stated that the "Guiding Opinions on the Pilot Comprehensive Reform of Public Hospitals in Cities," issued by the General Office of the State Council on May 17, 2015, proposed further expanding the pilot program for comprehensive reform of public hospitals in cities in 2015, with the goal of reducing the proportion of drug costs in these hospitals to around 30% overall by 2017. As a result, "drug cost ratio" has become a hot topic in the current healthcare reform, and health administrative departments across various regions have adopted it as an important indicator for evaluating hospital performance.

　　Since the implementation of the drug-to-total-revenue ratio indicator, discussions among medical institutions almost invariably revolve around this very ratio. Localities have adopted fairly stringent measures to enforce control over the drug-to-total-revenue ratio. However, further surveys reveal that the issue of high medical costs for ordinary people remains unresolved. On the contrary, the drawbacks of the drug-to-total-revenue ratio indicator are gradually coming to light—and in some cases, these drawbacks have even evolved into policy factors that exacerbate conflicts in medical treatment.

　　In some regions, local health authorities have been implementing policies in a rather rigid manner, treating general hospitals and specialized psychiatric hospitals alike. The diagnosis and treatment of mental disorders primarily rely on scale-based assessments and pharmacological therapies; as a result, examination costs are relatively low, and pharmaceuticals constitute the main expense for specialized psychiatric hospitals. The assessment of drug expenditure ratios will likely prompt patients currently undergoing outpatient treatment to switch to cheaper, less effective drugs with greater adverse effects, potentially even putting them at risk of having their treatment interrupted.

　　Some hospitals, in their ongoing efforts to reduce the proportion of drug-related expenses, have adopted various measures to increase non-drug revenue from medical services and other sources. At the same time, they have established a series of corresponding management systems covering drug procurement, drug information disclosure, dynamic drug monitoring, and tiered management of antimicrobial agents. These comprehensive management measures include signing responsibility agreements with heads of all clinical departments to ensure integrated control over the drug expenditure ratio. Hospitals have implemented drug expenditure ratio control and assessment, setting specific target ratios for each department—for example, the surgical system is set at 40%, internal medicine at 45%, and departments primarily reliant on drug therapy, such as oncology and infectious diseases, at 50%. The baseline drug usage ratios for each clinical department are assessed monthly, and the drug expenditure ratio is linked to performance-based incentives. For departments that exceed their baseline drug expenditure ratios, their performance bonuses will be reduced by double the amount of the excess; for every 1% exceeding the baseline, 2% of the department’s performance bonus will be deducted. Additionally, physicians who fail to comply with the prescribed drug usage guidelines under the medical insurance regulations—and whose departments consequently incur penalties—will have an equivalent amount directly deducted from their own performance bonuses.

　　Lei Jufang believes that if we fail to strengthen the evaluation of the appropriateness of diagnosis and treatment and fail to reform the medical insurance payment methods, merely mechanically assessing the proportion of drug costs will have negative consequences for patients and put medical professionals in a dilemma. The proportion of drug costs should serve only as one among many assessment indicators and must never be imposed forcibly. Given that patients’ conditions differ, departments vary, and disease types are distinct, how could the proportion of drug costs possibly remain the same? A simple logical analysis shows that if we want to reduce the proportion of drug costs, we either need to decrease the numerator or increase the denominator. Reducing the numerator means refraining from prescribing medications that shouldn't be prescribed in the first place—this approach is indeed correct. However, it also means that we might choose not to prescribe even clinically necessary, high-value medications. On the other hand, increasing the denominator by raising the costs of tests and examinations leads to situations where CT and MRI results from top-tier hospitals in the same city are mutually unrecognized—a phenomenon closely linked to these very policies.

　　Therefore, perhaps the regulation of drug-to-total-cost ratios cannot fundamentally address the issues of healthcare supply inducing demand and controlling medical expenses. On the contrary, it may push hospitals into distorted situations, where the more “regulated” patient welfare actually tends to decline. Not only is such regulation not worth promoting, but it should instead be thoroughly reexamined and adjusted.

　　Lei Jufang suggests that the drug-to-total-cost ratio is a macro-level requirement for hospitals and recommends that health authorities introduce policies to differentiate treatment based on the specific characteristics of various diseases. She proposes exploring the exclusion of certain special diseases—such as mental illnesses—as well as chronic conditions like hypertension and diabetes—from the drug-to-total-cost ratio assessment. At the same time, she suggests shifting from controlling the “drug-to-total-cost ratio” to implementing a “prescription review system.” For instance, a provincial-level platform could be established to create a prescription review mechanism, with a team of expert reviewers who would assign unique numbers to prescriptions from all public hospitals and conduct random spot checks and reviews. This approach would exert an invisible deterrent effect against practices such as excessive prescribing, duplicate prescriptions, and the overuse of ancillary medications, thereby ensuring the rationality of prescriptions.

　　Reporting media: Economic Observer

　　Report link: http://www.eeo.com.cn/2017/0306/299561.shtml