It is worth learning from China -- Li Guangyao's view on medical treatment

Li Guangyao China

weilaiyiliao· 2016-06-01 10:32:22

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Singapore's prime minister Li Guangyao died in the early hours of March 23rd, at the age of 91. Under his leadership, Singapore has become the financial center of Asia and the world. Singapore is happy, the sound of "3M" health care network, was rated as the highest level in the Asian WHO. Singapore's economic level has been an important reference for China's reform. Singapore's health care system, the same is worth learning from china.


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Singapore


by the Singapore government classification regulation, the drug belongs to chemical products, so the law of drug manufacture, import and sale are strictly the Singapore government and supervision procedures. At present, Singapore on drug management has 5 main rules: one is the "drug law", mainly related to the production of drugs and norms; two is "drug law (advertising and sales)", the relevant departments by the provisions of the drug advertising must be the management of drug approval to publish, and publish relevant content must be true and reliable the three is "drug abuse;" four "is incorrect usage; toxic drug law"; the five is the "drug sales law".


two procedures: urgent, common


Singapore in the framework of the implementation of the main drug registration and drug law, and drug registration requirements must be safe and effective and controllable quality. Responsible for the review of the center for drug evaluation of Singapore drug registration by the Singapore Health Sciences Authority, divided into the following 4 types: innovative drugs, ordinary preparation, has a significant change in the drug approval and approval of the drug have small change. The import drugs approved by the drug regulatory agency must be issued by the drug regulatory agency of the country of origin, such as the certificate of drug, the specification and the characteristics of the drug.


Singapore is responsible for Drug Registration Bureau under the Singapore Health Sciences Center for drug evaluation and the Ministry of health at the same level, while Singapore's drug distribution by the Singapore Ministry of health administrative department and the Department of drug drug joint management. According to the data shows that the overall domestic drug market in Singapore can guarantee the needs of the domestic market, but there are still many varieties still need to import. Singapore's new drug listing, must be approved by the Ministry of health, the Ministry of health, in particular by the Department of the National pharmacy management group and the drug assessment center is responsible for. Drug companies must also obtain permission from the Ministry of health to operate import drugs and wholesale drug business.


data show that the new year registered in Singapore to about more than and 200 varieties, has been listed in foreign drugs (except Chinese Medicine) imported into Singapore without clinical research and quality review. Typically, Singapore is divided into two kinds of common and urgent, urgent approval time is 4 months, average approval time is longer .


Singapore drug retail units scattered in major hospital pharmacy stores, pharmacies, private clinics and HDB area major. In terms of sales of prescription drugs, retail pharmacies are strictly in accordance with the provisions of the management of drug classification, or will be severely punished. Singapore has joined the international pharmaceutical inspection Treaty Organization, the drug production strictly enforce the production quality management specification.


medical price: zero profit drug costs, the online public style= "white-space: normal /span>


Singapore's medical prices are mainly regulated by the market, the medical costs are open and transparent. The Singapore government to implement a comprehensive intervention on hospital drug price, the policy is not allowed to profit in the hospital, so take drugs, all zero slip policy "font-size: 14px . That is to say, the factory price of drugs is the patient's purchase price, in order to reduce the hospital drug expenditure, thereby reducing hospital expenses, so that the cost control in the state of the hospital's total cost budget.


from 2003 onwards, the local people in charge of Singapore government website of the Ministry of health check and compare each hospital, people in the choice of hospital, we can check out the major hospitals in the average hospitalization expenses, average hospitalization days and single disease in order to make a reasonable choice cost. Singapore's health ministry said they regularly update the information every month so that the public can grasp and understand the relevant information in a timely manner.


Singapore private hospital fees from the end of 2007 was also on the Internet, it is more convenient to the public. This approach is in fact a two-way benefit, the public can understand the charges of the hospital, in order to make a choice, the hospital can learn from the site on the charges, thereby reducing the cost of maintaining competitiveness.


because of the implementation of scientific and effective management measures, " Singapore hospital basically does not exist false high in drug pricing, excessive medication, and hospital drug income it accounts for only about 10% of total revenue .


: Chinese medicine according to the OTC management

compared to western medicine, the Chinese medicine is still in the auxiliary or subordinate status. Formal western medicine hospital has not set up Chinese medicine clinic, the pharmacy does not sell Chinese medicine. Chinese medicine is still favored by many Singaporeans because of the influence of the traditional Chinese culture and the climate, because the population of Singapore is more than 70%. Style=

at present, the Singapore government's focus on the supervision of proprietary Chinese medicine is the safety and quality of products. The effectiveness of the product, the Singapore government has not made clear requirements. Singapore Chinese medicine at present according to the non prescription drug management, without obtaining approval, but also does not require its production in strict accordance with the norms of quality management to execute production. Singapore's traditional Chinese medicine regulation by the Health Sciences Bureau, mainly targeted at the Chinese medicine. The Chinese herbal medicine, Chinese herbal medicine in Singapore is the primary drug, so basically no regulation.


the traditional Chinese medicine has a specific meaning in Singapore, refers to "any used in traditional Chinese medicine drug treatment, drug manufactured goods that any effective ingredients containing one or more completely derived from plant, animal or mineral, and the drug or all of its effective components are included in the" dictionary of Chinese medicine "," Compendium of Materia Medica "or other approved by the government of publications. According to the regulations, does not include any medicine for injection of drugs, any body in Singapore "poison act" was included in the list of drugs, poisons from any plant, animal or mineral separating chemical substances as effective components of drugs etc..


Singapore Chinese medicine supervision the main purpose is to ensure that the Chinese listed in Singapore are safe and good quality. According to the relevant regulations, all Chinese medicine must be used Chinese and English writing "allowed as a proprietary sales" label on the package plus all medicine manufacturers, repackers, wholesalers and importers must obtain a license issued by the Health Sciences Authority, be engaged in business activities.


medicine research:


Singapore Science & Technology Bureau recently released data show that in recent years, Singapore attaches great importance to biomedical science research investment, the number of related research projects and rapid growth. According to statistics, New Scientific Research Bureau in fiscal year 2010 carried out a total of 24 biological scientific research project, the fiscal year 2012 increased to 64, in the first half of fiscal year 2013, reached more than 75 .


at the same time, the new Bureau of scientific research in the biomedical license issued by the past three years from 22 in fiscal year 2010, fiscal year 56 increased to 2012. In addition, from fiscal year 2008 to fiscal year 2012, the Singapore Science Research Council carried out a total of more than 7 thousand and 400 related projects, invested up to 690 million Singapore dollars (about 3 billion 450 million yuan). These studies mainly refer to Asian as the reference object, the research and development of cancer, metabolic disease and skin related health products. New scientific research bureau said, welcome more SMEs to join the field of biomedical science, and expect them to play a more important role.


Singapore health care system "white-space: normal; style=

Singapore after just a few decades of development, from a lack of resources for the development of the island country, is a new rapid economic development of the city state, in addition to creating the "Asian miracle" in the economy, Singapore created a very fruitful system in health care, " by less than 4%/GDP of medical expenses (Organization for economic cooperation and the national average is 10%), has made gratifying achievements in the field of medical care, is considered to be a typical "low input, high output" the medical care system .


Li Guangyao went to study in Britain, the local scenery quite appreciated. However, in 2003, in his wife's visit to Britain, the wife of a doctor's hospital to see a doctor in the hospital without the experience of the impact he caused. Li Guangyao opposed to Western democracy in education, pension, medical and other aspects of the implementation of free policy practices. He believes in the "welfare" go too far, will lead to absolute equalitarianism, easy social lose initiative. Li Guangyao once said: "we must learn from the British system, should not provide free public service. Because this will seriously weaken the spirit of public service personnel, so that public service is being abused by the public, the efficiency of the service to drop, the suffering will be the general people."


Singapore health care savings mode, public hospital is still the main provider of medical service, but with independent management rights, compensation , high level of medical services and public satisfaction. This model features the introduction of personal restraint mechanism, personal savings spending accounted for the majority of medical expenses, to solve the problem of resource waste and other mode is difficult to solve, so the efficiency at the international forefront.


Singapore private, public and non-governmental organizations (3P) of the 3 medical institutions to provide medical service system of , these services provided by 3P medical institutions, three medical institutions strictly implement two-way referral, the three complement each other, to ensure the reasonable distribution of medical resources and utilization.


20 century 80s, "guiding competition" was introduced into the Singapore public hospital system, the restructuring of public hospitals for business entities, the establishment of the Council and to establish public hospitals as the core in clinic, comprehensive, the surrounding community hospitals, nursing homes for the support of the medical group, the group of internal integration services, referral, sharing equipment, beds, electronic medical records, play the comprehensive effects and economies of scale. Between the groups is an orderly competition, to improve health care services. At present, style= color: "RGB , improve the efficiency and level of medical services.


Singapore Medical System "color: RGB style= minor at the grassroots level, serious illness to the hospital, the cost at the individual , establish 4 ward 3M system and medical insurance system, to meet the medical needs of different populations, and the basic medical institutions and hospitals together, the effective integration of medical resources, the formation of a close knit medical network, thereby improving the overall quality and ability of medical service system.



Singapore is to rely on government subsidies and Mandatory personal insurance to achieve the typical national universal health insurance, " by government subsidies, health savings plans, medishield programs, health care fund to build the entire network of medical security, the three is called "3M " strategy.


1


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Singapore government in accordance with the two types of outpatient and hospitalization for patients provide financial subsidies. Among them, on the style= font-size: "14px . For hospitalized patients, according to the differences in the conditions of hospitalization, style= font-size: "14px . If every time the total hospital charges for more than $500 (C) to 1000 yuan (B2), you can start the savings.


2 health care savings plan



this is a mandatory national medicine equivalent to China's urban workers basic medical insurance fund, the national monthly income must be 7% to 9.5% stores into the personal account for hospitalization expenses payment account holders and their immediate family members and special outpatient expenses . There is a limit to the use of this health savings in the use of savings in the early exhaustion or excessive savings, the government actively encourage patients to choose the appropriate level of care commensurate with their own economic strength.


3 medishield program



was set up in 1990, medishield insurance is Singapore citizens and permanent residents for the first time to pay : pay provident fund, automatically in medishield system unless they opt out on bail. This is a cheap insurance plan, to provide security for the insured in the event of serious illness, serious illness or chronic diseases require huge medical expenses, and health care savings are insufficient to pay these expenses, disposable medishield funds.


4


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, its essence is provided by the government safety net to pay for the poor, is one of the underpinning of the national insurance fund.


medical service system


< "white-space: normal;" P> dual health care system, namely the government nonprofit health care service system, private doctors provide for-profit medical health services . According to the ownership of different medical institutions, divided into four categories: 1 public hospitals, specialist centres or government clinics; 2 private hospitals or medical center; 3 private clinics; 4 charity institutions, including the elderly, community health service centers, rehabilitation centers, hospitals, compulsory terminal disease charity medical center. Public medical institutions in which a total of 8 large and large comprehensive hospital, 10 specialist centers, 18 integrated clinics, etc..


Singapore basic medical services for people to provide basic medical treatment, prevention and health care and health education, including outpatient treatment, post discharge follow-up care, immunization, health diagnosis and drug screening and education services. Singapore basic medical services by the United clinic public and private clinics to provide practitioners, and the implementation of the primary treatment system, in case of need by the general practitioner referral to the hospital for further examination and treatment. Singapore has 18 joint clinics and 2400 doctors in private clinics. The 18 joint clinic is a one-stop medical service center, a supplement to the private clinics of 2400 practitioners, and only 20% of the basic medical services are provided. Private clinics provide basic medical services 80% basic medical services.


Singapore hospital services in public hospitals, the dominant . Singapore has a total of 25 hospitals, a total of 10756 beds, 2 beds per thousand people, the public hospital holds 85% beds, each hospital beds from 185 to 2010 a range, while private hospital beds are accounted for only 15%, each hospital from 20 to 30 range. Public hospitals provide 80% of the inpatient service, while private hospitals offer only 20% of inpatient services. Public hospitals dominate, in the supply of beds, the introduction of high technology, high cost of drugs, medical costs and other aspects of the control has a greater impact on the weight, you can provide a benchmark for private hospital pricing.


Singapore has 15 public hospitals, including 6 acute general hospital, a hospital, a psychiatric hospital, also includes 6 national professional centre and a multidisciplinary medical center. Singapore public hospital ward is divided into 4 levels, A, B1, B2, C, and the different grades of ward beds are allocated C ward beds accounted for 27%, B1 beds and B2 wards accounted for 38%, a ward beds accounted for 35%, in order to encourage patients to seek medical treatment, save medical resources, the government gives different subsidies for different levels of the ward, C ward subsidies 80%, grade B2 65% grade B1 ward subsidies, subsidies for the 20% ward, a ward of the government are not subsidies. In 2012, the average hospital stay was 5.8 days and the average occupancy rate was 85%.



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