Internet hospitals need to be supervised
For a long time, China's medical system has faced more serious structural distortions, and the long-term depression of doctors' service income is one of the most important challenges. In the current situation of taking medicine and medicine, doctors must rely on issuing more prescriptions to increase their income, which leads to more medical treatment biased towards over-treatment. With the tightening of medical insurance funds, the payment side's supervision of the service providers is gradually strengthening and becoming stricter. At the same time, with the cancellation of hospital drug additions nationwide, in order to control costs, medical institutions have also strengthened their supervision of medical behavior. As medical behavior is increasingly controlled, the benefits of doctors are being affected. To address this issue, the policy is gradually increasing the income of medical services. However, compared with the revenue of the products, the increase in service-based income is still insufficient, and it cannot compensate for the losses caused by the decline in product revenue. In this case, telemedicine has become a way to increase revenue from products again. According to RAND's survey of the US online inquiry platform Teladoc, there is a certain risk of drug abuse in remote consultations. Because doctors do not know the patient very well, doctors may be more uncertain about making more drugs. Although the remote consultation in China has just started, it does not rule out the risks in this area. Moreover, the current remote consultation is mainly located in pharmacies rather than primary medical institutions, which helps drug manufacturers or distributors to obtain actual prescriptions and thus give rebates. At present, the access to medicines for remote consultation mainly comes from cooperative pharmacies and medical e-commerce. On the surface, prescriptions have flowed out of the hospital, making it difficult to pursue, and cutting off the chain of interest from medical care to products. But in fact, almost all remote consultation companies currently only work with designated pharmacies or medical e-commerce companies, which will build the interest chain from the hospital to the outside of the hospital. Before the model of taking medicine and medicine has not been completely reversed, the result of such operation by the remote consultation company is also a last resort, otherwise it is difficult to obtain the support of the service provider. However, telemedicine is currently a blank point of supervision. How to effectively supervise doctors' prescriptions and prevent it from becoming a “medical clinic†for community medical treatment has become a big challenge. Since drugs are not provided by hospitals, hospitals have no cost considerations, and there is no incentive for the supervision of doctors' behavior. Medical insurance does not have a very favorable tool for the supervision of out-of-hospital prescriptions, and it is not the current focus, which makes telemedicine a relatively vacuum. Therefore, in the telemedicine market, PBM (Pharmaceutical Welfare Management) has become an important management tool. Through the PBM system, it is possible to effectively control medical behaviors that extend beyond the hospital, especially afterwards. However, China's PBM company has not really started. At present, there are more reasonable drug companies for hospitals, and more are the main business of the trial. Because in the hospital market, the outflow of prescriptions is very difficult, and the rational drug use system can only be used by the hospital's pharmacist to conduct trials, and it is impossible to conduct independent trials by third parties. However, with the development of telemedicine, prescription outflows have become possible. Although the scale is still very small, it is worthy of rational drug companies to expand this business, mainly to provide services to the payers. As an effective monitoring tool, along with the development of remote consultation, the rational drug use system can also slowly transition to PBM, and eventually develop into a PBM model adapted to China's national conditions. Of course, if the government eventually removes the hospital's outpatient pharmacy from the hospital, PBM will see explosive growth. The development of remote consultations provides the best experimental soil for the improvement of rational drug use systems, prepares for possible future market changes, and provides a more favorable tool for payers. Of course, the mere review of prescriptions is more after-the-fact supervision. It is more important to establish a set of standards and payment standards for remote consultation. Because there are still some differences between online medical treatment and offline medical treatment, how to set standards according to the offline standards and the actual situation of telemedicine development in China has become a more urgent task.
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