"What does this have to do with kickbacks?" my father asked. I could see that he was very interested in this issue. Moreover, both A-Zhu and I were listening to me attentively.
I continued: "The price formation of drugs is very complicated and should include several aspects. One is the early scientific research funding, and the other is the cost of applying for drug production licenses. In fact, in the final analysis, it is intellectual property rights. Then there are the production costs and production costs of pharmaceutical companies.
Reasonable profit. This part of the price is the ex-factory price. This price is often not high. For example, the ex-factory price of ofloxacin injection, which we commonly use to treat diarrhea, is less than two yuan a piece, but when it is used on patients, it is
The price is as high as nearly fifty yuan a bottle. This is because the wholesale price is set too high. Dad, let me continue to talk about the composition of drug prices. I talked about the ex-factory price earlier, so how is the wholesale price formed? Formulated
What is the basis for the wholesale price? To be honest, there is no basis. It is entirely the result of the work of the price department of the pharmaceutical factory. Therefore, the wholesale price is often much higher than the ex-factory price. Let’s take the ofloxacin injection I just mentioned.
For example, what is its wholesale price? About thirty-eight yuan! By the way, I just mentioned that the state has regulations that the retail price of drugs can only increase by 15 to 100 percent on the basis of the wholesale price.
20, cannot be higher than 20%. Therefore, the hospital does not make much money from the drugs. On the contrary, the hospital basically adopts a 15% increase on the wholesale price.
The price is sold as the retail price. In fact, hospitals also have costs. For example, in our hospital, there are so many people in the logistics department to support, retired employees, etc. Therefore, the problem arises in the setting of wholesale prices.
At the same time, it can also be seen from this that the profits of pharmaceutical companies, including the high wages of medical representatives and the kickbacks from doctors, are included in this. How much are the kickbacks for doctors? About 5% of the wholesale price. This is for each patient
In terms of the cost, it’s not high, right? A patient buys a medicine worth 100 yuan, and the doctor only gets 5 yuan. Therefore, the doctor’s rebate is not the main reason why medical treatment is expensive.”
"Is it all made by the pharmaceutical company?" My father asked, "No, pharmaceutical companies also need to pay costs. According to you, this medicine should be so expensive, right?"
I shook my head, "No. Dad, you are right. Pharmaceutical companies also need costs, company operations, funds, warehouses, employee wages, etc. These costs are still very high. And rebates from doctors are also necessary. Now it has the same therapeutic effect.
There are many drugs, such as dozens of antibiotics. What drugs a doctor prescribes depends entirely on the doctor’s personal preference, because many similar drugs have similar therapeutic ranges and effects. Therefore, in this case, the rebate is very large.
It’s important. Just think about it, for the same medicine, if one is prescribed with rebates and the other is not, which one will the doctor choose? This doesn’t need an explanation, right? Therefore, the problem of high drug prices is not in the hospital, nor in
On the part of the doctors, and arguably not on the pharmaceutical companies.”
"Where is that?" asked the father.
I could see that he was confused by what I said, and then he smiled and said: "The problem lies in the national policy. On the one hand, there is lax control over the setting of drug prices, which allows for rebates and high profits.
space. On the other hand, the state has problems in the drug sales process. In the past, pharmaceutical companies were owned by the state, and there was no such problem at that time, because state-owned companies did not dare to give rebates to doctors, nor did they dare to pay too much internally.
A lot of money. This makes it easy for the state to regulate drug prices. But since individuals are allowed to open pharmaceutical companies, the situation is completely different, because state-owned companies can only fail in the competition due to the attraction of rebates, and then private pharmaceutical companies
The company used the money it earned to join forces with pharmaceutical companies to do work in the price department, thus gradually forming the current vicious cycle."
"According to what you said, there is nothing we can do about it?" the father asked.
"Of course there is a way, and that is to eliminate the intermediate links in drug supply. But is it possible? How many people's personal interests will be involved? Some policies are easy to liberalize, but difficult to take back. One move affects the whole body.
." I sighed.
"What's going to happen if this goes on?" Mother sighed. Father stopped talking.
I added: "Actually, it is the state that suffers the most, because the main consumer group of medicines is the public medical care sector."
"Isn't public medical care a tax paid by the people?" my father said abruptly.
I smiled bitterly and then said: "Yes, so the people are being exploited multiple times. Some time ago, when the unit paid wages, everyone was surprised: Why is the money in hand less than before? Some time ago, the state
Everyone’s salary was raised in a big way, but why is the money getting less and less? So I carefully studied my salary slip, and this study immediately surprised me. In fact, the money that the country really collects from us is
The personal income tax system is only a small part. The real big part is various social security in the name of protecting people's livelihood. And among these social security, individuals pay a small part. The real big part lies in the part paid by the unit. Pension insurance, medical care
Insurance, unemployment insurance and housing provident fund. Among them, the total contribution rate of individuals is 18%, while the total contribution rate of units is 43%. Don’t think that the payment by units has nothing to do with us.
In fact, this is the same thing. If the unit does not need to pay these, at least a large part of the money will be paid as salary. The only difference between the two is that if it is called payment by the unit, generally individuals will not have any resistance.
It is easier for the state to collect it. Assuming that a person's book salary is 6,000 yuan, then the actual payment by the employer should be 8,580 yuan, of which there is 1,440 yuan in the personal social security account and the social security overall account.
There are 2,220 yuan in it, personal tax income is 4,920 yuan, personal income tax is 348 yuan, and the final personal income is 4,572 yuan. If we call the money in the social security pooling account
In terms of social security tax, the social security tax rate is 25.9%, while the personal income tax rate is only 4%. So the actual tax rate on our income is about 30%. And the pension insurance pooling account
On the other hand, most of it is used to support civil servants. I also want to know where the money in the pension and medical pooling accounts is used. But what I firmly don’t believe is that the money is used by the corporate personnel who paid the money.
Regarding medical care and pension. I have seen information that more than 80% of the medical insurance is used for the medical care of government civil servants, mainly high-level civil servants. I don’t know whether this is true or not. The country’s original pension insurance system,
It is all-inclusive by the state. When the people who were fully insured by the state really retired in large numbers, they found that they could no longer afford it, so the current pension insurance system was launched. This is equivalent to canceling all previous debts in one sentence. This
That's all. The bigger question is, will the pension insurance we pay now be really useful when we retire? Will the country introduce any policies at that time? The key here is the opaque use of pension insurance funds. So
The social security fund paid by the employer on your behalf goes into the overall account and replaces the social security tax, which will reduce the dissatisfaction of the people to a great extent. As calculated previously, the employer pays you a salary of 6,000 yuan and then pays it on your behalf.
If you have a pooled account of 2,220 yuan, you will feel that you have earned something. Suppose your employer pays you a salary of 8,220 yuan and then tells you that 2,220 yuan of it will be used for social security taxes.
Nowadays, you will take this figure seriously for the retirement salary of employees. Also, if you no longer work in the same place and move your account, you have to surrender the insurance. At this time, only the money in the personal account can be withdrawn, and the money in the overall account can be withdrawn.
The money has to be treated as a contribution. In this sense, the personal account can be understood as forced savings, while the collective account is completely taxed. I calculated that 53% of our income will be paid to
In our own hands, 17% is forced to save, and 30% is taxed. In addition, more than half of the cost of our consumer goods is taxes. I won’t go into details, it’s scary anyway.
. So, we pay taxes at any time. In addition, I think the current problems with the social security fund are definitely not due to historical reasons. Due to historical debts, we have adopted a combination of personal accumulation and national co-ordination. Individuals accumulate for their own future.
, this is understandable. The biggest problem is the opacity of the social security system, social security rates, and the operation of social security funds. Taking me as an example, my original idea was: the country wants you to pay, so you have to study harder.
Okay, don’t you still have to pay it? What’s the use, so I never researched it. It wasn’t until recently that I became interested and took a look, and I was shocked. What’s more, the issue of social security is considered by the people in terms of ‘what to do when you get old’
Under the big hat, there is little discussion, and even fewer people know its operating rules, which gives the system designers the space and rights to seek rent. Some time ago, I went to the mall and bought a product worth 380 yuan.
When I received the shopping rebate gift, I got the news that I could issue an invoice. But when I saw the invoice, I was immediately angry. It turned out that the tax on the 380 yuan was actually 55 yuan, which is 50%.
A tax rate of 17%! In other words, if there is no tax, I only need to spend 325 yuan to buy this thing. A product has a tax rate of 17%, and I still have to pay my salary.
Tax, so I thought: We pay so much tax, why are our country’s welfare still so poor? Where did the money go?”
?"There is indeed a problem. Hey! Although we were a little poorer in Mao Zedong's era, everyone thought it was fair. Now...hey! To be honest, I don't understand it. It seems to be rich. The house we live in and the food we eat
Thing, Feng Xiao, you even drove a car. This was unimaginable before. But why are people becoming more and more dissatisfied? People’s moral standards and civic consciousness are getting worse and worse. I’m really screwed
I don’t understand. Maybe I’m getting old? Feng Xiao, people are social animals. Everyone has their own social life. I understand this, but some things have to be done in a certain way. The most important thing for a person is his family, because
The only people who can be with you when you are in the most difficult time are your family. So, I hope you treat them well. Look, Chen Yuan is like this now and you regret it. Isn’t it already too late? Human
, we often know how to cherish after we lose it. Feng Xiao, maybe we are too nagging, and we talk too much when we are old, but you should understand the feelings of us parents. Maybe, when your children grow up
You know it. We can't stay here for a long time this time. We will go home after the Spring Festival. After all, we haven't retired yet. We have worked for the country all our lives, and we don't want to give up our burden at this last moment.
.Hey! We are old, you can take charge of your own affairs from now on." My father sighed and said. (To be continued)