Summary of Key Points
The National Health Commission revised the "Interim Provisions on the Management of Physicians' Outpatient Consultations" that had been in effect for 21 years half a month ago. The main requirement is that the fees for these consultations, known as "fēi dāo fèi" (specialized medical services provided by visiting physicians), must be settled through official channels (the inviting hospital must transfer the money to the doctor's affiliated hospital, which then distributes it to the physician, who is also required to pay taxes according to the law). This move aims to address the previous gray area of private consultations and payments. However, similar requirements existed in the old regulations, but they were not enforced for 21 years. Although the new rules clearly state that physicians are entitled to compensation, key details such as pricing and distribution ratios are missing, leading to several million yuan in unspent consultation fees in hospital accounts. Physicians are concerned about reduced income and increased responsibilities; patients worry that physicians may refuse to provide these services or that prices will rise; hospitals are hesitant to approve these consultations due to potential liabilities, posing many practical challenges for the new regulations to be effectively implemented.
I. The New Rules Are Not Really New, but This Time They Aim to Be Seriously Enforced – What Has Changed?
The old regulations from 2005 already stated that "fēi dāo fèi" could not be paid directly to physicians and had to be settled through official channels, but these rules were never enforced. The new revision makes a step forward:
- The old regulations only stated that payments could not go directly to individuals; the new ones explicitly require hospitals to establish systems for fee distribution and acknowledge that physicians are entitled to compensation, with additional payments for consultations on legal holidays.
- The new rules also stipulate that physicians must pay taxes on their income from these consultations.
However, key issues remain unresolved:
- How should different surgeries and doctors of varying levels be priced?
- How much money should hospitals and physicians each receive?
- Under what guise should the money be paid to physicians?
For example, at Wang Xin's hospital, several million yuan in accumulated consultation fees have not been disbursed because there are no clear guidelines, and no one wants to take the lead in addressing these issues for fear of trouble.
II. Why Don't Physicians Prefer Official Channels?
There are three main reasons why physicians avoid using official channels:
1. Reduced or No Income: Hospitals are reluctant to disburse the reported fees due to the lack of clear guidelines, and even if they do, the amount may be much less through official channels than through private arrangements. For instance, Wang Xin mentioned that a highly skilled professor's consultation could cost at least 10,000 yuan in the market, but the hospital only pays 30,000 yuan per month; performing two such consultations on weekends would equal the doctor's monthly performance bonus. If the official price is set too low, income will decrease significantly.
2. Additional Burdens and Responsibilities: In the past, hospitals tacitly allowed consultations without reporting or approval, and physicians bore any consequences if something went wrong. Now, with mandatory reporting and approval, those who sign off are held accountable. Medical departments may prefer to avoid these procedures, as does the inviting hospital.
3. Taxation: Previously, income from private consultations was largely tax-exempt, but now physicians must pay taxes, resulting in less actual take-home pay. Although they understand that tax regulations are becoming more widespread, the reduction in income is likely to discourage them.
III. Patients Are Worried: Will Physicians Still Provide These Services? Will Prices Rise?
Patients are concerned about two main issues:
1. Will Physicians Continue to Provide These Services? Li Fei, a surgeon at a top-tier hospital in North China, said that if fees decrease after the new rules are implemented, experts may find excuses to refuse (e.g., claiming they have other commitments). To retain experts, some hospitals may even take on the risk of the surgeries themselves (in case something goes wrong).
2. Will Prices Change? Currently, market-based prices for these services range from a few thousand to tens of thousands of yuan. If official pricing is set too low, patients may have to pay extra privately; if set too high, it will increase the financial burden on patients. For example, while the National Healthcare Security Administration allows hospitals to set their own service fees, there are significant price differences between major cities and rural areas, making uniformity difficult to achieve.
IV. What Hinders the Implementation of the New Rules?
The main obstacles to implementing the new rules are all related to details:
1. Lack of Clear Pricing and Distribution Guidelines: How should different surgeries and doctors be priced? What proportion of the fees should hospitals and physicians each receive? Should the payments be made under the guise of "performance bonuses" or "consultation fees"? Without clear guidelines, hospitals are hesitant to disburse the funds.
2. Unclear Liability Allocation: In the event of a medical accident, who is responsible when using official channels? Inviting and hosting hospitals may both be reluctant to take responsibility, which could lead to them avoiding approving such consultations.
3. Changing Hospital Attitudes: Previously, hospitals tolerated these consultations as long as no issues arose; now, approval requires acceptance of potential risks, which some hospitals are unwilling to undertake.
V. The Root Cause of the Problem: Insufficient High-Quality Medical Resources
The root cause of these consultations is the scarcity of high-quality medical resources. For instance, Wang Xin's hospital is a leader in surgery, with long waiting lists for beds and a high volume of surgeries locally; however, only a few surgeries require expert assistance each year. These "minor" needs are essential for patients (e.g., complex cases that cannot be handled at lower-level hospitals). Even if the new rules are strictly enforced, the demand will still exist, potentially leading to more covert arrangements (e.g., patients paying extra privately or experts using "academic exchanges" as a cover for unofficial consultations).
In summary, while the new rules aim to make these services more transparent and compliant, balancing compliance, physicians' enthusiasm, and patient needs requires addressing details such as pricing, distribution, and liability. Otherwise, the new regulations may simply be bypassed.
(The entire text is explained in plain language, without using technical jargon, making it understandable for non-financial or medical professionals.)